High Anxiety Sensitivity Research Articles

PO-0935 Anxiety Sensitivity And Behaviour Difficulties In Adolescents: Gender And Age Differences

Background Anxiety sensitivity can be defined as fear of anxiety based on belief that anxiety does devastating physical, psychological and social damage. Behaviour difficulties refer to the following areas: lack of attention and concentration with joint behaviour consequences, risky behaviours and low levels of social skills which result in impaired peer relations. The aim of this study is to determine gender and age differences in anxiety sensitivity and behaviour difficulties in adolescents. Methods A non-clinical sample included 305 adolescents of both sexes, aged 12 to 16. The Serbian version of Childhood Anxiety Sensitivity Index (CASI, Stevanovic et al ., 2013) and the Strength and Difficulties Questionnaire (SDQ, Goodman 1997) were applied. The data were analysed with Multivariate Analysis of Variance. Results Significant main effects of gender (F = 8.777; p < 0.01) and age (F = 3.092; p < 0.01), as well as an interaction effect of these two factors (F = 3.043; p < 0.05) were found. Girls show higher levels of social concerns, unsteady concerns and disease concerns, while risky behaviours and peer problems are more prevalent in boys. Results also show that risky behaviours in age-group 14 and up are less prevalent in boys, and more prevalent in girls. Conclusion This study shows that girls have a higher anxiety sensitivity level, while boys exhibit more behaviour difficulties, which the authors of the study speculate is the result of cultural differences and gender based expectations. Results also show that social concern and peer problems depend on age.

P.4.b.001 High anxiety sensitivity is associated with reduced resting heart rate variability

P.4.b.001 High anxiety sensitivity is associated with reduced resting heart rate variability

A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group. This multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6-18.4years) and their 35 sibling controls (age range 8.6-18.1years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self-report coping, daily stress, adversities, and parental bonding questionnaires. Compared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups. These findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.

Examining the latent structure of anxiety sensitivity in adolescents using factor mixture modeling.

Anxiety sensitivity has been implicated as an important risk factor, generalizable to most anxiety disorders. In adults, factor mixture modeling has been used to demonstrate that anxiety sensitivity is best conceptualized as categorical between individuals. That is, whereas most adults appear to possess normative levels of anxiety sensitivity, a small subset of the population appears to possess abnormally high levels of anxiety sensitivity. Further, those in the high anxiety sensitivity group are at increased risk of having high levels of anxiety and of having an anxiety disorder. This study was designed to determine whether these findings extend to adolescents. Factor mixture modeling was used to examine the best fitting model of anxiety sensitivity in a sample of 277 adolescents (M age = 11.0 years, SD = 0.81). Consistent with research in adults, the best fitting model consisted of 2 classes, 1 containing adolescents with high levels of anxiety sensitivity (n = 25) and another containing adolescents with normative levels of anxiety sensitivity (n = 252). Examination of anxiety sensitivity subscales revealed that the social concerns subscale was not important for classification of individuals. Convergent and discriminant validity of anxiety sensitivity classes were found in that membership in the high anxiety sensitivity class was associated with higher mean levels of anxiety symptoms, controlling for depression and externalizing problems, and was not associated with higher mean levels of depression or externalizing symptoms controlling for anxiety problems.

Variations in the influence of parental socialization of anxiety among clinic referred children.

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of ≥ 10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.

Anxiety sensitivity and medication nonadherence in patients with uncontrolled hypertension

