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

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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.

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... Key socializing agents, such as parents, are theorized to facilitate these learning processes among offspring (Watt, Stewart, & Cox, 1998). Consistent with this perspective, research suggests that parents can facilitate fear of bodily arousal among offspring, via vicarious conditioning, verbal transmission of information, as well as positive and negative reinforcement (Ehlers, 1993;Leen-Feldner, Blumenthal, Babson, Bunaciu, & Feldner, 2008;Stewart et al., 2001;Watt & Stewart, 2000;Watt et al., 1998). For instance, if a parent responds repeatedly to an adolescent female's somatic complaints (e.g., gastrointestinal distress) by becoming visibly distressed, telling her the symptoms could be dangerous, or allowing her to skip an aversive after-school activity, she develops a learning history that may increase panic risk. ...
... It is critical to improve our understanding of factors that may enhance panic vulnerability among adolescents. A large self-report literature suggests that parents can enhance fear of bodily arousal among offspring via sick role reinforcement behavior (Ehlers, 1993;Leen-Feldner et al., 2008;Stewart et al., 2001;Watt & Stewart, 2000;Watt et al., 1998). Notably, few studies have examined the dyadic process of parents and adolescents in real-time. ...
... Second, the self-report sick role reinforcement measure utilized in this study was developed for the current project. A number of factors speak to the self-report measure's validity; first the measure was based on items from a well-validated measure (i.e., the LHQ-III; Stewart et al., 2001) and it was adapted for this study from a measure utilized in prior, published work . Further, preliminary data supported its construct validity. ...
Article
A large body of work links parental sick role reinforcement behavior to adolescent panic vulnerability. To date, however, little work has examined the role of the adolescent in this process. The current study addressed this gap in the literature, using a novel method to experimentally test the impact of adolescent anxiety during a straw-breathing task on parental propensity to engage in sick role reinforcement behavior. An unselected sample of 51 early adolescents (26 female, 10-14 years) and their parents participated in the study. Adolescents were trained to mimic a straw-breathing task, and adolescent reactions to the task were scripted. Parents were randomly assigned to watch their adolescent react either a) anxiously or b) non-anxiously to the straw-breathing task. Parents who viewed their adolescent react anxiously ended the task earlier, reported that they would reinforce more sick role behavior, and reported more negatively valenced reactions during the task than parents who viewed their adolescent react non-anxiously to the task. No group differences emerged in terms of parental self-reported or physiological arousal during the task. Results suggest that adolescent anxiety increases parental sick role reinforcement behavior. Findings are discussed in terms of future directions for reducing parenting behaviors thought to increase vulnerability for panic among adolescents.
... Concerning parental AS, however, mixed results have been obtained: some authors have observed a significant link between parental and child AS (e.g., East, Berman, & Stoppelbein, 2007;Tsao et al., 2005Tsao et al., , 2006, while others have not (e.g., Drake & Kearney, 2008;Silverman & Weems, 1999; van Beek, Perna, Schruers, Muris, & Griez, 2005). Other investigations have focused on the impact of learning experiences within the family environment (Stewart et al., 2001;Watt et al., 1998). ...
... Child's learning experiences: Learning Experience Indexsecond 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. ...
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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.
... Parents can facilitate offspring fear in response to bodily arousal via vicarious conditioning, operant conditioning, and the verbal transmission of information (Leen-Feldner, Blumenthal, Babson, Bunaciu, & Feldner, 2008;Stewart et al., 2001;Watt & Stewart, 2000;Watt, Stewart, & Cox, 1998). For example, parents may negatively reinforce anxious behavior in the context of somatic symptoms by allowing their son or daughter to miss school. ...
... In order to examine the validity of the vignettes, sick role reinforcement behavior that was endorsed by parents following the vignettes was compared to scores on the OFFSPRING AND PARENTS IMPACT ON PARENT SICK ROLE REINFORCEMENT well-established Learning History Questionnaire-III (LHQ-III; Stewart et al., 2001). The LHQ-III is designed to assess the degree to which parents encourage symptoms in the context of arousal reactive (e.g., nausea, shortness of breath, racing heart, and dizziness) and arousal non-reactive symptoms (e.g., colds, aches, and pains). ...
... Improving our understanding of sick role reinforcement is important in light of its association with elevated panic-relevant vulnerability (e.g., Leen-Feldner et al., 2008;Stewart et al., 2001), and the elevated financial burden as a result of health care faced by families (Cohen et al., 2012;Cohen & Kirzinger, 2014;Sommers & Cunningham, 2011). Parents can facilitate offspring fear in response to bodily arousal (Stewart et al., 2001;Watt & Stewart, 2000;Watt et al., 1998). ...
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.
... Although cognitive models emphasize the importance of the environmental factors in the development of anxiety disorders (e.g., Beck et al. 1985;, and despite the fact that a number of studies have found evidence of family transmission of risk of anxiety disorders (Rapee 2002), only a small number of studies have tested these relationships in the context of PD (e.g., Schmidt et al. 2000). Despite the fact that different types of learning processes are believed to confer vulnerability (e.g., classical vs. instrumental paradigms), few studies have directly examined the types of learning experiences that may lead to a cognitive vulnerability or investigated the relationships between learning experiences, cognitive vulnerability factors, and PD (Ehlers 1993;Schmidt et al. 2000;Stewart et al. 2001;Watt and Stewart 2000;Watt et al. 1998;Zvolensky et al. 2005). ...
... Both Watt et al. (1998) and Stewart et al. (2001) found differences between high and low anxiety sensitivity participants in both the anxiety and cold symptoms scales of the LHQ whereas Ehlers ' (1993) found that high and low anxiety sensitivity participants did not differ on the cold scale. This discrepancy regarding the specificity of the origins of anxiety sensitivity may possibly be accounted for by the fact that the studies used different measures to assess current fear of anxiety symptoms. ...
... Building on previous research (Ehlers 1993;Stewart et al. 2001;Watt et al. 1998), the present study examines specific aspects of the unified vulnerability model by investigating: (a) the relationship of CLH to anxiety specific symptoms and panic severity in adulthood, and (b) anxiety related cognitions as mediators in this relationship. According to cognitive models of panic, a CLH involving the dangerousness of anxiety symptoms should lead to the acquisition of beliefs about those symptoms as dangerous, and in so doing, increase the frequency and severity of panic attacks (Barlow 2002;Ehlers 1993). ...
Article
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Cognitive vulnerability models have been developed to explicate the etiology of panic and other anxiety disorders. This study takes a step forward by presenting a unified vulnerability model that incorporates a continuum of proximal and distal factors involved in the etiology of panic. The present study tested distal elements of the model, including childhood histories of vicarious and instrumental learning, and cognitive constructs such as anxiety sensitivity and perceived control. Our study found that parental modeling of the dangerousness of anxiety symptoms accounted for more model variance than from direct experiences with arousal-reactive symptoms or from parental reinforcement of the child’s own sick role behavior when experiencing arousal reactive symptoms. We found that parental modeling independently predicted model variance even when perceived control was included in the model. Our results indicated that low perceived anxiety control and anxiety about bodily symptoms uniquely accounted for variance in the model. Our findings add to the growing body of research and suggest that anxiety about bodily symptoms and low perceived control together may interact to create a stronger distal vulnerability construct for panic than either construct alone in individuals whose childhood caregivers may have modeled fear of anxiety symptoms. The results of this study provide support for the inclusion of distal factors in unified cognitive vulnerability models of panic disorder as well as for future prospective research of these constructs.
... Reiss and McNally (1985) stated that people with a high sensitivity to symptoms of anxiety, such as a racing heart rate, shortness of breath, or dizziness, tend to fear sensations, especially those related to anxiety. Stewart et al. (2001) stated that anxiety sensitivity is "a fear of anxiety-related sensations, which arises from beliefs that these sensations have harmful physical, social, or psychological consequences" (p. 443). ...
... 443). The level of anxiety sensitivity depends largely on environmental influences (Stewart et al., 2001;Watt & Stewart, 2000), for example, in a highly competitive environment, people can experience the state of emotional anxiety in which there is a conscious desire to win (Nichols, 2012). Nicaise (1995) defined competitive anxiety as a mixture of an individual's physiological, cognitive and behavioural responses that stimulates negative feelings about an evaluation. ...
