Assessing Anxiety Sensitivity Research Articles

Factor structure of the anxiety sensitivity index-3 in a sample of older adults.

The online version contains supplementary material available at 10.1007/s10433-022-00736-9.

Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms.

Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.

Development and Initial Validation of the Menstrual Sensitivity Index

The Anxiety Sensitivity Index is a widely-used measure to assess anxiety sensitivity (i.e., the fear of anxiety and its associated symptoms). More recently, researchers have developed disease-specific measures assessing sensitivity to specific symptoms. To assess sensitivity to menstrual symptoms, we developed and evaluated the reliability and initial validity of the Menstrual Sensitivity Index (MSI), a modification of the Visceral Sensitivity Index. The MSI consists of 10 items rated on a 6-point Likert scale from 1 (“strongly agree”) to 6 (“strongly disagree”). Items assess respondents’ menstrual symptom-specific anxiety (e.g., fear and anxiety induced by menstrual pain, the thought that menstrual pain is a sign of other problems, etc.). Items are reverse scored and re-coded on a 0 to 5 scale. Total scores are calculated by summing all item responses; higher scores indicate more severe menstrual-specific anxiety. Participants included 1,160 women ages 18-55 years (mean=34.6, SD=9.5) who completed an online survey. Average menstrual pain was rated on a 0 (no pain) to 10 (worst pain possible) Numeric Rating Scale; enrollment was stratified such that 14.8% of participants rated their menstrual pain as 0-2, 59.7% rated 3-7, and 25.4% rated 8-10. All participants had self-reported regular menstrual cycles over the previous 12 months. Internal consistency was calculated using Cronbach's alpha, and initial validity was assessed using Pearson bivariate correlations. The MSI demonstrated excellent internal consistency (alpha=0.942). Scores were positively correlated with measures of average menstrual pain, menstrual symptoms, non-menstrual bodily pain, anxiety sensitivity, and pain catastrophizing (R's from 0.39-0.65; all p's

Anxiety sensitivity and pain intensity independently predict opioid misuse and dependence in chronic pain patients

The United States (US) population consumes an estimated 68% of the world's prescribed opioids each year, and over 2 million adults in the US suffer from an opioid use disorder. Although chronic pain populations are among the highest risk segments of the general population for opioid misuse and dependence, there is little understanding of individual risk characteristics that may contribute to greater risk for these outcomes among this group. The present investigation explored the concurrent role of anxiety sensitivity and pain intensity and their interaction in relation to opioid misuse and dependence among 429 adults with chronic pain (73.9% female, Mage = 38.32 years, SD = 11.07). Results revealed that both anxiety sensitivity and pain intensity were associated with opioid misuse and dependence. There was no evidence of an interaction for either outcome. Post-hoc analyses indicated that of the lower-order anxiety sensitivity facets, physical and mental incapacitation concerns contributed to variance in opioid misuse and only mental incapacitation concerns contributed to variance in opioid dependence. Overall, the current findings suggest the importance of assessing anxiety sensitivity in screening for opioid-related problems among persons with chronic pain, as it may represent a distinct pathway to poorer opioid-related outcomes among this group.

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study.

BackgroundAnxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive–compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive–compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.MethodsAdolescent twins and siblings (N = 1,579) from the G1219 study completed self‐report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross‐lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations.ResultsAnxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by nonshared environmental influences.ConclusionsOur findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by nonshared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa.

Anxiety sensitivity and smoking outcome expectancies among Spanish-speaking Latinx adult smokers.

Smoking is among the most important health behaviors linked to premature death and disability among the Latinx population. Yet there is limited understanding of whether transdiagnostic factors like anxiety sensitivity may help explain smoking expectancies among Spanish-speaking Latinx smokers. The present investigation evaluated anxiety sensitivity in regard to smoking outcome expectancy factors among a large sample of adult Latinx smokers. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.8). As expected, anxiety sensitivity was significantly related to expectancies of negative reinforcement and negative personal consequences. Anxiety sensitivity also was a significant predictor of smoking expectancies of appetite control and positive reinforcement. The present study provides novel empirical evidence that anxiety sensitivity explains a notable degree of variance in smoking outcome expectancies over the variance accounted for by a range of theoretically relevant covariates among Latinx smokers. These results highlight the clinical utility in assessing anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to better understand cognitive-based smoking expectancies among this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Anxiety Sensitivity as a Risk Indicator for Anxiety, Depression, and Headache Severity in Women With Migraine.

