Anxiety Sensitivity as a Moderator of the Relation Between Trauma Exposure Frequency and Posttraumatic Stress Symptomatology

Abstract

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. …