... Watt and Stewart (2000) and Stewart et al. (2001), believed that in a highly competitive environment, people can experience a state of emotional anxiety in which there is a conscious desire to win (Nichols, 2012). But, Kriz and Hegarty (2007) argued that in an animated system, a picture can float in the back of the mind, and thus, the benefits of learning from animations compared to static diagrams remain uncertain. ...
... Plusieurs auteurs (Watt, Stewart & Cox, 1998 ;Stewart, Taylor, Jang, Cox, Watt, Fedoroff & Borger, 2001) ont examiné le rôle des expériences d'apprentissages dans l'étiologie de l'AS. De jeunes adultes ont été questionnés sur leurs expériences lorsqu'ils étaient confrontés à des symptômes d'anxiété (nausées, palpitations, difficultés respiratoires) ou de douleur (mal à la tête ou mal au ventre). ...
... Même si ces études mettent clairement en évidence un lien entre les expériences d'apprentissage et le développement d'une AS élevée, celles-ci présentent certaines limites. Les deux premières études (Watt & al.,1998 ;Stewart & al., 2001) ont été effectuées auprès d'une population adulte (> 21 ans), à laquelle il était demandé de se souvenir de faits particuliers de leurs parents. Des biais mnésiques peuvent donc être mis en avant : l'âge des sujets étudiés pourrait avoir un impact sur leur capacité à se souvenir d'expériences d'apprentissage durant l'enfance (Watt & al.,1998 ;Stewart & al., 2001). ...
... Les deux premières études (Watt & al.,1998 ;Stewart & al., 2001) ont été effectuées auprès d'une population adulte (> 21 ans), à laquelle il était demandé de se souvenir de faits particuliers de leurs parents. Des biais mnésiques peuvent donc être mis en avant : l'âge des sujets étudiés pourrait avoir un impact sur leur capacité à se souvenir d'expériences d'apprentissage durant l'enfance (Watt & al.,1998 ;Stewart & al., 2001). ...
Article
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La sensibilité à l’anxiété (AS) est la peur des sensations corporelles liées à l’anxiété, qui proviendrait de croyances que ces sensations ont des conséquences somatiques, psychologiques ou sociales néfastes. L’AS a été considérée comme un facteur de risque dans le développement et le maintien des troubles anxieux. Il est donc pertinent de s’y intéresser afin d’apporter une action préventive aux troubles anxieux. Cet article porte sur une synthèse des informations existantes concernant l’étiologie de la sensibilité à l’anxiété chez l’enfant afin d’en dégager les modèles explicatifs. Plusieurs facteurs semblent intervenir : le facteur biologique, interpersonnel et environnemental. Les résultats montrent que les diverses études ont étudié ces facteurs de manière isolée et qu’ils n’expliquent qu’une partie de la variance de l’AS développée par l’enfant. Afin d’améliorer la compréhension du développement de l’AS, un modèle intégré comprenant plusieurs variables - sexe de l’enfant, sexe des parents, sources d’apprentissage, états émotionnels et relationnels des parents - pourrait être envisagé dans des études ultérieures.
... I soggetti con una bassa AS tendono a considerare tali sensazioni associate all'arousal autonomico (palpitazioni, dispnea, parestesia, ecc) come "fastidiose", mentre i soggetti con punteggi elevati mostrano una tendenza ad interpretarle come "pericolose", foriere di disastri (un aumento del battito cardiaco può essere decifrato come indicatore di infarto, un lieve capogiro come un segnale di svenimento, la confusione mentale come segno di impazzimento) (Reiss, 1991;Schmidt et al., 1997;Pérez Benítez et al., 2009;Naragon-Gainey, 2010). Vi sono ormai prove sostanziali sul fatto che l'AS sia un fattore di vulnerabilità per la psicopatologia in genere (Schmidt et al., 1999(Schmidt et al., , 2008Taylor et al., 1999;Rodriguez et al., 2004), ma assume un ruolo cruciale nel mantenimento dei disturbi d'ansia e più specificamente del DAP (Cox et al., 1999(Cox et al., , 2001McNally, 2002;Norton et al., 2005;Sexton et al., 2003;Taylor, 1999) e questo dato suggerisce la necessità di considerare tale costrutto come un vero e proprio fattore di rischio per la cronicità del disturbo stesso (Pérez Benítez et al., 2009;Olatunji e Wolitzky-Taylor, 2009). In ultimo, insieme ai meccanismi di natura intrapsichica, vorremmo sottolineare l'importanza dei fattori relazionali sul mantenimento del disturbo. ...
... Non di rado si tratta di sistemi familiari molto rigidi che fanno un uso massiccio dell' ipercontrollo giustificandone il valore; b) l'importanza di evitare la perdita del controllo su di sé, si riscontra spesso in storie di bambini che assistono ad importanti perdite del controllo da parte di un genitore (ad es., perché ubriaco, arrabbiato o per gravi disturbi mentali) magari con conseguenze gravi o comunque impressionanti; o che si assumono la responsabilità dei genitori (in quanto non in grado o non disposti ad accudire), i cosiddetti "parental child", che dunque, per esperienza appresa, ritengono indispensabile essere sempre ben presenti a se stessi, o, bambini che hanno subito squalifiche (invalidazioni) o rifiuti quando esprimevano segni di vulnerabilità, di bisogno e di dipendenza; c) la credibilità della convinzione condizionale, soprattutto in persone che già si considerano psichicamente fragili, che certe sensazioni possano essere il sintomo o la causa di una perdita del controllo e che questa sia definitiva ed irreparabile è di frequente riscontro in persone che hanno realmente sviluppato una vulnerabilità psicologica per una serie di motivi, come l'aver assistito frequentemente a reazioni d'allarme da parte dei genitori di fronte alle sue reazioni ed attivazioni emotive con espliciti commenti preoccupanti. Studi retrospettivi (Ehlers, 1993;Watt et al. 1998;Stewart et al., 2001) suggeriscono che alcuni tipi di comportamenti genitoriali possono contribuire ad una elevata AS nei bambini: ad esempio, genitori che frequentemente manifestano attenzione preoccupata nei confronti del bambino quando è ansioso, oppure che lo mettono in guardia rispetto all'eventualità di intraprendere attività che inducano attivazione autonomica, incoraggiandone l'evitamento, oppure da esplicite informazioni da parte dei genitori (come "la depersonalizzazione è segno di pazzia imminente"). Infine, intense e persistenti sensazioni legate all'attivazione autonomica possono rafforzare le credenze rispetto alla pericolosità di queste sensazioni, specialmente in persone a cui non viene fornita una adeguata spiegazione riguardo alle cause di queste sensazioni; d) l'incapacità di gestire i momenti, peraltro normalissimi, in cui il senso di sé fisiologicamente si riduce. ...
Article
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Riassunto: Lo scopo di questo articolo risiede nel presentare un perfezionamento del modello cognitivista del Disturbo di Panico, in particolare quello di Clark, che nonostante abbia conseguito negli anni robuste prove empiriche e cliniche a supporto, considera l'agorafobia esclusivamente come una sottoclasse di evitamenti del Disturbo di Panico. Il nostro modello si propone di superare i limiti esplicativi del modello classico e prevede la presenza di una specifica classe di sensazioni temute dall'agorafobico, quelle legate all'indebolimento del senso di sé ed una peculiare valutazione catastrofica delle stesse. Essa si manifesta apparentemente sotto forma di timori di morte ed impazzimento, ma sarebbe riconducibile al timore relativo alla perdita di controllo percepita come dissolvimento definitivo e irrecuperabile del senso di sé. Accanto alla descrizione degli elementi intrapsichici ed interpersonali favorenti lo scompenso, il mantenimento e il trattamento del disturbo, è stata data una particolare enfasi alla spiegazione dei fattori di vulnerabilità che incidono sulla sua insorgenza. Summary: The aim of this article lies in presenting a improvement of the cognitive model of Panic Disorder, particularly to Clark, who although over the years has achieved strong empirical evidence and clinical support, it considers agoraphobia not just as a subclass of avoidances of Panic Disorder. Our model aims to overcome the explanatory limits of the classical model and it provides the presence of a specific class of sensations feared by agoraphobic subject, those related to the impairment of the sense of self, and a peculiar catastrophic evaluation of them. It is manifested apparently as fears of death and madness, but it would be due to fear of loss of control perceived as final and irrecoverable dissolution of the sense of self. Next to the description of the intrapsychic and interpersonal elements conducive to the failure, the maintenance and treatment of the disorder, has been given special emphasis to explanation of the vulnerability factors affecting its occurrence.