The primary aim of this exploratory study was to assess the relationship between anxiety sensitivity and emotional disorders, migraine characteristics, and migraine-related fear and avoidance behaviors in women with probable migraine. Anxiety and depressive disorders are the most frequent comorbid psychiatric conditions in migraine, particularly in women; however, the underlying reasons for these comorbidities are uncertain. Anxiety sensitivity, the tendency to catastrophically appraise anxiety and bodily sensations in terms of their physical, social, or cognitive consequences, is a psychological factor that may contribute to the comorbidity of anxiety and depressive disorders and migraine. It was hypothesized that anxiety sensitivity would be associated with greater migraine severity and psychiatric symptoms. Participants were women (n=100) who screened positive for migraine on the validated IDMigraine Screener participated in an anonymous single-session online survey-based study on migraine. The Anxiety Sensitivity Index-3 total and subscales scores were used to assess anxiety sensitivity. Anxiety and depression symptoms were assessed with the brief Patient Health Questionnaire. On average, anxiety sensitivity was clinically elevated (mean±SD: 24.0±15.2). Anxiety sensitivity cognitive and social concerns were most strongly correlated with severity of anxiety (r's=.38-.46) and depressive symptoms (r=.35-.39, P's<.001), and all anxiety sensitivity facets were related to fear of head pain (r's=.35-.38, P's<.001). Anxiety sensitivity cognitive concern facet was uniquely related to headache patterns, including longer migraine attack duration (r=.22, P=.029) and pain intensity (r=.24, P=.029), pain-related avoidance, including avoiding movement and more frequent misuse of prescribed or non-prescribed pain medication (r's=.20-.21, P's<.01). These novel findings indicate that anxiety sensitivity, specifically fearful appraisal of bodily sensations, are linked to both psychiatric symptoms and migraine severity in women. In this cross-sectional study, causal sequence cannot be determined. If anxiety sensitivity leads to more severe pain and psychiatric distress, targeting anxiety sensitivity could lead to better headache outcomes.

Reliability, validation and norms of the Chinese version of Anxiety Sensitivity Index 3 in a sample of military personnel.

This study aimed to explore the properties of the Chinese version of the Anxiety Sensitivity Index– 3 (ASI-3) in a sample of military personnel. Using non-probabilistic sampling, the Chinese version of the ASI-3 was administered to 3,077 valid participants aged 16 to 36 years old (M = 22.35, SD = 3.57) from nine military units. The Depression Anxiety Stress Scales-21 (DASS-21) and The State-Trait Anxiety Inventory (STAI) were used to assess the construct validity. A one-way analysis of variance was conducted to compare the differences in the services and positions of the participants. It was found that ①The indices of confirmatory factor analysis met the standard values, which supported the hypothesis of the three-factor model of the original ASI-3; ②ASI-3 was significantly associated with DASS-21 in positive ways, which indicated the high convergent validity; on the other hand, the correlation between ASI-3 and TAI was relatively low, which indicated there was an empirical discrimination between anxiety sensitivity and trait anxiety. ③The Cronbach’s α coefficients were 0.926 for the total scale and 0.828–0.841 for the three subscales; ④At a cut-off score of 16, the sensitivity and specificity levels were 71.1% and 76.7%, respectively, where the sum of sensitivity and specificity becomes the maximum, accompanied with improvement of PPV and NPV; ⑤There were significant findings in the ASI and subscales among the five services and four positions. This study provides new evidence that the Chinese version of the Anxiety Sensitivity Index-3 has good validity and reliability and could be applied as an effective tool to assess anxiety sensitivity in military personnel. Our recommendations to researchers and practitioners are that the three factor model should be replicated across some different special forces and the items and constructs could be modified on Chinese culture.