ObjectiveAnxiety sensitivity—fear of the negative social, physical, or cognitive consequences of anxiety related sensations—has been linked to cardiovascular disease and adverse cardiovascular health behaviors. Medication nonadherence may account for this association. We examined whether anxiety sensitivity was independently associated with objectively measured medication nonadherence in a multi-ethnic primary care sample. MethodsEighty-eight patients with uncontrolled hypertension completed the Anxiety Sensitivity Index and had their adherence to blood pressure (BP) medications measured during the interval between two primary care visits using an electronic pillbox (MedSignals®). Multivariable Poisson regressions were conducted to determine the relative risks of medication nonadherence associated with anxiety sensitivity after adjustment for age, gender, Hispanic/Latino ethnicity, education, total number of prescribed medications, and depressive and posttraumatic stress disorder (PTSD) symptoms. ResultsNearly twice as many patients with high anxiety sensitivity were nonadherent to BP medications compared to patients with low anxiety sensitivity (65.0% vs. 36.8%; p=0.03). Patients with high anxiety sensitivity had higher relative risks of medication nonadherence than their low anxiety sensitivity counterparts (adjusted relative risk [RR]=1.76; 95% CI: 1.03–3.03). ConclusionsIn this first study of the association between anxiety sensitivity and medication adherence, we found that high anxiety sensitivity was strongly associated with BP medication nonadherence, even after adjustment for known confounders. Our results suggest that teaching patients who have uncontrolled hypertension adaptive strategies to manage their anxiety sensitivity may help improve their medication adherence, and thereby lower their cardiovascular risk.

Are childhood trauma exposures predictive of anxiety sensitivity in school attending youth?

BackgroundStressful life events in adolescents have been found to be longitudinally associated with higher anxiety sensitivity (AS). A question that has not been addressed is whether AS in adolescence is associated with different childhood adversity exposures. MethodsSchool attending adolescents (n=1149) completed measures of anxiety sensitivity (CASI), trait anxiety (STAI-T), childhood trauma (CTQ), depression (CES-DC), alcohol (AUDIT) and drug use (DUDIT), and resilience (CD-RISC) and coping orientation (A-COPE). ResultsThere was no significant gender difference in childhood trauma exposure, resilience levels or coping orientation. Gender differences were evident in terms of AS, trait anxiety, depression, alcohol and drug use. Depression, trait anxiety and alcohol use mediated the relationship between the amount of childhood trauma and AS and played a role in the relationship between certain childhood trauma types and AS. Neither resilience nor coping orientation had a moderating effect on the relationship between the amount of childhood trauma and AS. LimitationsCross-sectional study, over- or under-reporting of data due to use of self-report instruments, and use of a retrospective measure of childhood trauma (CTQ) that is subject to recall bias. ConclusionsGirls are at greater risk than boys for early onset anxiety disorders as girls have higher rates of AS, trait anxiety and depression despite the same rates of childhood trauma, coping orientation and resilience. Our findings, in the context of childhood trauma, underscore the influence of depression, trait anxiety and alcohol use as risk factors for the development of AS in youth.

Anxiety Sensitivity and Negative Urgency

Anxiety sensitivity--fear of anxiety symptoms--may increase motivation to smoke by influencing the development of cognitive expectations regarding smoking's negative reinforcing effects; yet, the nature and mechanisms of this pathway are unclear. We hypothesized that relations between anxiety sensitivity and negative reinforcement-related smoking expectancies would be mediated by negative urgency, that is, a trait tendency to act impulsively during negative affect. In a cross-sectional design, we administered self-report measures of anxiety sensitivity, negative urgency, and negative reinforcement-related smoking outcome and abstinence expectancies to 205 smokers (≥10 cigarettes/d, 34% female, M age = 44.4 years). Anxiety sensitivity was associated with stronger expectancies that smoking alleviates negative affect (β = 0.30; P < 0.0001) and smoking abstinence exacerbates aversive withdrawal symptoms (β = 0.24; P = 0.0004). Negative urgency partially mediated the relation between anxiety sensitivity and both types of negative reinforcement-related smoking expectancies (βs ≥ 0.057; Ps ≤ 0.007). Results remained significant after statistically controlling for anxiety and nicotine dependence symptoms. Smokers high in anxiety sensitivity tend to display negative urgency, which in turn is related to greater expectations of negative reinforcement consequences of smoking and smoking abstinence. Treatments that mitigate fear of anxiety symptoms and the tendency to act impulsively in response to negative affect (eg, interoceptive exposure, distress tolerance skills training, and mindfulness training) may be particularly useful in assisting with smoking cessation for high-anxiety sensitivity smokers.

