Fear Of Respiratory Symptoms Research Articles

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.

The Amelioration of Anxiety Sensitivity by Cognitive Defusion Techniques: A Focus on the Fear of Respiratory Symptoms

Anxiety sensitivity (AS) refers to the tendency to fear of anxiety-related sensations. Catastrophic interpretation of bodily sensation is the major characteristic of AS. Cognitive Defusion (CD), the key process of acceptance and commitment therapy, is to prevent suffering from one's own thoughts (i.e., Cognitive Fusion) and aims to make people aware that a thought is just a thought and a feeling is just a feeling. To investigate CD's effects on AS, this study focused on fear of respiratory symptoms (FRS), one of the sub-components of AS, and examined whether FRS can be conceptualized as Cognitive Fusion (CF) and whether CD can ameliorate FRS. Female college students who scored in the top 75 percentile or the bottom 25 percentile in their FRS scores were invited (28 people for each group) to participate in the experiment among 329 preliminary survey respondents. Two groups (high FRS and low FRS) showed significant differences in all scales related with CF. Afterwards, half of both groups were given CD intervention while the remaining were allotted into a control condition. After intervention, the changes of FRS and other measures measuring CF were analyzed. Results showed that CD decreased FRS and believability of a negative thought during a breath-holding task only in high FRS group, but increased willingness and breath-holding duration for both high and low FRS groups. In this regard, the present study suggests that even a short intervention, such as CD focusing on disconnecting a catastrophic thought process, can ameliorate AS.

Taxonicity of anxiety sensitivity: a multi-national analysis

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index—Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.

Factor Structure and Reliability of the Anxiety Sensitivity Profile in a Turkish Sample1

Summary: Anxiety sensitivity is an individual difference variable defined as the fear of fear or the fear of anxiety, arising from the belief that the experience of anxiety symptoms leads to illness or additional anxiety. The Anxiety Sensitivity Profile (ASP) is a 60 item self-report measurement, and each item is assessed on a 7-point scale. The purpose of this study is to determine the factor structure and reliability of the Turkish version of the ASP. To address this purpose, first the scale was translated into Turkish, and then it was administered to 434 university students. Principal components factor analysis with promax rotation revealed four factors in which all items had a factor loading of 0.30 or more. The factors were as follows: (1) fear of respiratory symptoms, (2) fear of cognitive dyscontrol, (3) fear of cardiac symptoms, and (4) fear of gastrointestinal symptoms. The internal consistency of these four factors was 0.97, 0.93, 0.91, and 0.86, respectively. The overall scale also had a high degree of internal consistency, with an α coefficient of 0.98. Item-total analysis revealed that the internal consistency of all items was satisfactory (rs 0.30-0.77). Data provided evidence that the Turkish version of the ASP had a multidimensional construct with four lower order factors loaded on a higher order factor.

An expanded childhood anxiety sensitivity index: its factor structure, reliability, and validity in a non-clinical adolescent sample

Anxiety sensitivity refers to the fear of anxiety-related bodily sensations that are interpreted as having potentially harmful somatic, psychological, or social consequences. The current study examined the factor analytic structure of anxiety sensitivity in a large sample of normal adolescents ( N=518) using the revised childhood anxiety sensitivity index (CASI-R). Confirmatory factor analysis indicated that anxiety sensitivity as measured by the CASI-R can best be conceptualised as a hierarchical construct with four lower-order factors loading on a single higher-order factor. The lower-order factors were ‘fear of cardiovascular symptoms’, ‘fear of publicly observable anxiety reactions’, ‘fear of cognitive dyscontrol’, and ‘fear of respiratory symptoms’. An additional aim of the present study was to investigate the psychometric properties of the CASI-R. Results showed the CASI-R to be a reliable scale in terms of internal consistency. Furthermore, CASI-R scores were substantially related to levels of anxiety sensitivity as measured by the original index, trait anxiety, symptoms of anxiety disorders, in particular ‘panic disorder and agoraphobia’, and depression. Finally, some evidence was found for the validity of the CASI-R factor scores. That is, all factors convincingly loaded on symptoms of ‘panic disorder and agoraphobia’, whereas the factor ‘fear of publicly observable anxiety reactions’ was also strongly associated with symptoms of ‘social phobia’.

The relationship between anxiety sensitivity and fear of pain in healthy adolescents

The present study investigated the relationship between anxiety sensitivity and fear of pain in a large group of healthy adolescents ( N=200). Participants completed the childhood anxiety sensitivity index for children-revised, a questionnaire measuring four specific domains of anxiety sensitivity: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of cognitive dyscontrol, and fear of publicly observable anxiety symptoms, and a simplified version of the pain anxiety symptoms scale, a self-report instrument assessing pain-related anxiety and avoidance (i.e. fear of pain). In line with previous research in adult populations, it was found that anxiety sensitivity is substantially and positively related to fear of pain. Even when controlling for other potential predictors of fear of pain (i.e. pain symptoms, other somatization symptoms, trait anxiety, and panic disorder symptoms), anxiety sensitivity appeared to declare a unique proportion of the variance in pain anxiety symptoms.

An Expanded Anxiety Sensitivity Index: Evidence for a Hierarchic Structure in a Clinical Sample

Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss’s (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS—the ASI-R—which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss’s expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.

Anxiety sensitivity: multiple dimensions and hierarchic structure

Anxiety sensitivity (AS) is the fear of anxiety-related sensations, based on beliefs that these sensations have harmful consequences. AS is thought to play an important role as a diathesis for anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower-order factors, which load on a single higher-order factor. If each factor corresponds to a discrete mechanism, then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index (ASI), which may not contain enough items to reveal the type and number of lower-order factors. Accordingly, we developed the 60-item Anxiety Sensitivity Profile, which was administered to 349 university students. Factor analyses revealed four lower-order factors: (1) Fear of respiratory symptoms, (2) fear of cognitive dyscontrol, (3) fear of gastrointestinal symptoms, and (4) fear of cardiac symptoms. These loaded on a single higher-order factor. The lower-order factors shared variance with the higher-order factor, but also contained unique variance. Thus, the results suggest that AS is the product of a general factor, with independent contributions from four specific factors.