... Retrospective studies show that childhood learning experiences are related to both AS and frequency of panic attacks and hypochondriac concerns in adulthood (Stewart et al. 2001;Watt and Stewart 2000;Watt et al. 1998). It has been suggested that childhood learning history related to the meaning of somatic and anxiety symptoms occurring within affective relationships with parents may be one important antecedent of AS in adulthood. ...
... As to the indirect pathway to children's anxiety, our findings suggest parents experiencing fear for anxiety and/or anxiety-related bodily sensations may expose their children to dysfunctional learning experiences, such as sharing with the child the threatening meaning attributed to anxiety-related symptoms, validating and reinforcing the same kind of fear in the child or modeling dysfunctional reactions to the child, enhancing therefore his/her AS levels and anxiety symptoms (Stassart et al. 2017); this interpretation is in line with previous studies showing that parents influence both children's AS and anxiety (e.g., Creswell et al. 2011;Rapee et al. 2009;Stein et al. 1999;Stewart et al. 2001;Varela et al. 2009Varela et al. , 2013Watt and Stewart 2000;Watt et al. 1998;Wood et al. 2003). ...
Article
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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.
... Anxiety is a cognitive response to a threat to the self-concept, characterized by subjective, consciously perceived feelings of tension (Spielberger 1970). Stewart et al. (2001) stated that anxiety sensitivity is "a fear of anxiety-related sensations, which arises from beliefs that these sensations have harmful physical, social, or psychological consequences" (p. 443). ...
... However, competitive anxiety was defined as a feeling of tension that a person experiences before and during a contest (Akca 2011). The level of anxiety sensitivity depends on the influence of the competitive environment (Watt and Stewart 2000;Stewart et al. 2001;Reiss and McNally 1985). This study focused on a one-on-one competition setting, in which a high level of anxiety would be encountered by the students and a high degree of psychological state of anxiety would be aroused (Wilson and Eklund 1998). ...
Article
Individual gameplay interest is affected by numerous factors and a competition setting is also of importance as there are factors that need to be managed. To understand the motivational variables related to an educational game competition, this study explored the interrelatedness between self-efficacy, competitive anxiety, and gameplay interest in a one-on-one Chinese idiom string up game competition. Effective data from 278 elementary school students from grades five to six were collected and subjected to confirmatory factor analysis and structural equation modeling. The results of this study showed that the higher the level of competitive anxiety, the lower the degree of gameplay interest (i.e. Like, Enjoyment, and Engagement). In addition, self-efficacy in learning Chinese idioms was negatively associated with competitive anxiety. The implication of this study contributed towards understanding that low competitive anxiety is more facilitative to interest in gameplay. The results also suggested that enhancing self-efficacy in a specific task can eliminate anxiety and support players’ interests to play the game in a competitive setting. © 2015, Association for Educational Communications and Technology.
... A set of collaborative studies that I have conducted with my longtime collaborator, Margo Watt, have also shown an important role for childhood learning experiences involving operant and vicarious conditioning in the origins of AS. Our research has shown that AS arises from learning to catastrophize about the meaning of bodily sensations (anxietyrelated sensations and other sensations like rashes) through operant and vicarious conditioning of sick role behaviour in response to such sensations in childhood/adolescence (Stewart, Taylor, et al., 2001;Watt et al., 1998;Watt & Stewart, 2000). For example, a family might inadvertently reward a child or adolescent who is experiencing dizziness by having them rest and watch TV whenever they experience these sensations; or the child/adolescent might observe parents being rewarded for sick role behaviour in response to parental experiences of bodily sensations. ...
Article
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Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
... H3: Perceived enjoyment is positively related to L2 learning outcome Stewart et al. (2001) elaborated on anxiety sensitivity, describing it as a fear of anxiety-related sensations, rooted in the belief that these sensations may have harmful consequences. In the digital era, technological advancements have the potential to reshape language interactions (Dizon, Tang, and Yamamoto 2022). ...
... For example, one retrospective study assessing childhood learning history regarding bodily symptoms found that individuals with panic disorder and individuals with infrequent panic attacks reported having observed their parents experiencing panic symptoms more often than healthy controls did (Ehlers, 1993). Similarly, other retrospective studies have provided evidence that observing parents' fear responses to anxiety-related bodily symptoms during childhood is associated with increased fear of bodily symptoms (Watt, Stewart, & Cox, 1998;2000;Stewart et al., 2001). Although these studies suggest that observational learning may increase an individual's susceptibility to developing fear of bodily symptoms, the evidence is limited by the recall bias inherent in retrospective reports. ...
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Although observational fear learning has been implicated in the development of phobic-related fears, studies investigating observational learning of fear of bodily symptoms remain scarce. Therefore, the aim of the present study was to investigate whether fear in response to bodily symptoms can be acquired simply by observing a fearful reaction to provocation of aversive bodily symptoms in others. Forty healthy participants underwent an observational fear conditioning paradigm consisting of two phases. In the first phase, participants observed a demonstrator reacting to an aversive bodily symptom provocation (unconditioned stimulus or US, i.e., labored breathing) paired with one conditioned stimulus (CS+) but not with the other one (CS-, both CSs were geometric symbols presented on a screen the demonstrator was watching). In the second phase, participants were directly presented with the same conditioned stimuli, but in the absence of the US. Our results revealed enhanced conditioned fear responses in the beginning of the second phase to the CS + as compared to CS-, as indexed by greater skin conductance and subjective fear responses, as well as greater potentiation of startle eyeblink responses to the CS + as compared to the ITI. Taken together, these findings implicate that fear of bodily symptoms can be learned through observation of others, that is, without first-hand experience of bodily threat.
... Individuals with high anxiety sensitivity show more anxiety symptoms than other individuals (Ölmez & Ataoğlu, 2019). Anxiety sensitivity arises from genetic predisposition (Stein et al., 1999) and direct and indirect learning (Reiss, 1991;Stewart et al., 2001). ...
Article
The study's objective was to determine the mediation role of anxiety sensitivity in the relationship between interpersonal competence and phubbing. The study was an observational cross-sectional study based on the survey with the aim to determine the mediation role of anxiety sensitivity in the relationship between interpersonal competence and phubbing. In this context, data were collected from a convenience sample of 321 participants with the Phubbing Scale, Anxiety Sensitivity Index-3, Interpersonal Competence Scale (ICC)-Short Form. Data were analyzed with regression-based mediation analysis and Pearson correlation coefficient. The analysis demonstrated that phubbing was positively related to anxiety sensitivity and negatively related to interpersonal competence. Furthermore, the mediation analysis showed that the anxiety sensitivity had a mediating effect in the relationship between interpersonal competence and phubbing. Furthermore, the bootstrap (10000) method was used to determine whether the mediation analysis was significant. These findings suggest that the level of anxiety sensitivity partly explains the inverse relationship between interpersonal competence and phubbing. Research results both support previous research results and reveal new findings. The findings of the research indicate that anxiety sensitivity is more effective than interpersonal competence in phubbing.
... Previous studies have suggested AS as a predictor of panic-related pathology, which may affect the frequency of panic attacks. [48][49][50] Although AS is significantly positively associated with pathological worry 51 and increases the level of symptom severities, it is unknown whether it has a direct relationship with the unfavorable longterm PTR. Therefore, further studies are needed to examine whether AS directly contributes to long-term poor PTR. ...