Psychometric properties of the Functional Disability Inventory for assessing Pain-related disability in children from the community

Purpose: The aim of this study was to evaluate the psychometric properties of the Functional Disability Inventory for assessing pain-related disability in a community sample of children and adolescents.Materials and methods: Five hundred and sixty-one schoolchildren (aged 8–18 years) completed the Functional Disability Inventory. They were also administered measures assessing anxiety sensitivity, internalizing pain coping behaviors, social support seeking, and positive self-statements. A subset of 107 participants completed measures of quality of life.Results: The results confirmed the two-factor structure solution for the Functional Disability Inventory items. The measure’s scales scores demonstrated adequate to good internal consistencies. Convergent validity was supported by significant positive correlations between FDI scores and anxiety sensitivity and internalizing pain coping behaviors, and negative correlations with quality of life. Discriminant validity was supported by weak and non-significant correlations between disability scores and the social support seeking and positive self-statements pain coping strategies scores. Differences in the disability scores between participants who did not experience pain in the last 3 months and those that experienced at least some pain provided additional evidence for construct validity.Conclusions: The findings support the Functional Disability Inventory as a reliable and valid measure for assessing pain-related disability in children and adolescents from the community.Implications for rehabilitationChronic pain is a common health problem in youths and is associated with disability (which implies difficulties in physical, psychological, social or school functioning).The FDI is one of the most used measures to assess disability in youths with chronic pain. However, its psychometric properties have not been studied in a community sample.This study shows new and important findings demonstrating that the FDI provides reliable and valid scores when used to assess pain-related disability in a community sample of schoolchildren.These findings support the use of the FDI as a measure of the benefits of community-based pain treatments or the benefits of disability prevention programs over time.

Psychometric properties of the Spanish version of the Anxiety Sensitivity Index for Children.

Anxiety sensitivity is a useful construct in explaining anxiety disorders. The Anxiety Sensitivity Index for Children (ASIC) is a brief self-report designed to assess anxiety sensitivity in youth. Students (N = 1348; ages 10-17) completed a Spanish translation of the ASIC and measures of anxiety and depression. Confirmatory factor analyses found that scores on the ASIC- Spanish version can be fitted to two factorial structures: A single factor and two first-order factors grouped into one higher-order factor. The two-factor structure was invariant between children and adolescents, and between boys and girls. The ASIC scales (Total Score, Mental Concerns, and Physical Concerns) demonstrated high internal consistency and test-retest reliability. ASIC scores were significantly related to measures of anxiety and, to a lesser extent, to a measure of depression. Results supported the factorial, convergent, and discriminant validity of ASIC scores in Spanish youth.

The Psychometric Properties of the Cognitive Fusion Questionnaire in Adolescents

Abstract. Cognitive fusion can be defined as the inability to view thoughts as just thoughts, which is hypothesized to increase the impact of those thoughts on behavior. Cognitive fusion is a core concept of Acceptance and Commitment Therapy, a therapeutic approach that is being increasingly studied as a treatment for a plethora of chronic health problems. The objective of this study was to evaluate the psychometric properties of the Cognitive Fusion Questionnaire (CFQ) in a sample of adolescents. Three hundred eight adolescents (11–20 years) completed the Catalan version of the questionnaire (CFQ-C) as well as measures assessing anxiety sensitivity and acceptance. The results supported a one-factor solution for the CFQ-C, and indicated an adequate level of internal consistency (Cronbach’s α = 0.79). The validity of the CFQ-C was supported by a significant positive association between the CFQ-C total score and the measure of anxiety sensitivity and by a significant negative association with the measure of acceptance. The findings support the psychometric properties of the CFQ to study the role that cognitive fusion may play in functioning among adolescents.

Suicide risk among male substance users in residential treatment: Evaluation of the depression–distress amplification model

Suicide is a leading cause of death and is significantly elevated among those with substance use disorders (SUDs). However, specific mechanisms of suicide in this population have been relatively understudied. The depression–distress amplification model posits that one pathway to increased suicide risk is through the intensification of depressive symptoms by anxiety sensitivity cognitive concerns. However, this model has not been tested in populations with SUDs. The current study tested the depression–distress amplification model of suicide risk and examined the relation of anxiety sensitivity to suicide risk in a sample of men in residential SUD treatment. Consistent with prior work, anxiety sensitivity cognitive concerns were significantly associated with suicide risk. Moreover, and consistent with the depression–distress amplification model, anxiety sensitivity cognitive concerns related to elevated suicide risk among those with a current major depressive episode specifically, above and beyond insomnia (another risk factor for suicide) and relevant covariates. The results of this study corroborate the relevance of anxiety sensitivity cognitive concerns and the depression–distress amplification model to suicide risk in an at-risk clinical sample of SUD patients. Findings suggest the importance of assessing anxiety sensitivity cognitive concerns and targeting this vulnerability through brief interventions to reduce suicide risk.