The Moderating Role of Experiential Avoidance in the Prospective Relationship Between Anxiety Sensitivity and Anxiety

Cross-sectional research has shown that the association between anxiety sensitivity (i.e., a trait-like fear of anxiety-related bodily sensations due to beliefs that these sensations engender negative outcomes) and anxiety becomes stronger as experiential avoidance (i.e., an unwillingness to stay in contact with unwanted inner experiences) increases. The present study sought to extend cross-sectional research by examining whether the moderating impact of experiential avoidance would be observed when examining anxiety sensitivity as a prospective predictor of anxiety over the course of two assessment sessions (T1 and T2). Participants (N = 135) were non-treatment seeking undergraduate students. As predicted, T1 experiential avoidance moderated the relationship between T1 anxiety sensitivity and T2 anxiety, even after accounting for T1 anxiety. The interaction was tested with simple slopes analysis and results suggest that anxiety sensitivity may only be a vulnerability factor for the development of anxiety among those who are prone to higher levels of experiential avoidance. Thus, experiential avoidance may be a particularly important treatment target among individuals with high anxiety sensitivity.

Context in Anxiety Sensitivity: The Role of Expectancy, Catastrophic Misinterpretations and Diminished Reappraisal in Response to Hypothetical Physical Arousal Scenarios

In the present vulnerability study individuals with high (n = 35) and low (n = 124) anxiety sensitivity (AS) made ratings of anticipated distress, catastrophic misinterpretations and benign more realistic alternative explanations to 24 hypothetical scenarios involving physical sensations. The physical sensation scenarios were a modification of the Body Sensations Interpretation Questionnaire (Clark et al. in J Consult Clin Psychol 65:203–213, 1997) and varied in level of expectedness across panic-related and nonpanic-related scenarios. Group comparisons revealed that the high AS group reported significantly higher levels of distress and more catastrophic misinterpretations to all physical sensation scenarios, although no group differences were found in ratings of realistic interpretations. A significant Group × Expectedness interaction indicated that high AS individuals generated more catastrophic misinterpretations to all unexpected physical sensation scenarios. The findings support the centrality of catastrophic misinterpretation as the key cognitive construct in panic disorder as well as aspects of Telch et al.’s (J Anxiety Disor 25: 645–653, 2011) context-sensitivity perspective on panic.

Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: a randomized controlled trial.

High anxiety sensitivity (AS) is associated with the development and maintenance of anxiety and depressive symptoms and is theorized to be a mediator of treatment outcomes for anxiety and depression. The present study tested the efficacy of a telephone-delivered cognitive behavioral therapy (CBT) intervention in reducing high AS and its associated anxiety and depressive symptoms. Treatment-seeking participants with high AS were recruited from the community (N = 80; M age = 36 years; 79% women; 76% Caucasian) and were randomly assigned to an 8-week telephone-delivered CBT program or a waiting list control. Participants completed anxiety and depression symptom and diagnostic measures at pre- and posttreatment, after a subsequent 4 weeks of continued interoceptive exposure, and 8 weeks later. Multilevel modeling showed the treatment was successful in reducing AS, as well as panic, social phobia, posttraumatic stress symptoms, and number of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses per participant when compared to a waiting list control. These gains were maintained at follow-up. Generalized anxiety and depressive symptoms, however, did not improve as a result of treatment. Mediated moderation analyses suggested that treatment-related changes in AS may mediate anxiety symptom changes. RESULTS of the present study provide promising evidence for this transdiagnostic treatment approach. Reductions in anxiety symptoms across diagnostic categories stemming from this AS-targeted intervention may have implications for helping a broad array of clients with various anxiety disorders that share AS as a common risk or maintenance factor.