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Objective: Several predictors of unfavorable pharmacological treatment response (PTR) in panic disorder (PD) patients have been suggested, such as the duration of the illness, presence of agoraphobia, depression, being a woman, and early trauma. This study aimed to examine whether pathological worry is associated with PTR in PD patients. Methods: This study included 335 PD patients and 418 healthy controls (HCs). The Penn State Worry Questionnaire (PSWQ), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Beck Depression Inventory (BDI), Panic Disorder Severity Scale (PDSS), and Anxiety Sensitivity Inventory-Revised (ASI-R) were administered. We measured the PTR at 8 weeks and 6 months. Student t-test, chisquare tests, Pearson's correlation analyses, and binary logistic regression model were used. Results: Our results showed that the total scores of the PSWQ correlated with the ETISR-SF, BDI, and ASI-R were significantly higher in patients with PD compared with HCs. The PSWQ and BDI could predict unfavorable PTR at 6 months in PD patients. Conclusion: This is the first study to demonstrate that pathological worry may contribute to poor long-term PTR in PD patients. Therefore, our research suggests that clinicians must be aware of worry to optimize PTR for PD patients.
... Non di rado si tratta di sistemi familiari molto rigidi che fanno un uso massiccio dell' ipercontrollo giustificandone il valore; b) l'importanza di evitare la perdita del controllo su di sé, si riscontra spesso in storie di bambini che assistono ad importanti perdite del controllo da parte di un genitore (ad es., perché ubriaco, arrabbiato o per gravi disturbi mentali) magari con conseguenze gravi o comunque impressionanti; o che si assumono la responsabilità dei genitori (in quanto non in grado o non disposti ad accudire), i cosiddetti "parental child", che dunque, per esperienza appresa, ritengono indispensabile essere sempre ben presenti a se stessi, o, bambini che hanno subito squalifiche (invalidazioni) o rifiuti quando esprimevano segni di vulnerabilità, di bisogno e di dipendenza; c) la credibilità della convinzione condizionale, soprattutto in persone che già si considerano psichicamente fragili, che certe sensazioni possano essere il sintomo o la causa di una perdita del controllo e che questa sia definitiva ed irreparabile è di frequente riscontro in persone che hanno realmente sviluppato una vulnerabilità psicologica per una serie di motivi, come l'aver assistito frequentemente a reazioni d'allarme da parte dei genitori di fronte alle sue reazioni ed attivazioni emotive con espliciti commenti preoccupanti. Studi retrospettivi (Ehlers, 1993;Watt et al., 1998;Stewart et al., 2001) suggeriscono che alcuni tipi di comportamenti genitoriali possono contribuire ad una elevata AS nei bambini: ad esempio, genitori che frequentemente manifestano attenzione preoccupata nei confronti del bambino quando è ansioso, oppure che lo mettono in guardia rispetto all'eventualità di intraprendere attività che inducano attivazione autonomica, incoraggiandone l'evitamento, oppure da esplicite informazioni da parte dei genitori (come "la depersonalizzazione è segno di pazzia imminente"). Infine, intense e persistenti sensazioni legate all'attivazione autonomica possono rafforzare le credenze rispetto alla pericolosità di queste sensazioni, specialmente in persone a cui non viene fornita una adeguata spiegazione riguardo alle cause di queste sensazioni; d) l'incapacità di gestire i momenti, peraltro normalissimi, in cui il senso di sé fisiologicamente si riduce. ...
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Lo scopo di questo articolo risiede nel presentare un perfezionamento del modello cognitivista del disturbo di panico, in particolare quello di Clark, che nonostante abbia conseguito negli anni robuste prove empiriche e cliniche a supporto, considera l'agorafobia esclusivamente come una sottoclasse di evitamenti del disturbo di panico. Il nostro modello si propone di superare i limiti esplicativi del modello classico e prevede la presenza di una specifica classe di sensazioni temute dall'agorafobico, quelle legate ed una peculiare valutazione catastrofica delle stesse. Essa si manifesta apparentemente sotto forma di timori di morte ed impazzimento, ma sarebbe riconducibile al timore relativo alla perdita di controllo percepita come definitivo e irrecuperabile del .
... In addition to early trauma, several risk factors contribute to worse pharmacological treatment responses of patients with PD. 10,12,13,15 Especially, studies have proposed AS as a predictor of panic-related pathology that directly affects the frequency of panic attacks. 33,34 However, there was no observed correlation between ASI and treatment response in the short-term and long-term in our study. Although ASI may affect some symptoms of PD and increase the PDSS score, which is the criterion for measuring treatment response, it is unlikely that it has a direct relationship with the pharmacological treatment response. ...
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Objective: Pharmacotherapy is established as an effective method for reducing symptoms of panic disorder (PD). However, about 20-40% of PD patients are treatment-resistant. Predictors of pharmacotherapy outcomes for PD patients are needed. Methods: This study included 152 PD patients to measure the clinical severities of PD symptoms and used the Early Trauma Inventory (ETI) to measure early trauma. Treatment response was defined as a 40% reduction in the total Panic Disorder Severity Scale score from baseline. We measured the treatment responses at 8 weeks and 6 months. Binary logistic regression was used to predict treatment response after controlling for confounding variables. Results: Early sexual trauma alone was associated with poor treatment response at 8 weeks. However, at 6 months, the total ETI score was associated with an unfavorable treatment response. Conclusion: Therefore, our study suggests that clinicians need to be aware of a history of early trauma to optimize treatment outcomes for PD patients.
... Anxious rearing behaviors encompass a wide variety of behaviors including displays of excessive worry and concern about offspring well-being, encouragement and reinforcement of catastrophic interpretations in the face of uncertainty, modeling avoidant coping behavior, and overtly expressing fear and anxiety [39]. Scholars have proposed that parents elevated in anxiety may increase risk for offspring internalizing symptoms through social learning processes [40], such as the modeling of parental maladaptive coping strategies (e.g., [41][42][43], the reinforcement of avoidant responses in offspring [44], and through the transmission of threat related information [45]. One of the most commonly used assessments of anxious rearing is the "Egna Minnen Betraffadnde uppfostran" anxious rearing subscale, which assesses primarily parental worry about offspring (EMBU, [46]. ...
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Both maternal symptoms and adolescent offspring characteristics are associated with maladaptive parenting among families at risk for anxiety. One disorder that may be particularly associated with maladaptive parenting behaviors is generalized anxiety disorder (GAD). Previous work suggests that offspring negative affect (NA) is associated with different levels of maladaptive parenting behaviors among mothers with GAD. No work to date, however, has examined the association between offspring reported NA, maternal GAD, and maternal worry about offspring or maternal perceptions of psychological control (PC) among mothers of adolescents. Sixty-five mothers who were elevated in anxious arousal and their adolescent offspring between the ages of 12 and 16 years old (n = 65, 55% male, Mage = 13.89) reported on parenting (mother report), NA (offspring report), and GAD symptoms (assessed via structured clinical interview), and maternal anxiety sensitivity (AS) symptoms. Study results indicated that maternal GAD status interacted with offspring NA in relation to maternal reported use of PC and worry about offspring. Specifically, offspring NA was positively related to PC for mothers without GAD, but not for mothers with GAD. Further, for mothers with GAD, offspring NA was negatively related to worry about offspring, but this relation did not persist for mothers without GAD. Maternal AS was related to overall higher levels of worry about offspring and PC. Mothers with GAD report using higher levels of maladaptive parenting when offspring report lower levels of NA, and lower levels when offspring report high NA. This pattern was specific to maternal GAD (c.f. anxiety sensitivity).
... Reiss and McNally [1] defined anxiety sensitivity as the fear of anxiety-related bodily sensations derived from beliefs that these symptoms have harmful physical, psychological, or social consequences. AS is thought to arise from the interaction of genetic predispositions [24] and direct or indirect adverse learning experiences [25,26]. An association between AS and anxiety disorders has been found across several independent samples of children and adolescents [2,[27][28][29]. ...
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In this study, we examined the degree to which children’s level of anxiety sensitivity (AS) was a precursor to both internalizing problems and peer victimization experiences. Participants were 581 fourth-grade children (M age = 9.31; 51.8% girls; 42.3% Hispanic/Latinx) and their teachers. Measures of AS, internalizing problems, and peer victimization were collected across a single academic year (Fall, Spring). Structural equation modeling and logistic regression analyses indicated AS predicted future internalizing symptoms as well as self- and teacher-reports of peer victimization. Also, children with heightened AS were 2.70 times more likely to reach elevated levels of self-rated peer victimization and 11.53 times more likely to have clinically elevated internalizing problems. This is the first study to examine prospectively the link between AS and children’s peer victimization experiences. We discuss implications of the findings for developing preventative interventions for children at risk for peer victimization and internalizing difficulties.
