A hierarchical model of affective and cognitive factors in trauma: examination utilizing the AURORA database of participants following trauma exposure

Lower-order anxiety sensitivity and intolerance of uncertainty dimensions operate as specific vulnerabilities for social anxiety and depression within a hierarchical model

There is continuing debate as to the latent structure underpinning posttraumatic stress disorder symptomatology. The transdiagnostic vulnerability factors of negative affect, anxiety sensitivity (and subcomponents) and intolerance of uncertainty have previously demonstrated the ability to explain symptom clusters in a range of anxiety and depressive disorders, and may give further understanding of PTSD symptomatology. Within an Australian Defence Force veteran population, structural equation modeling is utilized to assess whether a hierarchical Original Model containing negative affect as the general cognitive factor, anxiety sensitivity and intolerance of uncertainty as mid-level factors, can explain variability among posttraumatic stress disorder symptom clusters as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A further hierarchical Anxiety Sensitivity Extended model consisting of the general cognitive factor of negative affect and the three sub-factors of anxiety sensitivity as mid-level factors was also tested upon PTSD symptom clusters. Both the hierarchical Original and Anxiety Sensitivity Extended models fit the data well. Within both models, negative affect consistently showed significant direct effects upon the posttraumatic stress disorder symptom clusters. In the Original Model, anxiety sensitivity served as a significant mediator of negative affect for several symptom clusters, while intolerance of uncertainty was non-significant both as a direct effect and as a mediator of negative affect. In the Anxiety Sensitivity Extended Model, the cognitive concerns sub-factor of anxiety sensitivity served as a significant mediator of negative affect for several symptom clusters, while the social and physical concerns sub-factors did not have significant direct or mediating effects. This study demonstrates a transdiagnostic hierarchical model significantly explains the severity of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition posttraumatic stress disorder symptom constructs within a subclinical population. Negative affect and anxiety sensitivity can each be targeted with specific interventions, suggesting new avenues to augment current gold standard psychotherapeutic interventions.

Background: Negative affectivity (NA) has been linked to anxiety and depression (DEP). Identifying the common factors between anxiety and DEP is important when explaining their overlap and comorbidity. However, general factors such as NA tend to have differential relationships with different disorders, suggesting the need to identify mediators in order to explicate these relationships. Methods: The current study tests a theoretically and empirically derived hierarchical model of emotional disorders including both a general factor (NA) and transdiagnostic risk factors [anxiety sensitivity (AS) and intolerance of uncertainty (IoU)] using structural equation modeling. AS was tested as a mid-level factor between NA and panic disorder/agoraphobia, while IoU was tested as a mid-level factor between NA and social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and DEP. Data from 642 clinical outpatients with a heterogeneous presentation of emotional disorders were available for analysis. Results: The hierarchical model fits the data adequately. Moreover, while a simplified model removing AS and IoU fits the data well, it resulted in a significant loss of information for all latent disorder constructs. Limitations: Data were unavailable to estimate post-traumatic stress disorder or specific phobias. Future work will need to extend to other emotional disorders. Conclusions: This study demonstrates the importance of both general factors that link disorders together and semi-specific transdiagnostic factors partially explaining their heterogeneity. Including these mid-level factors in hierarchical models of psychopathology can help account for additional variance and help to clarify the relationship between disorder constructs and NA.