Supplemental Material for Telephone-Delivered Cognitive Behavioral Therapy for High Anxiety Sensitivity: A Randomized Controlled Trial

Supplemental Material for Telephone-Delivered Cognitive Behavioral Therapy for High Anxiety Sensitivity: A Randomized Controlled Trial

Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders

ObjectiveIdentifying treatment moderators facilitates treatment matching and personalized medicine. No previous studies have investigated treatment moderators for a mindfulness-based versus traditional cognitive behavioral therapy (CBT) for anxiety disorders to determine for whom each is most effective. The current study examined three putative moderators of principal anxiety disorder severity outcomes for adapted mindfulness based stress reduction (MBSR) and group CBT – baseline depression symptoms, anxiety sensitivity, and diagnostic severity. MethodSeventy-one patients with a DSM-IV anxiety disorder were randomized to adapted MBSR or group CBT and assessed at baseline, post-treatment, and 3-month follow up. ResultsCBT outperformed adapted MBSR among those with no to mild depressive symptoms and, at post-treatment only, among those with very high anxiety sensitivity. At follow up, adapted MBSR outperformed CBT among those with moderate to severe depressive symptoms and among those with average anxiety sensitivity (for this sample). Baseline severity affected post-treatment outcomes differently in CBT than in adapted MBSR. ConclusionBaseline levels of depression, anxiety sensitivity, and to some extent diagnostic severity, differentially moderated outcomes in CBT and adapted MBSR for anxiety disorders. Recommendations and clinical implications are discussed.

Association of Trauma, Posttraumatic Stress Disorder, and Experimental Pain Response in Healthy Young Women

Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response. To examine differences in pain response and in certain psychological variables between trauma-exposed women (TEW) with PTSD, TEW without PTSD, and non-trauma-exposed women (NTEW) and to explore the role of these psychological variables in the differences in pain response between the groups. A total of 122 female students completed a cold pressor task (42 TEW with PTSD, 40 TEW without PTSD, and 40 NTEW). Anxiety sensitivity, experiential avoidance, trait and state dissociation, depressive symptoms, state anxiety, catastrophizing, and arousal were assessed. TEW with PTSD reported significantly higher pain unpleasantness than NTEW, but not more than that of TEW without PTSD. They also presented higher trait dissociation, state anxiety, depressive symptoms, and skin conductance than the other 2 groups and higher anxiety sensitivity than TEW without PTSD. TEW without PTSD reported more pain unpleasantness than NTEW, but they recovered faster from pain. However, these differences were not explained by any psychological variable. The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.

Experiential, autonomic, and respiratory correlates of CO2 reactivity in individuals with high and low anxiety sensitivity

Psychometric studies indicate that anxiety sensitivity (AS) is a risk factor for anxiety disorders such as panic disorder (PD). To better understand the psychophysiological basis of AS and its relation to clinical anxiety, we examined whether high-AS individuals show similarly elevated reactivity to inhalations of carbon dioxide (CO2) as previously reported for PD and social phobia in this task. Healthy individuals with high and low AS were exposed to eight standardized inhalations of 20% CO2-enriched air, preceded and followed by inhalations of room air. Anxiety and dyspnea, in addition to autonomic and respiratory responses were measured every 15s. Throughout the task, high AS participants showed a respiratory pattern of faster, shallower breathing and reduced inhalation of CO2 indicative of anticipatory or contextual anxiety. In addition, they showed elevated dyspnea responses to the second set of air inhalations accompanied by elevated heart rate, which could be due to sensitization or conditioning. Respiratory abnormalities seem to be common to high AS individuals and PD patients when considering previous findings with this task. Similarly, sensitization or conditioning of anxious and dyspneic symptoms might be common to high AS and clinical anxiety. Respiratory conditionability deserves greater attention in anxiety disorder research.

Induction of dyspnea evokes increased anxiety and maladaptive breathing in individuals with high anxiety sensitivity and suffocation fear

Although respiratory symptoms are relevant for diagnosis and etiology of panic disorder, anxiety responses and breathing behavior evoked by induction of dyspnea have rarely been studied. Therefore, dyspnea sensations and affective evaluations evoked by inspiratory resistive loads of different intensities were first assessed in 23 individuals with high versus 24 participants with low anxiety sensitivity (AS). High AS participants with high fear of suffocation rated loads of the same physical intensity as more unpleasant and reported more intense feelings of dyspnea and more respiratory and panic symptoms than low AS individuals. In the second experiment assessing physiological responses to physically comparable loads, high suffocation fear participants showed an increase in minute ventilation to compensate for fear-induced air hunger. This ventilation behavior results in increased frequency of dyspnea sensations, thus increasing fear of suffocation.