... The anxiety sensitivity construct suggests that some individuals attribute harmful physical, psychological and social consequences to their anxiety-related symptoms (e.g., Reiss and McNally 1985). In this model, both biological vulnerabilities and maladaptive learning experiences contribute to the development of beliefs about the danger of physical sensations (e.g., Stewart et al. 2001). This line of research is consistent with cognitive-perceptual models of maladaptive somatic interpretation of physical sensations (e.g., Cioffi 1991) that have been used in biopsychosocial approaches to health-related syndromes and diseases. ...
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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.
... Se cree que la SA surge de la combinación de una predisposición genética (Stein, Jang y Livesley, 1999) y de las experiencias de aprendizaje que se traducen en la adquisición de creencias sobre el potencial efecto dañino de la activación autonómica (Stewart et al., 2001). De esta forma, la SA es independiente y distinta de la ansiedad rasgo (es decir, la tendencia a responder con temor a una amplia gama de factores de estrés) y describe una tendencia más específica a responder con miedo a los propios síntomas de ansiedad (Sandín, 2009). ...
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. ...
... 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 ). ...
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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.
... La sensibilità all'ansia consegue in parte a una predisposizione genetica e in parte a esperienze di apprendimento che implicano l'assunto di un potenziale danno dovuto all'arousal; infatti, essa può amplificare la reazione ansia-paura (69,70). ...
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.
... AS is a trait-like cognitive vulnerability that amplifies preexisting anxiety levels such that those high in AS misinterpret physical sensations as danger signals and, as a result, experience elevated levels of anxiety. AS is thought to arise from a combination of genetic predispositions (Stein, Jang, & Livesley, 1999) and learning experiences that result in the acquisition of beliefs about potential harmful effects of autonomic arousal (e.g., Stewart et al., 2001). AS is thought to amplify fearful reactions, thereby placing individuals at risk for the development of anxiety-related conditions, especially panic disorder (Olatunji & Wolitzky-Taylor, 2009;Schmidt, Lerew, & Jackson, 1997;Schmidt, Zvolensky, & Maner, 2006). ...
Article
A growing body of research has implicated anxiety sensitivity (AS) and its dimensions in the development of post-traumatic stress disorder (PTSD). However, the mechanism(s) that may account for the association between AS and PTSD remains unclear. Using the "trauma film paradigm," which provides a prospective experimental tool for investigating analog intrusion development, the present study examines the extent to which intrusions mediate the association between AS and the development of posttraumatic stress reactions. After completing a measure of AS and state mood, unselected participants (n=45) viewed a 10min film of graphic scenes of fatal traffic accidents and then completed a second assessment of state mood. Participants then kept a daily diary to record intrusions about the film for a one-week period. Post-traumatic stress reactions about the film were then assessed after the one-week period. The results showed that general AS and physical and cognitive concerns AS predicted greater post-traumatic stress reactions about the film a week later. Furthermore, the number of intrusions the day after viewing the traumatic film, but not fear and disgust in response to the trauma film, mediated the association between general AS (and AS specifically for physical and cognitive concerns) and post-traumatic stress reactions a week later. Subsequent analysis also showed that physiological arousal during initial exposure to the traumatic film moderated the association between general AS and the number of intrusions reported the day after viewing the film. The implications of these analog findings for conceptualizing the mechanism(s) that may interact to explain the role of AS in the development of PTSD and its effective treatment are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
... Interestingly, these studies demonstrated that, in contrast to the findings for high AS, only parental reinforcement of anxiety-related symptoms (and not general somatic symptoms) differentiated participants with a history of panic from those without. Using structural equation modelling, Stewart et al. (2001) concluded that anxiety sensitivity acted as a mediating variable between childhood learning experiences and the development of panic attacks in young adulthood. However it should be noted that childhood learning experiences acted directly on both anxiety sensitivity AND panic frequency. ...
... Tanto la ansiedad como el miedo activan cogniciones desagradables que se manifiestan en respuestas emocionales displacenteras (Caballo, Buela-Casal y Carrobles, 1995), como sensación de indefensión, confusión, aprensión, inquietud y pensamientos catastróficos repetitivos. La Sensibilidad a la Ansiedad (SA) es un constructo que hace referencia a la creencia de que experimentar sensaciones corporales asociadas con la ansiedad o el miedo, provocan consecuencias adversas tales como la muerte, el desarrollo de enfermedades o el rechazo social (Reiss y McNally, 1985) y esta íntimamente relacionada a la presencia de ataques de pánico (Donnell y McNally, 1988; Reiss, Peterson, Gursky, y McNally, 1986; Westling, y Öst, 1995; Cox, Endler, y Swinson, 1995; Stewart, Taylor, Jang, Cox, Watt, Fedoroff, y Borges, 2001; Pollock, Carter, Amir, y Marks, 2006). ...
... Anxiety sensitivity appears to be a partially heritable, relatively stable dispositional trait (Zavos et al. 2012). Retrospective and cross-sectional studies suggest that catastrophic beliefs about the meaning of anxiety symptoms develop through operant and vicarious learning experiences in the context of childhood attachment relationships (Scher and Stein 2003;Stewart et al. 2001;Watt et al. 1998). Within the framework of attachment theory, anxiety sensitivity can thus be conceptualized as an attachment-acquired internal working model (or set of expectations) regarding the interpersonal and intrapersonal consequences of arousal-related somatic sensations. ...
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Mindfulness (tendency to attend to present experience without expectation or judgment) is generally considered to be an adaptive way of responding to emotional experience. Anxiety sensitivity can be conceptualized as a maladaptive response (fear) to arousal-related somatic sensations commonly associated with anxiety. Emotion regulation strategies are learned in the context of early attachment relationships, and adult attachment styles have been linked to both mindfulness and anxiety sensitivity. This study examined whether mindfulness facets (observe, describe, act with awareness, accept without judgment) would mediate associations between attachment and the dimensions of anxiety sensitivity (physical, social, cognitive concerns). Multiple mediation analyses showed that observe mediated the relation between attachment anxiety and physical concerns, and accept mediated the relation between attachment anxiety and social concerns. Accept, aware, and observe each mediated the relation between attachment anxiety and cognitive concerns. Only accept mediated the association between attachment avoidance and the three anxiety sensitivity dimensions. Findings suggest the importance of measuring mindfulness as a multidimensional construct, and the value of assessing attachment style and incorporating mindfulness elements in interventions designed to reduce anxiety sensitivity.
... As previously stated, individuals with hunger sensitivity may eat because others around are eating as the external cues trigger the internal sensitivity to one's hunger sensations. It is likely that symptoms of hunger may sometimes (but not always) be triggered by something in the environment, just as anxiety sensitivity often occurs when real, anxiety-provoking situations occur (Stewart et al., 2001). Moderate overlap between the constructs is expected although they are hypothesized as separate. ...
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Hunger sensitivity is a cognitive style associated with heightened distress in response to hunger sensations. We hypothesized that hunger sensitivity would be predictive of attitudes surrounding eating. Our goal was to develop and validate the Hunger Sensitivity Scale (HSS). Item generation was based on conceptual grounds. The resulting 29-item instrument was subjected to item analysis using a sample of 556 university student participants and demonstrated excellent scale score reliability. After parallel analysis and exploratory factor analysis with 50% of the sample that supported a unifactorial solution, confirmatory factor analysis (with the remainder of the sample) was conducted. After the deletion of 16 items, the unifactorial model was supported. A second study, with a separate sample of 101 university students, involved administration of the 13-item HSS along with discriminant validity measures and measures tapping eating-related attitudes. Scores on the HSS were significantly associated with measures of hunger, disinhibition, rumination, and bulimia. Discriminant validity was supported through the absence of significant correlations with general anxiety, depression, and anxiety sensitivity. With more research, the HSS may have potential clinical application through the addition of a new dimension to the existing clinical assessment armamentarium.
