Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks

ArticleinBehaviour Research and Therapy 39(4):443-56 · May 2001with 127 Reads
DOI: 10.1016/S0005-7967(00)00023-1 · Source: PubMed
Abstract
We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.

Do you want to read the rest of this article?

Request full-text
Request Full-text Paper PDF
  • Article
    Background The clinical relevance of Anxiety Sensitivity (AS) is well established, as well as the association between parents’ and children’s AS. However, there is little data data on the indirect relation between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms through children’s AS, and the few findings available are inconsistent. Objective The study examined, in a community sample, whether children’s AS was associated to their anxiety and somatic-hypochondriac symptoms, and tested whether children’s AS mediated the link between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms. MethodsA total of 392 children and one of their parents completed a battery of questionnaires. ResultsChildren’s AS mediated the links between parents’ AS and children’s anxiety and somatic-hypochondriac symptoms. These pathways were moderated by the child’s age, in that they were significant for older children (ages 11–17 years old), but not for younger ones (ages 8–10 years old). Conclusions The findings advance understanding of how parental AS might be implicated in children’s AS and clinical symptoms.
  • Article
    Drinking behaviors among college students have become problematic as evidenced by 20% of students who endorse five or more problems associated with alcohol use. Alcohol use problems are associated with numerous anxiety problems and can begin as early as young adolescence. The period for risk of developing emotional problems peaks during the transition to college. Despite the relationship between anxiety and alcohol use problems, little is known about the cross-cutting mechanisms that explain their relationship and comorbidity. Researchers have proposed affective (i.e. anxiety sensitivity and distress tolerance) and alcohol-specific motivations (i.e. expectancies, valuations, peer influence, and drinking motives) as vulnerabilities for alcohol use and anxiety problems. To address the relationship gap,, the current study examined how changes in anxiety sensitivity, alcohol expectancies, valuations, peer resistance, and drinking motives contributed to changes in alcohol and anxiety interference across three waves of time. Key findings from 297 college students revealed expectancies predicted positive changes alcohol use problems across two phases of time. Anxiety sensitivity predicted alcohol use problems, drinking motives, expectancies, and valuations. Moreover, anxiety sensitivity predicted positive changes in anxiety interference and peer resistance. Drinking motives were associated with increased changes in alcohol useproblems. The relationship between anxiety sensitivity and alcohol use problems were serially mediated via expectancies and motives. These results highlight the importance of targeting specific cognitive- affective mechanisms among early college students to reduce the risk of alcohol use and anxiety-related problems. Adviser: Debra Hope
  • Article
    Women with panic disorder are likely to experience greater menstrual-specific symptoms (e.g., headaches, cramps) as well as more panic/anxiety-related symptoms (e.g., dizziness, faintness, chest pain, heart pounding), and may be more likely to experience these symptoms during the premenstrual phase. This study examines the attributions women make about the somatic and affective symptoms they experience during the menstrual cycle. Using a 30-day prospective design, women with and without panic disorder monitored physical and affective symptoms. Participants reported on severity of various symptoms and a primary cause for each symptom (menstrual cycle-related, panic/anxiety related, stress-related, health-related). Women with panic disorder reported more panic attacks during the premenstrual phase compared to other cycle phases. They also reported more severe affective and panic symptoms during the premenstrual phase compared to other phases, but did not significantly differ from the comparison group in menstrual symptom severity across the three cycle phases. Although women with panic disorder attributed more panic/anxiety-related causes for their symptoms across the menstrual cycle, they were able to discriminate between panic/anxiety causes and menstrual cycle-related causes. Women with panic disorder may benefit for therapy that focuses on their exacerbation of panic symptoms during the premenstrual phase.
  • ... Child's learning experiences: Learning Experience Index -second version (LEI-II) was based on the expanded version of Muris et al.'s (2001) Learning Experience Questionnaire, which itself was based upon the Learning History Questionnaire developed by Ehlers (1993) and used in previous studies (Stewart et al., 2001;Watt & Stewart, 2003;Watt et al., 1998). This scale is divided into three parts. ...
    ... The role of parental AS and learning experiences in child's AS Consistent with other studies ( Muris et al., 2001;Stewart et al., 2001;Watt et al., 1998), learning experiences following children's somatic sensations influenced their level of AS. More specifically, only learning experiences following pain symptoms were observed to have an impact. ...
    Article
    This study evaluated the impact of the mother's and father's anxiety sensitivity (AS) and learning experiences on children's AS, and the influence of two moderators: the children's femininity orientation and the children's emotional intelligence (EI). The sample comprised 200 non‐clinical children, aged 9–13 years, and their parents (mothers and fathers). Results revealed that the effect of parental AS on children's AS is moderated by the children's EI for maternal AS and by their femininity traits for paternal AS. Learning experiences following somatic sensations influenced the children's level of AS. More specifically, special attention by parents following a child's somatic sensations (reinforcement and transmission of information) was associated with high AS in children. Parental reactions of fear following a parent's somatic sensations (modelling) seem to predict higher scores for AS when the link is moderated by the child's femininity orientation. The implications of these findings are discussed. Statement of contribution What is already known on this subject • The influence of parental factors in child's AS has been demonstrate, but these studies are limited. • Specific mechanisms might condition the relationship between child's AS and parental factors. What does this study add? • Learning experiences and parental AS influence the child's level of AS. • It is important to consider the influence of mothers and fathers in child's AS. • Child's emotional intelligence and expressive traits may moderate the effect of parental factors.