The present study tested if the global anxiety sensitivity construct and its constituent factors (i.e., physical, mental incapacitation, and social concerns) moderate the relation between traumatic event exposure frequency and posttraumatic stress symptomatology. Participants were 61 rural young adults who reported experiencing at least 1 lifetime traumatic event. Consistent with prediction, anxiety sensitivity total and subfactor levels moderated the relation between trauma exposure frequency and posttraumatic stress symptomatology. These moderating effects were above and beyond variance accounted for by the respective anxiety sensitivity and stress main effects as well as other theoretically relevant factors (e.g., negative affectivity). Findings are discussed in relation to better understanding cognitive-based individual difference factors associated with posttraumatic stress symptomatology. Keywords: anxiety sensitivity; trauma; posttraumatic stress disorder; moderating effects Anxiety sensitivity (AS), defined as the fear of anxiety and anxiety-related sensations (Reiss & McNally, 1985), is a trait-like cognitive characteristic that can predispose individuals to the development of anxiety-related problems. For example, if a person believes bodily sensations are a sign of imminent personal harm or threat, this "high AS" individual would experience escalating levels of anxiety and perhaps a panic attack when exposed to such sensations. The global AS construct encompasses fears of physical, mental incapacitation, and social experiences (Zinbarg, Barlow, & Brown, 1997), all of which can theoretically amplify preexisting anxiety (Reiss, 1991). Since the late 1980s, separate lines of research have generally supported the AS model of panic disorder vulnerability (see Taylor, 1999). Furthermore, recent studies suggest an association between AS and psychopathology beyond panic disorder, including various types of substance use disorders (Otto, Safren, & Pollack, 2004; Stewart, Samoluk, & MacDonald, 1999; Zvolensky, Schmidt, & Stewart, 2003), major depressive disorder (Otto, Pollack, Fava, Uccello, & Rosenbaum, 1995; Taylor, Koch, Woody, & McLean, 1996), chronic pain (Asmundson & Norton, 1995), hypochondriasis (Watt & Stewart, 2000), and more recently, posttraumatic stress disorder (PTSD; Taylor, 2003). Interest in AS and PTSD has emerged, at least in part, due to the increased recognition that cognitive factors play an important role in the nature of the disorder (e.g., Ehlers & Clark, 2000). Although numerous cognitive variables have been studied in relation to the etiology and maintenance of PTSD symptoms (e.g., neuroticism; Breslau, Davis, Andreski, & Peterson, 1991; see also Schnurr & Vielhauer, 1999), AS may hold considerable explanatory promise. For example, persons high in AS who have experienced a trauma may interpret symptoms of PTSD as personally harmful (e.g., "I'm dying," "I'm going crazy"), thereby exacerbating affective symptoms (Fedoroff, Taylor, Asmundson, & Koch, 2000). As a second illustrative example, persons high in AS may be more likely to cognitively avoid trauma-related cues, thereby preventing emotional processing of the event (Lang, Kennedy, & Stein, 2002) and perhaps recovery from a traumatic event (see Brewin, Dalgleish, & Joseph, 1996). Both of these accounts are supported by previous work that has shown AS is related to catastrophic thinking (e.g., Donnell & McNally, 1990) and avoidance of emotionally salient events (e.g., Zvolensky & Forsyth, 2002) in non-PTSD relevant studies. Although limited in overall scope, several converging pieces of empirical evidence support the postulation that AS [as measured using the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986)] is related to posttraumatic stress symptomatology. First, there have been at least three studies indicating AS is elevated among persons who have experienced a trauma and developed PTSD symptoms relative to persons without such symptoms (i. …

Anxiety sensitivity has been proposed as a psychological vulnerability factor for post-traumatic stress disorder (PTSD). Studies have also supported the protective role of resilience for overcoming the negative effects of trauma exposure. Given the linkages between anxiety sensitivity, resilience, trauma exposure and post-traumatic stress, this study explored the potential moderating roles of anxiety sensitivity and resilience on the association between trauma history and PTSD symptoms in a sample of individuals with chronic pain. A total of 100 patients with chronic pain were recruited from a large public hospital. Patients who had pain lasting for more than 3 months and a pain intensity rating of at least 4/10 were included. The study participants were administered measures of PTSD symptoms (PTSD Checklist - Civilian Version), resilience (Brief Resilient Coping Scale) and anxiety sensitivity (Anxiety Sensitivity Index). An analysis of outcome measures indicated that anxiety sensitivity and resilience were independently associated with PTSD symptoms, where βs were 0.57 and -0.23, respectively. The relationship between trauma and PTSD symptom severity was also moderated by anxiety sensitivity. Trauma history was associated with higher PTSD symptom severity only in those with high anxiety sensitivity. However, contrary to the hypotheses, resilience did not serve as a moderator. There are potential benefits of PTSD interventions that increase resilience and decrease anxiety sensitivity in individuals with chronic pain, especially for those who have experienced a traumatic event. Given that the presence of PTSD symptomatology in chronic pain populations negatively impact patient well-being, it would be important for clinicians to assess, monitor and treat PTSD in individuals with chronic pain.