... These behaviours are thought to function to amplify children's cognitions about the inherent threat value of pain and reinforce pain behaviours (e.g., escape/avoidance; see Wilson, Lewandowski & Palermo, 2011). These early social learning processes related to somatic symptoms (including pain) in childhood are predictive of high levels of anxiety sensitivity and pain-related anxiety in adulthood (Watt & Stewart, 2000;Stewart et al., 2001;Watt, O'Connor, Stewart, Moon, & Terry, 2008;Watt, Stewart, Moon, & Terry, 2010). Similarly, children's autobiographical memories develop within this familial context and are highly influenced by the quality and content of their verbal interactions with individuals in their social environments, particularly parents (Bauer et al., 2010;Peterson et al., 2007). ...
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Objective: This study aimed to determine the mediating role of difficulty in emotion regulation in the relationship between anxiety sensitivity and a sense of coherence with readiness to use drugs in students. Method: The method of descriptive-correlation research was structural equation modeling. The statistical population included all students of Lorestan University, and based on Morgan's table, 384 students were selected according to the entry and exit criteria by available sampling method. The research tools included questionnaires of anxiety sensitivity, sense of coherence, abbreviated version, short form of the scale of difficulty in emotion regulation and preparedness for addiction were completed. In order to analyze the research model, AMOS-24 software was used with the method of structural equation modeling. Results: The findings showed that Anxiety sensitivity and sense of coherence had a direct and significant effect on readiness to use drugs, and difficulty in regulating emotions played a role in the relationship between anxiety sensitivity and sense of coherence with readiness to use drugs. Were considered significant mediators. In short; The results showed that the research model had a good fit. Conclusion: According to the findings, individuals who were more inclined to use drugs exhibited higher levels of anxiety sensitivity and difficulty in regulating emotions, and conversely, lower levels of sense of coherence. Given that sense of coherence plays a pivotal role in the regulation of emotions and anxiety management, it is recommended that university-level trainers and counselors provide the necessary training to students to enhance their sense of coherence. Therefore, it is crucial to pay attention to these variables in order to reduce students' readiness to use drugs.
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Despite the high prevalence, and high functional impairment associated with panic disorder, programs targeting the prevention of panic psychopathology are still very limited. This article aims to guide panic disorder prevention programs, by analyzing different psychological risk factors, and their interactions in the pathogenesis of the psychopathology of panic disorder. The results show, on the one hand, that neuroticism, perceived control, emotional clarity, and anxiety sensitivity are causal risk factors for the development of panic disorder. On the other hand, several causal pathways involving complex chains of these factors lead to the development of panic disorder. These results may help guide panic disorder prevention interventions by guiding, on the one hand, decisions concerning the populations to be targeted for prevention efforts as well as, on the other hand, by identifying the risk and protective factors to be targeted to reduce the probability of occurrence of panic disorder.
Chapter
The Cambridge Handbook of International Prevention Science offers a comprehensive global overview on prevention science with the most up-to-date research from around the world. Over 100 scholars from 27 different countries (including Australia, Bhutan, Botswana, India, Israel, Mexico, Singapore, South Korea, Spain and Thailand) contributed to this volume, which covers a wide range of topics important to prevention science. It includes major sections on the foundations of prevention as well as examples of new initiatives in the field, detailing current prevention efforts across the five continents. A unique and innovative volume, The Cambridge Handbook of International Prevention Science is a valuable resource for established scholars, early professionals, students, practitioners and policy-makers.
Chapter
Panic attacks are prevalent; almost one in three people will experience a panic attack in their lifetime. The occurrence of a panic attack is not sufficient for panic disorder diagnosis and can be added as a specifier to other disorders. DSM-5 separated the diagnoses panic disorder and agoraphobia. Various comorbidities with panic disorder and/or agoraphobia are summarized. Genes implicated in the etiology of PD are discussed including genes related to COMT, adenosine, MAO, GABA, and CRHR. Epigenetic factors such as methylation across different genes and G × E interactions are considered. Learning theory’s account of how panic disorder/agoraphobia develop is reviewed. The chapter offers a detailed explanation of the involvement of anxiety sensitivity trait in the development and maintenance of the disorder. Various cognitive models including Barlow’s, Clark’s, and Reiss’ expectancy model and integrative attempts are discussed. Gorman’s seminal neuroanatomical model of the disorder and its updates are examined considering functional connectivity, structural, and functional MRI studies. Finally, neurochemical hypotheses related to serotonergic and opioidergic deficits are explained.
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Co-creativity has recently received increasing attention. However, few empirical studies explore individuals’ creative performance in a group, and fewer have approached creative ideation in different task situations. This study recruited 156 participants to complete creativity tests on an online creativity task platform. Participants were randomly assigned to either cooperative or competitive task situations. Their performance was analyzed using two creativity tests: the Alternative Uses Test (AUT) and Chinese Radical Remote Associates Test (CRRAT). Participants completed tasks alone (i.e., in single player mode) and in a cooperative or competitive situation (i.e., in paired-player mode). The results revealed that participants in the competitive task situation showed higher levels of competitive anxiety. Moreover, their AUT and CRRAT performances in paired-player mode were better than those in single player mode. In the cooperative task situation, participants’ CRRAT performance was significantly better than in the competitive task situation. This study had two main findings. First, it strengthens the understanding of how group work enhances individual online creative performance. Second, it distinguishes the influences of cooperative or competitive task situations on different creative performance. This study revealed the differences in creative performance in distinct task situations.
Article
Purpose With the popularity of the internet, access to health-related information has become more convenient. However, the easy acquisition of e-health information could lead to unfavorable consequences, such as health anxiety. The purpose of this paper is to explore a set of important influencing factors that lead to health anxiety. Design/methodology/approach Based on the stimulus–organism–response (S-O-R) framework, we propose a theoretical model of health anxiety, with metacognitive beliefs and catastrophic misinterpretation as the mediators between stimulus factors and health anxiety. Using 218 self-reported data points, the authors empirically examine the research model and hypotheses. Findings The study results show that anxiety sensitivity positively affects metacognitive beliefs. The severity of physical symptoms has a significant positive impact on catastrophic misinterpretation. Metacognitive beliefs and catastrophic misinterpretation have significant positive impacts on health anxiety. Originality/value Based on the S-O-R model, this paper develops a comprehensive model to explain health anxiety and verifies the model using firsthand data.
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Background and Aim: Anxiety sensitivity or fear of anxiety and its associated physical sensations as a transdiagnostic construct have attracted increasing attention in the developmental psychopathology of emotional disorders and their treatment. Considering the multidimensional nature of anxiety sensitivity and a similar response of patients to anxiety, many studies have been conducted on the role of this construct in predicting and maintaining of emotional disorders. The aim of this study was to review various studies in this field for a better understanding of the anxiety sensitivity in the development and continuation of emotional disorders, its assessment, and therapeutic measures. Materials and Methods: This was a literature review study. Articles were searched in the Google Scholar search engine and the databases of PsycINFO, PubMed, and Scopus. Results: Most studies about anxiety sensitivity in emotional disorders have emphasized the role of this construct in the development and maintenance of these disorders. Currently, the third version of the Anxiety Sensitivity Index as a validated index has the most psychometric evidence. The importance of this construct in psychopathology has given it a special position in both diagnosis-specific cognitive-behavioral therapy and transdiagnostic cognitive-behavioral therapy. Conclusions: It seems that anxiety treatment not only reduces the symptoms of emotional problems but also improves response to treatment. Therefore anxiety sensitivity should be considered in the assessment, selective conceptualization, and treatment of emotional disorders. Keywords: Anxiety sensitivity, Psychopathology, Emotional disorders
Article
Background and objectives: The present study examines the extent to which intrusive thoughts and associated distress explains the association between anxiety sensitivity (AS) and post-traumatic stress (PTS) using the "trauma film paradigm". Methods: Participants high and low in AS viewed a 10-min film of graphic scenes of fatal traffic accidents and then underwent a 10-min thought suppression period where intrusive thoughts and associated distress about the film was assessed. Participants also kept a diary of intrusions and associated distress about the film for one-week and post-traumatic stress reactions about the film were assessed after the one-week period. Results: The high AS group reported greater post-traumatic stress reactions about the film a week later than the low AS group. Although the high AS group also reported more intrusion distress than the low AS group during thought suppression in the laboratory, this difference did not mediate group differences in subsequent post-traumatic stress reactions. Furthermore, the intercept and slope of intrusions and associated distress about the film during the week generally did not differentiate those high in AS from those low in AS. However, the intercept of distress during the week mediated the association between intrusion distress during thought suppression in the laboratory and post-traumatic stress reactions at the end of the week. Limitations: The present study is limited by use of an analogue sample as well as modeling trauma exposure with a film. Conclusions: Distress about intrusive thoughts in proximity to the trauma and over time may be an important determinant of PTS.