  • Article
    Objective. Parents can facilitate offspring anxiety in response to bodily arousal via “sick role reinforcement,” a process that may be important during adolescence. Although a sizeable body of work has examined the role of parent behavior in this process, no study to date has examined child-driven effects on parental sick role reinforcement. Furthermore, little work has examined whether parental factors are related to sick role reinforcement, including anxiety sensitivity. Design. The current study investigated the associations among these variables using a set of vignettes in which 225 parents were asked to imagine their adolescent offspring describing somatic sensations in either an anxious or non-anxious manner. Results. Effects of offspring descriptions, parental AS, and an interaction between the two emerged on parental sick role reinforcement behavior. Conclusions. These findings lay the groundwork for future work targeted at improving our understanding of the unique and interactive roles parents and offspring play in the sick role reinforcement process.
  • Article
    Fumar constituye un grave problema de salud pública, siendo la primera causa evitable de morbimortalidad en el mundo. En las últimas décadas se ha observado una elevada prevalencia de consumo de tabaco en personas con diferentes trastornos psicopatológicos. Se ha propuesto la existencia de factores de vulnerabilidad psicológica como, por ejemplo, la sensibilidad a la ansiedad, la anhedonia o la tolerancia al malestar, que podrían explicar, al menos en parte, la relación entre fumar y la ansiedad y otros trastornos emocionales. Este trabajo es una revisión descriptiva de la literatura que se centra en analizar el papel de la sensibilidad a la ansiedad en relación con el consumo de tabaco, concluyéndose que existe evidencia de que esta variable influye en varios aspectos relacionados con la conducta de fumar, su mantenimiento y en el proceso de dejar de fumar.
  • ... IIS has been shown to be a stronger predictor than AS of pain catastrophizing, pain-related fear, pain-related anxiety, and pain tolerance (Vancleef and Peters 2006b ; Vancleef et al. 2006 ). In contrast, heightened AS appears related to learning to catastrophize about the meaning of somatic sensations, rather than catastrophizing about the sensations themselves ( Stewart et al. 2001 ;Watt and Stewart 2000 ;Watt et al. 1998 ). In contrast, IIS appears linked to parental modelling and reinforcement of sick-role behaviour specifically related to aches and pains, which is in line with precedent research (Vancleef and Peters 2006b ;Vancleef et al. 2006 ) that IIS may be subsumed within a more general fear of somatic sensations. ...
  • Article
    A relatively limited research base suggests parenting practices, particularly those characterized by overcontrol, are linked to elevated risk for offspring experiencing panic symptoms. However, extant research conducted in this domain is based on adult retrospective report, and the relation between parental psychological control (parenting characterized by control attempts that intrude on the emotional development of the child) and adolescent symptoms of panic has not been examined. Moreover, few studies have examined both maternal and paternal parenting practices in relation to panic symptoms among adolescents. To address these gaps in the literature, the current study evaluated relations between both adolescent-reported maternal and paternal psychological control and panic symptom frequency. Results indicate that maternal and paternal psychological control relate positively to panic symptom frequency among adolescents.
  • ... Given that environmental factors may vary across cultures, crosscultural studies in AS manifestations and in instruments devised to assess AS are recommended. Indeed, even though the influence of genetic factors in the etiology of AS has been confirmed (Stein et al., 1999; Taylor et al., 2008), both empirical (Taylor et al., 2008) and retrospective (Stewart et al., 2001; Scher and Stein, 2003) studies have bolstered the role of environmental factors in AS development. For example, although a few studies found that AS is associated in the same way with anxiety and related disorders across socio-cultural contexts (Zvolensky et al., 2001Zvolensky et al., , 2003 Bernstein et al., 2006; Taylor et al., 2007), symptom perception and expression may be affected by cultural variability (Kirmayer et al., 1995 ). ...
    Article
    Anxiety Sensitivity (AS) is defined as the fear of anxiety and of arousal-related bodily sensations, arising from erroneous beliefs that these sensations will have adverse consequences. AS plays a key role both in the onset and in the maintenance of several disorders, particularly anxiety disorders. To date, only two studies on American samples have examined the bifactor structure of the Anxiety Sensitivity Index-3 (ASI-3); therefore, findings on different cultures are needed. The main purpose of the present study was to assess the factor structure and psychometric properties of the ASI-3 in an Italian community sample. Participants were recruited from the general population (N = 1507). The results of a series of confirmatory factor analyses indicated that the bifactor structure fitted the data better than the most commonly accepted structure for the measure and that it was invariant across gender. Moreover, the current study provided evidence regarding the ASI-3’s reliability and its convergent and divergent validity. Lastly, results pertaining incremental validity of the ASI-3 Physical and Cognitive Concerns subscales above and beyond the total showed that the former was not associated with a measure of physiological anxiety, whereas the latter was weakly associated with a measure of worry. Findings suggest that the ASI-3 is comprised of a dominant general factor and three specific independent factors; given the dominance of the general factor, the use of the ASI-3 total score as a measure of the general fear of anxiety is recommended in both clinical and research settings.