Background:Approximately two million children sustain a concussion annually, with negative mood being associated with elevated initial symptom reporting and longer recoveries. Despite this finding, minimum research has explored the predictive value of a person’s negative mood and propensity to misinterpret internal sensations (anxiety sensitivity) on concussion outcomes.Hypothesis/Purpose:The purpose of this study was to examine how the relationship between anxiety sensitivity, negative affect, and positive affect relate to various concussion outcomes. It was hypothesized that higher anxiety sensitivity, higher negative affect, and lower positive affect would be predictive of higher initial concussion symptom reporting, increased number of total visits, and longer time to medical clearance.Methods:Children aged 8-18 years who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. Patients were evaluated within 14 days of injury and remained under clinical care until cleared to return to activity/sport. Patients were administered the Anxiety Sensitivity Index-3 (ASI-3), The International Positive and Negative Affect-Short Form (I-PANAS-SF) and Post-Concussion Symptom Scale (PCSS). Independent t-tests were run for all independent variables. Linear regressions were run to determine potential predictive value of ASI-3 (cognitive, physical, social subscale and total score) and I-PANAS-SF (negative and positive affect) on concussion outcomes (initial visit concussion symptom scores calculated by PCSS, total number of clinical visits, and days till medically cleared).Results:A total of 43 children (age: 15.6±1.6 years) were enrolled. Independent t-tests for all independent variables resulted in females on average having higher ASI-3 subscale and total scores (p<0.01). Sex was therefore entered as a control variable in the regression models. Higher negative affect was significantly predictive (β = 0.38, p=0.030) of higher initial visit concussion symptom reporting (R2 =0.46, F(5,36)=4.48, p=0.003). More days to clinic (β = 0.88, p≤0.001) and higher ASI-3 physical subscale scores (β = 0.25, p=0.008) were predictive of more days until medical clearance (R2 =0.88, F(5,35)=5.33, p=0.001).Conclusion:Results from this study show that both a person’s negative affect and anxiety sensitivity are not just related to concussion outcomes but also predictive. Negative affect and anxiety sensitivity are easy to measure and amenable to treatment. Targeted interventions on improving negative affect and normalizing symptoms to minimize misinterpretations (anxiety sensitivity), could improve concussion outcomes.

Anxiety sensitivity (AS) comprises three lower-order dimensions, physical concerns, cognitive concerns, and social concerns, all of which are related to unipolar mood and anxiety disorders (emotional distress disorders). The pattern of these relations suggests that AS cognitive concerns might be best classified as associated with emotional distress disorders clustered together as distress disorders whereas AS physical concerns might be best classified as associated with emotional distress disorders clustered together as fear disorders. In contrast, AS social concerns appears to be generally associated with both fear and distress disorders. To test the specificity of lower-order AS dimensions, structural equation modeling was employed in a sample of 579 individuals (M age = 36.87 years, SD = 13.47; 51.6% male) constituting a sample at risk for psychopathology as these individuals were seeking smoking cessation treatment. AS physical concerns was associated with the fear disorders dimension, even when controlling for negative affect (NA). AS cognitive concerns was associated with the distress disorder dimension, only when the effects of NA were not included. Finally, AS social concerns demonstrated non-specific relations with both the distress and fear disorders dimensions. Given that measures of AS and psychopathology were collected concurrently, these findings cannot address the role of lower-order AS dimensions as risk factors for specific psychopathology clusters. These results provide further support for the hierarchical model of emotional distress disorders as well as implicate AS cognitive and physical concerns as important variables at the intermediate level of this model.