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
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Objectives: Elevated levels of anxiety sensitivity (AS; fear of anxiety and internal sensations) is highly common among adults who smoke, and contributes to several maladaptive smoking beliefs and behaviors. AS is comprised of 3 empirically established factors, relating to fears of social concerns, fears of physical symptoms, and fears of cognitive dyscontrol. Relatively few studies have examined how these 3 subscales pertain to smoking processes. The aim of the present investigation was to examine, among treatment-seeking adults who smoke, the interactive effects of AS-physical and cognitive concerns in relation to: perceived barriers to smoking cessation; smoking-related negative reinforcement expectancies; and smoking-related avoidance and inflexibility. Methods: Participants included 470 adults who smoke (47.8% female; mean age 37.2, SD 13.5), who were recruited to participate in a smoking-cessation treatment study. At the baseline assessment, participants completed self-report measures, including the Anxiety Sensitivity Index-3, Barriers to Cessation Scale, Smoking Consequences Questionnaire, and Avoidance and Inflexibility Scale. Results: Results indicated that after controlling for the effects of sex, cigarette dependence, alcohol problems, tobacco-related medical illness, current axis 1 disorder, and AS-social concerns, a significant interaction emerged, such that the association between AS-cognitive concerns and the studied smoking-based cognitions were stronger among lower levels of AS-physical concerns (but not higher physical concerns). Conclusions: The current findings suggest that it may be beneficial to provide specialized smoking-cessation interventions for certain subgroups of adults who smoke, such as those with different AS profiles, to promote healthier beliefs about quitting.
Article
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Objectives: Recent work has highlighted the link between acculturative stress and depression/anxiety symptoms among Hispanic young adults, but the nature of these relations is not well understood. The present study aimed to clarify the relation between acculturative stress and depression/anxiety symptoms by examining anxiety sensitivity, globally and via subfactors, as an explanatory variable. Method: A cross-sectional sample of 788 Hispanic college students (80.8% female; Mage = 20.83 years, SD = 1.93) was recruited from a southwestern public university and completed an online self-report assessment battery. Results: Acculturative stress exerted an indirect effect, via the global construct of anxiety sensitivity, on depression symptoms, suicidality, anxious arousal, and social anxiety symptoms. Follow-up simultaneous analytic models demonstrated indirect effects via the anxiety sensitivity subfactors that were pathognomonic with each of the specific affective outcomes. Conclusions: These findings suggest the utility of assessing and targeting anxiety sensitivity in the treatment of acculturative stress-related depression/anxiety problems among Hispanic college students.
Thesis
The Fear-Avoidance model proposes that pain-related fear and avoidance behavior play a key role in the maintenance and exacerbation of chronic pain problems. Both experimental and clinical studies have widely corroborated this model. However, there remain some unresolved issues that warrant further scientific scrutiny. One of the challenges is that pain (behavior) does not occur in a motivational vacuum, but that the goal to avoid pain interacts with other, often competing goals. It is argued that fear-avoidance models would benefit from the inclusion of a motivational perspective. The main aim of this dissertation was to experimentally investigate the impact of goal competition on pain-related fear and avoidance behavior. Additionally, we studied the presence and experience of goal conflict in a clinical population. For this purpose, a series of experiments building on a well-established differential fear conditioning paradigm, the Voluntary Joystick Movement Paradigm, was developed. In a typical experiment, healthy participants completed movements in different directions. Some of these movements were associated with painful electrocutaneous stimuli, whereas other movements were not. Likewise, movements could be associated with reward—in the form of lottery tickets—or the loss thereof. Experiment I.1 (N=55) demonstrated that presenting a concurrent reward attenuated avoidance behavior, but did not alter pain-related fear. Experiment I.2 (N=57) corroborated these findings, and additionally demonstrated that these effects were modulated by goal prioritization. Experiment II.1 (N=48) showed that avoidance-avoidance competition installed more fear and slowed down decision-making compared to other types of competition. Experiment III.1 (N=46) showed that cues predicting a painful outcome increased pain-related fear as well as avoidance behavior, and installed competition when combined with a movement that was associated with reward. Experiment III.2 (N=42) demonstrated that although pain avoidance was prominent, a pain cue was associated with less pain-avoidance behavior than a neutral or reward cue. To address the second aim of this dissertation, patients with fibromyalgia (N=40) and healthy, matched controls (N=37) participated in a semi-structured interview mapping the presence of goal conflicts (Study IV.1). More than half of the patients reported that pain control or avoidance goals conflict with other goals, such as household activities or social activities. This dissertation provides novel experimental evidence for the inclusion of a broad motivational perspective in the Fear-Avoidance model, and may also help improve the effectiveness of existing cognitive-behavioral treatments for patients suffering from chronic pain by addressing goal competition.
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.
Chapter
In this chapter we review the empirical foundation for Eye Movement Desensitization and Reproessing Therapy (EMDR) for posttraumatic stress disorder. We present a brief description of the therapy, critically review recent primary and meta-analytic investigations concerning its efficacy and effectiveness, offer a summary of recent primary investigations that addressed the mechanism of action for EMDR, and based on this overall review, we suggest limitations with recommendations for future research. Recent empirical investigations of the efficacy of EMDR have improved along a number of important dimensions, and these along with the few completed effectiveness trials, position this therapy among evidence-based frontline interventions for PTSD. What is less thoroughly researched, and thus less well understood, are putative models of its theoretical mechanism of action. In addition to continuing specific improvements in research concerning efficacy and effectiveness, we recommend more and higher quality empirical studies of its mechanism of action.
Article
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A developmental model of antisocial behavior is outlined. Recent findings are reviewed that concern the etiology and course of antisocial behavior from early childhood through adolescence. Evidence is presented in support of the hypothesis that the route to chronic delinquency is marked by a reliable developmental sequence of experiences. As a first step, ineffective parenting practices are viewed as determinants for childhood conduct disorders. The general model also takes into account the contextual variables that influence the family interaction process. As a second step, the conduct-disordered behaviors lead to academic failure and peer rejection. These dual failures lead, in turn, to increased risk for depressed mood and involvement in a deviant peer group. This third step usually occurs during later childhood and early adolescence. It is assumed that children following this developmental sequence are at high risk for engaging in chronic delinquent behavior. Finally, implications for prevention and intervention are discussed.
Article
Full-text available
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.
Article
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Anxiety sensitivity (AS; the fear of anxiety-related sensations) has been proposed as a risk factor for the development of panic disorder. The present study involved a conceptual replication of Ehlers' (1993, Behaviour Research and Therapy, 31, 269–278) study on childhood learning experiences and panic attacks, but also extended her work by investigating the relationship between early learning experiences and the development of AS, in a non-clinical sample. A sample of 551 university students participated in a retrospective assessment of their childhood and adolescent instrumental and vicarious learning experiences with respect to somatic symptoms (i.e. anxiety and cold symptoms, respectively) using an expanded version of Ehler's (1993) Learning History Questionnaire. AS levels were assessed using the Anxiety Sensitivity Index, and panic history was obtained using the Panic Attack Questionnaire, Revised. Contrary to hypotheses, the learning experiences of high AS individuals were not found to be specific to anxiety symptoms, but involved parental reinforcement of sick-role behavior related to somatic symptoms in general. High AS subjects reported both more anxiety and cold symptoms prior to age 18 than individuals with lower levels of AS. In addition, both cold and anxiety symptoms elicited more special attention and/or instructions from parents for high AS individuals to take special care of themselves. These findings are contrasted with the results for self-reported panickers who reported more learning experiences (modeling and parental reinforcement) specific to anxiety-related symptoms, than the non-panickers. The results suggest that higher-than-normal levels of AS may arise from learning to catastrophize about the occurrence of bodily symptoms in general, rather than anxiety-related symptoms in particular.