  • Article
    Aim. The aim of the study was: comparing the psychological differences in states and traits in a sample of Obsessive-Compulsive Disorder (OCD) patients matched with a control group; identifying the pre-treatment clinical predictors, with assumption that anxiety and depression affect the disorder and his treatment; evaluating the relations between illness behaviours, obsessive-compulsive (OC) symptomathology and clinical scales. Material and Method. Fifty-one patients with DSM-IV criteria for OCD were matched with normal control group (n=51) balanced for sociodemographic variables. All subjects were assessed using self rating scales - ASI, SQ, IAS, CC, TPQ - and assessor rating scales - Y-BOCS, BPRS. To identify the clinical and demographic variables predicting OC symptomathology was conducted the regression analysis. Results. Seventy-two per cent of patients had axis I secondary diagnosis. Patients with OCD presented higher scores in anxiety sensitivity, anxiety, depression, hostility, somatic symptom, illness behaviour and harm avoidance trait. Duration of illness, anxiety sensitivity and harm avoidance were found to significantly predict patients OCD clinical symptomatology. In OCD illness behaviour was related with anxiety sensitivity and somatic symptoms. Conclusions. The results of this study lend support to importance of Anxiety Sensitivity, duration of illness and harm avoidance trait. The anxiety sensitivity plays a primary role of severity in OCD symptomatology, and illness behaviour had a secondary importance.
  • Conference Paper
    Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.
  • Book
    Preface. List of Figures. List of Tables. 1. The Scope of Genetic Analyses. 2. Data Summary. 3. Biometrical Genetics. 4. Matrix Algebra. 5. Path Analysis and Structural Equations. 6. LISREL Models and Methods. 7. Model Fitting Functions and Optimization. 8. Univariate Analysis. 9. Power and Sample Size. 10. Social Interaction. 11. Sex Limitation and GE Interaction. 12. Multivariate Analysis. 13. Direction of Causation. 14. Repeated Measures. 15. Longitudinal Mean Trends. 16. Observer Ratings. 17. Assortment and Cultural Transmission. 18. Future Directions. Appendices: A. List of Participants. B. The Greek Alphabet. C. LISREL Scripts for Univariate Models. D. LISREL Script for Power Calculation. E. LISREL Scripts for Multivariate Models. F. LISREL Script for Sibling Interaction Model. G. LISREL Scripts for Sex and GE Interaction. H. LISREL Script for Rater Bias Model. I. LISREL Scripts for Direction of Causation. J. LISREL Script and Data for Simplex Model. K. LISREL Scripts for Assortment Models. Bibliography. Index.
  • Article
    Psychological models of panic disorder propose that panic attacks result from the patient's fear response to certain body sensations. In the present study, we assessed three aspects of the fear of body sensations: subjective symptom probability, symptom sensitivity, and perceived coping ability (Symptom Probability and Cost Questionnaire, SPCQ). One-hundred-and-ten patients with panic disorder (88 with current panic attacks, 22 in remission), 81 infrequent panickers, 37 patients with other anxiety disorders, and 61 normal controls without a history of psychiatric disorders answered the SPCQ for three groups of bodily sensations: general anxiety, panic, and nonanxiety control symptoms. Significant group differences were found for the anxiety and panic scales, and for control symptom probability. With the exception of panic symptom sensitivity in the patient control group, all anxiety groups differed from normal control subjects on the anxiety and panic scales. Overall, group differences in anxiety and panic symptom appraisal could not be accounted for by differences in trait anxiety or depression scores. Even when these variables were controlled for by analysis of covariance, panic disorder patients and infrequent panickers differed significantly from normal controls. Panic patients endorsed a higher probability of anxiety and panic symptoms and a higher sensitivity and lower coping ability for panic symptoms than infrequent panickers, and higher anxiety and panic symptom probabilities and sensitivities than patients with other anxiety disorders. Subjects with infrequent panic attacks gave similar ratings on the anxiety symptom scales as patients with other anxiety disorders, but had higher probability and sensitivity scores for panic symptoms. The present study provides evidence that a fear of body sensations associated with anxiety is a prominent characteristic of patients with panic disorder, but is also found to a lesser degree in infrequent panickers and patients with other anxiety disorders.
  • Article
    This study addresses the manner in which trait and rater variance combine in multitrait-multirater (MTMR) performance appraisal data. The Confirmatory Factor Analytic (CFA) model assumes trait and rater variance combine additively, whereas the Composite Direct Product (CDP) model assumes a multiplicative relationship. Implications of these models are explicated for MTMR data, and empirical differences are examined using four data sets. Results indicated that the fit of the CDP model was superior to that of the CFA model in all four data sets. Discussion centered on strengths and weaknesses of the CDP and CFA models, assumptions regarding trait/rater relationships and conflict between conceptual simplicity and realistic representation of relationships. Guidelines for applying the CDP method were provided.
  • Article
    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.