Anxiety sensitivity mediates relations between emotional disorders and smoking.

Research has documented consistent and robust relations between emotional disorders (i.e., depressive and anxiety disorders) and smoking. Yet, it is presently unclear whether anxiety sensitivity--the fear of aversive internal anxiety states--accounts for the relations between emotional disorders and various smoking processes, including nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms during past cessation attempts. Participants (N = 465) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco-cessation study. Baseline (pretreatment) data were utilized. Emotional disorders were assessed via clinical diagnostic interview; self-report measures were used to assess anxiety sensitivity and 3 criterion variables: nicotine dependence, barriers to smoking cessation, and severity of problematic symptoms while quitting in past attempts. Emotional disorders were predictive of higher levels of nicotine dependence, greater perceived barriers to cessation, and greater severity of problematic symptoms while attempting to quit in the past; each of these relations were accounted for by the indirect effect of anxiety sensitivity. The present findings suggest that anxiety sensitivity may be an important transdiagnostic construct in explicating the nature of the relations between emotional disorders and various smoking processes.

The role of smoking inflexibility/avoidance in the relation between anxiety sensitivity and tobacco use and beliefs among treatment-seeking smokers.

Recent scholarly attention has focused on explicating the nature of tobacco use among anxiety-vulnerable smokers. Anxiety sensitivity (fear of aversive internal anxiety states) is a cognitive-affective individual difference factor related to the development and maintenance of anxiety symptoms and disorders and various smoking processes. The present study examined the cross-sectional associations between anxiety sensitivity and a range of cognitive and behavioral smoking processes, and the mediating role of the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (i.e., avoidance and inflexibility to smoking [AIS]) in such relations. Participants (n = 466) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco cessation study. Baseline (pretreatment) data were utilized. Self-report measures were used to assess anxiety sensitivity, AIS, and 4 criterion variables: barriers to smoking cessation, quit attempt history, severity of problematic symptoms reported in past quit attempts, and mood-management smoking expectancies. Results indicated that anxiety sensitivity was indirectly related to greater barriers to cessation, greater number of prior quit attempts and greater mood-management smoking expectancies through the tendency to respond inflexibly/avoid to the presence of distressing smoking-related thoughts, feelings, and internal sensations; but not severity of problems experienced while quitting. The present findings suggest AIS may be an explanatory mechanism between anxiety sensitivity and certain smoking processes.

Rumination, anxiety sensitivity, and negative reinforcement drinking

Objective: Prior research has established anxiety sensitivity (AS, essentially fear of anxiety) as an individual difference variable conveying risk for alcohol abuse and specifically negative reinforcement drinking (NRD). This study sought to replicate and extend that finding, examining the role of rumination (related to the cognitive dyscontrol aspect of anxiety sensitivity) in mediating this association.Method: Seventy-three women and 40 men collegiate drinkers completed several questionnaire measures assessing anxiety sensitivity and negative reinforcement drinking, including an adapted measure of anxiety rumination.Results: Findings indicated a moderate relationship (R2 = 0.21) between anxiety sensitivity components and NRD with regression analyses showing that cognitive dyscontrol and anxiety rumination were most strongly associated with NRD. As predicted, anxiety rumination fully statistically mediated (ß = 0.50) the relationship between AS and NRD.Conclusions: Rumination, conceptualized as a maladaptive coping response for emotional regulation, warrants further study in relation to NRD and in developing treatment interventions for high anxiety, at-risk drinkers.

Assessing Anxiety Sensitivity in Inner-City African American Children: Psychometric Properties of the Childhood Anxiety Sensitivity Index

This study examined the psychometric properties of the Childhood Anxiety Sensitivity Index (CASI; Silverman et al., 1991) in a sample of urban African American elementary school children. One hundred forty-four 4th- and 5th-grade children completed the CASI as part of a larger project. In contrast to prior research with community samples, CASI total scores were higher and means did not differ by sex. Internal consistency (α = .82), 2-week test–retest reliability (r = .80), and convergent and divergent validity were good and consistent with prior research. The factor structure of the CASI differed from the structure found with White children. Results of exploratory factor analyses suggest two factors: physical concerns and mental incapacitation concerns. Implications for assessing anxiety and anxiety sensitivity among African American children are discussed.

Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression

The frequent comorbidity of anxiety disorders and mood disorders has been documented in previous studies. However, it remains unclear whether specific anxiety traits or disorders are more closely associated with unipolar major depression (MDD) or bipolar disorder (BPD). We sought to examine whether MDD and BPD can be distinguished by their association with specific types of anxiety comorbidity. Individuals with a primary lifetime diagnosis of either bipolar disorder ( N=122) or major depressive disorder ( N=114) received diagnostic assessments of anxiety disorder comorbidity, and completed questionnaires assessing anxiety sensitivity and neuroticism. The differential association of these anxiety phenotypes with MDD versus BPD was examined with multivariate modeling. Panic disorder and generalized anxiety disorder (GAD) specifically emerged amongst all the anxiety disorders as significantly more common in patients with BPD than MDD. After controlling for current mood state, anxiety sensitivity and neuroticism did not differ by mood disorder type. This study supports prior research suggesting a specific panic disorder–bipolar disorder connection, and suggests GAD may also be differentially associated with BPD. Further research is needed to clarify the etiologic basis of anxiety disorder/BPD comorbidity and to optimize treatment strategies for patients with these co-occurring disorders.

Psychometric Properties of the Childhood Anxiety Sensitivity Index in A sample of Catalan School Children

This study tested the utility of assessing anxiety sensitivity (AS) in children by investigating the long term stability and psychometric properties of a Catalan version of the Childhood Anxiety Childhood Anxiety Sensitivity Index (CASI, Silverman et al ., 1991, Journal of Clinical Child Psychology , 20 , 162-168) in a sample of 291 elementary-school children. The Catalan CASI demonstrated acceptable internal consistency and convergent validity estimates, similar to previous research with the English version. The measure also showed incremental validity in relation to other measures of anxiety and test-retest analyses suggested considerable three month and one-year stability in children's level of AS. Finally, a principal component analysis of the Catalan CASI yielded five lower-order factors grouped on a unique higher-order factor. The similarity of the findings to previous research on the CASI and on AS in English speaking children and adults is discussed and some suggestions for future investigations are presented.

Anxiety Sensitivity in Adolescents at Risk for Psychopathology

Examined the associations of adolescents' self-reported anxiety sensitivity with semistructured, interview-based anxiety and depressive symptoms and anxiety disorders. The sample included 121 adolescents and their parents who participated in a larger epidemiological, high-risk family study of substance abuse and anxiety disorders (Merikangas, Dierker, & Szatmari, 1998). A series of hierarchical multiple regressions revealed the incremental validity of anxiety sensitivity, beyond the contribution of self-rated anxiety, to anxiety symptoms and comorbid anxiety disorders. Furthermore, familial risk for anxiety moderated the association between anxiety sensitivity and number of anxiety symptoms as well as number of comorbid anxiety disorders. Analyses of high- and low-risk groups demonstrated that the association between anxiety sensitivity and anxiety symptoms and disorders was evident in high-risk adolescents only. Although self-reported anxiety was associated with depressive symptoms, anxiety sensitivity was not. Results from this investigation further support the utility of assessing anxiety sensitivity in an adolescent population and suggest it as a trait marker of anxiety among at-risk individuals.

Anxiety Sensitivity in Adolescents at Risk for Psychopathology

Examined the associations of adolescents' self-reported anxiety sensitivity with semistructured, interview-based anxiety and depressive symptoms and anxiety disorders. The sample included 121 adolescents and their parents who participated in a larger epidemiological, high-risk family study of substance abuse and anxiety disorders (Merikangas, Dierker, & Szatmari, 1998). A series of hierarchical multiple regressions revealed the incremental validity of anxiety sensitivity, beyond the contribution of self-rated anxiety, to anxiety symptoms and comorbid anxiety disorders. Furthermore, familial risk for anxiety moderated the association between anxiety sensitivity and number of anxiety symptoms as well as number of comorbid anxiety disorders. Analyses of high- and low-risk groups demonstrated that the association between anxiety sensitivity and anxiety symptoms and disorders was evident in high-risk adolescents only. Although self-reported anxiety was associated with depressive symptoms, anxiety sensitivity was not. Results from this investigation further support the utility of assessing anxiety sensitivity in an adolescent population and suggest it as a trait marker of anxiety among at-risk individuals.