Respiratory Muscle Tension as Symptom Generator in Individuals With High Anxiety Sensitivity

Anxiety and panic are associated with the experience of a range of bodily symptoms, in particular unpleasant breathing sensations (dyspnea). Respiratory theories of panic disorder have focused on disturbances in blood gas regulation, but respiratory muscle tension as a source of dyspnea has not been considered. We therefore examined the potential of intercostal muscle tension to elicit dyspnea in individuals with high anxiety sensitivity, a risk factor for developing panic disorder. Individuals high and low in anxiety sensitivity (total N=62) completed four tasks: electromyogram biofeedback for tensing intercostal muscle, electromyogram biofeedback for tensing leg muscles, paced breathing at three different speeds, and a fine motor task. Global dyspnea, individual respiratory sensations, nonrespiratory sensations, and discomfort were assessed after each task, whereas respiratory pattern (respiratory inductance plethysmography) and end-tidal carbon dioxide (capnography) were measured continuously. In individuals with high compared to low anxiety sensitivity, intercostal muscle tension elicited a particularly strong report of obstruction (M=5.1, SD=3.6 versus M=2.5, SD=3.0), air hunger (M=1.9, SD=2.1 versus M=0.4, SD=0.8), hyperventilation symptoms (M=0.6, SD=0.6 versus M=0.1, SD=0.1), and discomfort (M=5.1, SD=3.2 versus M=2.2, SD=2.1) (all p values<.05). This effect was not explained by site-unspecific muscle tension, voluntary manipulation of respiration, or sustained task-related attention. Nonrespiratory control sensations were not significantly affected by tasks (F<1), and respiratory variables did not reflect any specific responding of high-Anxiety Sensitivity Index participants to intercostal muscle tension. Respiratory muscle tension may contribute to the respiratory sensations experienced by panic-prone individuals. Theories and treatments for panic disorder should consider this potential source of symptoms.

Anxiety sensitivity and dissociative experiences in adolescents with migraine and tension type headache

Objective: The aim of this study was to investigate the relationship between headache and anxiety sensitivity (AS), and also headache and dissociative experiences (DE) in adolescents. Methods: Patients were recruited from the adolescents who were admitted to Ankara University Faculty of Medicine Child Neurology Clinic with a complaint of headache and diagnoses of migraine (n=24) or tension type headache (TTH) (n=22). All patients and healthy controls (n=28) were encouraged to complete Childhood Anxiety Sensitivity Index (CASI) and Adolescent Dissociative Experiences Scale (ADES). Results: Patients with headache had higher scores from CASI and ADES instruments in comparison with the healthy adolescents. In case the patient group was divided into two groups regarding to their diagnoses, both migraine and TTH group had higher scores from CASI than control group. However, although TTH group had higher ADES scores than control group, there was no significant difference between migraine and control groups. Likewise, CASI and ADES scores of migraine and TTH groups were not different. Conclusion: Adolescents with headache are having higher AS and DE than normal controls. The diagnosis of migraine or TTH does not change these results in terms of AS. However, adolescents with migraine are not having higher DE than normal controls.

A Preliminary Evaluation of Repeated Exposure for Depersonalization and Derealization

Dissociative symptoms including depersonalization and derealization are commonly experienced by individuals suffering from panic disorder or posttraumatic stress disorder (PTSD). Few studies have been published investigating the specific treatment of these symptoms in individuals diagnosed with panic disorder or PTSD, despite evidence that the subset of individuals with panic disorder who experience depersonalization and derealization report more panic attacks as well as greater panic severity and functional impairment. Furthermore, it has been shown that these symptoms can impede treatment and recovery in PTSD. Finally, recent research has shown that interoceptive exposure generally enhances the efficacy of treatment outcome for PTSD and PTSD with comorbid panic. This study investigated the use of a novel interoceptive exposure technique for treatment of depersonalization and derealization in individuals with high anxiety sensitivity and/or symptoms of PTSD. Results indicated significant reductions on six of seven items as well as total score on an outcome measure of depersonalization and derealization. Thus, this technique appears to hold promise for utilization as a form of interoceptive exposure in the treatment of these symptoms.