In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO2 sensitivity). A heretofore unexplored possibility is that a psychological characteristic that predisposes to panic-anxiety sensitivity-might be inherited. In this study, the authors examined the heritability of anxiety sensitivity through use of a twin group. Scores on the Anxiety Sensitivity Index were examined in a group of 179 monozygotic and 158 dizygotic twin pairs. Biometrical model fitting was conducted through use of standard statistical methods. Broad heritability estimate of the Anxiety Sensitivity Index as a unifactorial construct was 45%. Additive genetic effects and unique environmental effects emerged as the primary influences on anxiety sensitivity. There was no evidence of genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index. This study suggests that one psychological risk factor for the development of panic disorder-anxiety sensitivity-may have a heritable component. As such, anxiety sensitivity should be considered in future research on the heritability of panic disorder.

Recent models of depression (e.g., from Hyde and colleagues) have integrated affective and cognitive vulnerability factors, positing that a temperamental factor (i.e., negative emotionality) contributes to the development of cognitive vulnerability factors, which in turn conveys risk for depressive symptoms. Recent literature suggests that effortful control may reduce the strength of the relationship between affective and cognitive factors. However, few studies have examined the different cognitive vulnerability factors (cognitive style, brooding, and stress-reactive rumination) through which negative emotionality contributes to depressive symptoms, or how effortful control may influence these paths. 315 young adults (72% women, M age= 20.7 yr., SD = 1.4) answered psychometric measures of temperament factors (negative emotionality and effortful control), and three cognitive vulnerability factors (cognitive style, brooding, stress-reactive rumination), and depressive symptoms. Two hypotheses were tested concerning mediation and moderation of the relationship between negative emotionality and depressive symptoms. Cognitive style and brooding were significant mediators of this relationship, while effortful control did not moderate relations between negative emotionality and cognitive vulnerability factors. Results support models that integrate affective and cognitive vulnerability factors predicting depressive symptoms.

Background and Objectives: Addiction is a social issue and a fundamental health challenge which the average age of its onset has decreased.Psychological factors play a key role in predisposition to drug use.Therefore, this study aimed to analyze the pathway of drug use readiness, considering anxiety sensitivity and sensation seeking with the mediating role of negative affectivity among students.Materials and Methods: This descriptive study employed structural equations modeling.The statistical population comprised Lorestan University's students during the academic year 2022-2023.Three-hundred and eighty four students met the inclusion criteria and were selected using the convenience sampling method.Research tools used included Floyd et al.'s Anxiety Sensitivity Scale, Zuckerman's Sensation Seeking Scale, Watson et al.'s Negative Affectivity Assessment, and Weed et al.'s Addiction Readiness Scale.Data analysis was conducted through structural equations modeling. Results:The findings indicated that anxiety sensitivity and excitement seeking had a direct, positive, and significant impact on drug use readiness with =0.25 (p<0.001) and =0.30(p<0.001),respectively.Furthermore, anxiety sensitivity and sensation seeking were directly linked to negative affectivity with =0.26 (p<0.001) and =0.25 (p<0.001),respectively.Lastly, negative emotionality significantly and directly influenced the willingness to use drugs with =0.29 (p<0.001). Conclusion:The current study findings indicated that sensation seeking, anxiety sensitivity, and negative affectivity are the significant predictors of drug use.It is recommended that experts develop therapeutic and educational programs to enhance students' awareness and coping skills.

The interactive effects of AS and trauma exposure on suicide capability and suicide risk

Anxiety sensitivity (AS), defined as the extent to which individuals believe anxiety and internal sensations have harmful consequences, is associated with the maintenance and relapse of smoking. Yet, little is known about how AS interplays with negative affect during the quit process in terms of smoking behavior. To address this gap, the current study examined the dynamic interplay between AS, negative affect, and smoking lapse behavior during the course of a self-guided (unaided) quit attempt. Fifty-four participants (33.3% female; M age = 34.6, SD = 13.8) completed ecological momentary assessment procedures, reporting on negative affect and smoking status via a handheld computer device, three times per day for the initial 14 days of the self-guided cessation attempt. As expected, a significant interaction was observed, such that participants characterized by high levels of AS were at a higher risk of smoking on days when negative affect was high (relative to low). Results also revealed a significant interaction between AS and daily smoking lapse behavior in terms of daily change in negative affect. Participants characterized by high levels of AS reported significant increases in same-day negative affect on days when they endorsed smoking relative to days they endorsed abstinence. This study provides novel information about the nature of AS, negative affect, and smoking behavior during a quit attempt. Results suggest there is a need for specialized intervention strategies to enhance smoking outcome among this high-risk group that will meet their unique "affective needs." The current study underscores the importance of developing specialized smoking cessation interventions for smokers with emotional vulnerabilities.

Posttraumatic stress disorder (PTSD) symptoms are associated with coping-motivated alcohol use in trauma-exposed samples. However, it is unclear which individuals experiencing PTSD symptoms are at greatest risk for alcohol-use problems following trauma exposure. Individuals endorsing high anxiety sensitivity, which is the fear of anxiety and related sensations, may be particularly motivated to use alcohol to cope with PTSD symptoms. In the current study, we examined the moderating role of anxiety sensitivity in the association between PTSD symptoms and coping motives in a sample of 295 young adults with a history of interpersonal trauma and current alcohol use. Participants completed measures of past 30-day alcohol consumption, trauma history, current PTSD symptoms, anxiety sensitivity, and alcohol-use motives. Results of hierarchical multiple regression analyses indicated that greater anxiety sensitivity was significantly associated with greater coping (β = .219) and conformity (β = .156) alcohol-use motives, and greater PTSD symptoms were associated with greater coping motives (β = .247), above and beyond the covariates of sex, alcohol consumption, trauma load, and noncriterion alcohol-use motives. The interaction of anxiety sensitivity and PTSD symptoms accounted for additional variance in coping motives above and beyond the main effects (β = .117), with greater PTSD symptoms being associated with greater coping motives among those high but not low in anxiety sensitivity. Assessment and treatment of PTSD symptoms and anxiety sensitivity in young adults with interpersonal trauma may be warranted as a means of decreasing alcohol-related risk in trauma-exposed young adults. (PsycINFO Database Record

Boston University The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. Lilienfeld, Turner, and Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures. In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed. Reiss and his colleagues (Reiss, 1987; Reiss & McNally, 1985; Reiss, Peterson, Gursky, & McNally, 1986) have defined the construct of anxiety sensitivity (AS) as fear of anxiety and physical sensations related to anxiety, and they hypothesize that this fear arises from beliefs that anxiety and related physical sensations have harmful somatic, psychological, or social conse- quences. AS and closely related constructs have played a central role in recent theorizing about the nature and etiology of the anxiety disorders in general and panic disorder in particular (e.g., Barlow, 1988, 1991; Clark, 1986; Goldstein & Chambless, 1978; McNally, 1990; Reiss, 1991; Reiss & McNally, 1985; Reiss et al., 1986). Reiss et al. (1986) created one of the most Richard E. Zinbarg, Department of Psychology, University of Oregon; David H. Barlow and Timothy A. Brown, Center for Anxiety and Related Disorders, Boston University. This work was supported in part by Grant RO1M-39096 from the National Institute of Mental Health and by a Shannon Award (1 R55 MH/OD53425-01A1 ) from the National Institute of Mental Health. We are grateful to the individuals who graciously consented to serve as judges for the matching task. The judges included seven PhD-level psy- chologists with expertise in clinical psychology (Anne Marie Albano, Janet Borden, Paul Collins, Peter M. Lewinsohn, Susan Mineka, Anne Simons, and Robert Weiss), two PhD-level psychologists with expertise in personality and factor analysis (Lewis R. Goldberg, William R. Re- velle), and three graduate students in clinical psychology who had just completed an anxiety assessment and treatment practicum with Richard E. Zinbarg (Leslie Dana, Amy Reiss, Carie Rodgers). We thank Stephen Haynes, Scott O. Lilienfeld, Janet Mohlman, and Steven Taylor for their extensive and helpful comments on earlier versions of this article. We also thank Brian Cox, Steven Taylor, and Sherry Stewart for graciously providing the factor loadings from their analyses that have not yet been published. We are also grateful to Steven Taylor for providing the factor loadings from Peterson and Heilbronner's (1987) four-factor solution because these results are unpublished. Correspondence concerning this article should be addressed to Rich- ard E. Zinbarg, Department of Psychology, 1227 University of Oregon, Eugene, Oregon 97403-1227. Electronic mall may be sent via the In- ternet to rzin@oregon.uoregon.edu. 277 widely used measures of the AS construct, known as the Anxiety Sensitivity Index (ASI). Until recently, there has been considerable debate surrounding the issue of the factor structure of the ASI. On the one hand, Reiss et al. (1986) and several other researchers (e.g., Pe- terson & Heilbronner, 1987; Reiss, Peterson, & Gursky, 1988; Sandin, Chorot, & McNally, 1996; Stewart, Dubois-Nguyen, & Pihl, 1990; Taylor, Koch, & Crockett, 1991; Taylor, Koch, McNally, & Crockett, 1992) advocated a unidimensional struc- ture, whereas others (e.g,, Telch, Shermis, & Lewis, 1989; War- die, Ahmad, & Hayward, 1990) advocated a multidimensional structure including as many as four factors. The debate regarding the factor structure of the ASI appears to have been largely resolved by a hierarchical model proposed by Lilienfeld, Turner, and Jacob (1993). Their model is hierar- chical in that it contains several first-order factors that aU load on a single, higher order factor. Furthermore, it is capable of integrating many of the apparently discrepant findings in the literature by suggesting that those investigators who have advo- cated a multifactor solution were focused on the lower level of the hierarchy, whereas those who have advocated a single-factor solution were focused on the higher level. Indeed, the hierarchi- cal model appears to have been largely accepted by Taylor (1995a), who was formerly one of the main proponents of the unifactorial view. Given the relatively long history of hierarchi- cal models of intelligence, an analogy to the structure of intelli- gence may be useful. Within a hierarchical model of intelligence, the identification of separable lower order factors would not dispute the existence of a general intelligence factor. Fur exam- ple, at least two group factors (e.g., Verbal and Spatial) in addition to a general factor of intelligence are hypothesized in Vernon's (1969) model of intelligence. Similarly, Lilienfeld et al. suggested that there may be group factors (i.e., common to some but not all items) and a general factor (i.e., common to nearly all items) underlying the ASI. Although a hierarchical model has promise for resolving con- troversies in this area, appropriate tests of the hierarchical nature

Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self-injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic background, negative affectivity). AS dimensions were expected to account for additional unique variance in NSSI outcomes. Participants included 204 patients (50.5% female) with substance use disorders in residential treatment. In this sample, 37.2% reported a history of NSSI. The hierarchical regression models revealed a unique positive association between AS social concerns and NSSI outcomes when adjusting for model variables. In contrast, AS physical concerns were uniquely negatively associated with NSSI outcomes. Findings provide support for AS social concerns as a vulnerability for engagement in NSSI behaviors and highlight this particular AS dimension as a potential treatment target for NSSI prevention and intervention programs.