Article
Full-text available
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.
Article
Full-text available
Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.
Book
Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions.© 1999 by Lawrence Erlbaum Associates, Inc. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions. © 1999 by Lawrence Erlbaum Associates, Inc. All rights reserved.
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.
Article
Monte Carlo research increasingly seems to favor the use of parallel analysis as a method for determining the "correct" number of factors in factor analysis or components in principal components analysis. We present a regression equation for predicting parallel analysis values used to decide the number of principal components to retain. This equation is appropriate for predicting criterion mean eigenvalues and was derived from random data sets containing between 5 and 50 variables and between 50 and 500 subjects. This relatively simple equation is more accurate for predicting mean eigenvalues from random data matrices with unities in the diagonals than a previously published equation. Moreover, given that the parallel analysis decision rule may be too dependent on chance, our equation is also used to predict the 95th percentile point in distributions of eigenvalues generated from random data matrices. Multiple correlations for all analyses were at least .95. Regression weights for predicting the first 33 mean and 95th percentile eigenvalues are given in easy-to-use tables.
Article
The purpose of the paper is to describe a more generally applicable method of factor analysis which has no restrictions as regards group factors and which does not restrict the number of general factors that are operative in producing the intercorrelation. Applications of the method to different types of correlation problems are suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Reviewed 23 studies with 18,627 Ss to explore 5 areas of the literature on nonclinical panickers (NCPs): (1) prevalence of panic attacks (PATs) and factors affecting prevalence rates, (2) panic symptom profile, (3) measures of psychopathology, (4) family history of PATs, and (5) psychophysiological responses to challenge tasks. Results suggest that (1) reported prevalence of PATs depends on the way PATs are defined and measured; (2) the symptom profile of nonclinical panic is consistent; (3) levels of associated depressed and anxious mood are consistent and show that the scores of NCPs fall between those of nonpanickers and clinical panickers; (4) NCPs, compared with nonpanickers, report a higher prevalence of family members experiencing PATs; and (5) psychophysiological responses to challenge tasks show both similarities and differences to those of nonpanickers and clinical patients. The requirement that nonclinical panic be spontaneous in nature is not valid. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The cognitive hypothesis proposes that panic disorder and hypochondriasis both result from the enduring tendency to misinterpret bodily changes or variations as indicating catastrophic harm. Although there is considerable overlap (and hence comorbidity), the differences between the two problems lies in (i) the extent to which the symptoms misinterpreted are capable of being rapidly increased by anxiety; (ii) the perceived imminence of the feared catastrophe; (iii) the safety seeking behaviors which are triggered (and which play a part in the maintenance of misinterpretation) and (iv) the general beliefs and assumptions upon which some of the misinterpretations are based. Recent research into misinterpretation and related factors is reviewed, and the implications for clinical treatments are outlined.
Article
The role of anxiety sensitivity in the etiology and maintenance of various anxiety disorders has received increased attention over the past decade. To date, no studies have empirically addressed the relationship between anxiety sensitivity, physiological reactivity, and self-reports of anxiety symptomatology across the menstrual cycle. In this study, high- and low-anxiety sensitivity women in either the premenstrual or intermenstrual phase of the menstrual cycle completed questionnaires and listened to anxiety and neutral scenes while psychophysiological data were collected. In addition, mood ratings were obtained at baseline and after scene presentations. High anxiety sensitivity sitivity participants scored higher on measures of anxiety, depression, and menstrual distress than low anxiety sensitivity females. Premenstrually, high anxiety sensitivity females exhibited greater skin conductance response frequency and magnitude to the anxiety scenes compared to the other three groups. Similar results were obtained when initial levels of state anxiety and panic history were controlled for statistically. Furthermore, high anxiety sensitivity females reported more anxiety and depressed mood following presentation of anxiety scenes. Implications of these results for the mediation of menstrual cycle timing and anxiety sensitivity hypotheses are discussed.
Article
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Article
Sixty-two subjects with panic disorder recorded a total of 285 panic attacks over a two-week period using continuous self-monitoring forms. Compared to retrospective self-report during an initial interview, subjects recorded significantly fewer panic attacks and fewer total symptoms using self-monitoring. Self-monitored panic attacks occurred with an average frequency of 2.3 attacks per week, involved an average of 4.6 DSM-III-R synptoms per attack, and involved an average anxiety level of 5.4 on a 0–8 scale. The degree of anxiety experienced during panic attacks, both within and between individuals, was highly correlated with the number of symptoms. Interestingly, less than one symptom was experienced consistently, during every panic attack, by the average subject. In other words, it appeared that a given subject could experience different symptoms during separate attacks. Implications for the nature and assessment of panic attacks are discussed.
Article
Self-regulation is a complex process that involves consumers’ persistence, strength, motivation, and commitment in order to be able to override short-term impulses. In order to be able to pursue their long-term goals, consumers typically need to forgo immediate pleasurable experiences that are detrimental to reach their overarching goals. Although this sometimes involves resisting to simple and small temptations, it is not always easy, since the lure of momentary temptations is pervasive. In addition, consumers’ beliefs play an important role determining strategies and behaviors that consumers consider acceptable to engage in, affecting how they act and plan actions to attain their goals. This dissertation investigates adequacy of some beliefs typically shared by consumers about the appropriate behaviors to exert self-regulation, analyzing to what extent these indeed contribute to the enhancement of consumers’ ability to exert self-regulation.
Article
A developmental model of antisocial behavior is outlined. Recent findings are reviewed that concern the etiology and course of antisocial behavior from early childhood through adolescence. Evidence is presented in support of the hypothesis that the route to chronic delinquency is marked by a reliable developmental sequence of experiences. As a first step, ineffective parenting practices are viewed as determinants for childhood conduct disorders. The general model also takes into account the contextual variables that influence the family interaction process. As a second step, the conduct-disordered behaviors lead to academic failure and peer rejection. These dual failures lead, in turn, to increased risk for depressed mood and involvement in a deviant peer group. This third step usually occurs during later childhood and early adolescence. It is assumed that children following this developmental sequence are at high risk for engaging in chronic delinquent behavior. Finally, implications for prevention and intervention are discussed.
Article
The pain sensitivity of 18 patients with panic disorder and age- and sex-matched controls was assessed by signal detection analysis. The authors failed to demonstrate any difference in pain sensitivity between the two groups. The relationship between state anxiety, as assessed by the Spielberger scale, and pain in panic patients tended to be in the opposite direction from that in normals.
Article
It has been proposed that high anxiety sensitivity amplifies a number of fears and anxiety reactions. The purpose of this study was to examine whether anxiety sensitivity influences pain-related anxiety and associated cognitive and affective reactions in patients with physically unexplained chronic back pain. Seventy patients with chronic back pain without demonstrable organic pathology completed a battery of questionnaires prior to admission to a multidisciplinary treatment centre. Fourteen patients (20.0%) were classified as high, 44 (62.9%) as medium and 12 (17.1%) as low anxiety sensitive. Multivariate analysis of variance indicated that the high anxiety sensitive patients were more negatively affected by their experience with pain. Specifically, high anxiety sensitivity patients exhibited greater cognitive disruption and anxiety in response to pain, greater fear of negative consequences of pain, and greater negativity of affect than the other groups. Groups did not differ in the intensity of pain that they were experiencing. The proportion of high anxiety sensitive patients reporting current use of analgesic medication was, however, significantly greater than the medium and low anxiety sensitive patients. Correlational analyses indicated significant associations between anxiety sensitivity and pain-related cognitive/affective variables that were independent of pain severity. These results suggest that chronic back pain patients with high anxiety sensitivity, despite equal levels of pain severity, are more likely to be negatively affected by their pain experiences than those with medium and low anxiety sensitivity.
Article
Individuals with panic attacks evaluate physical anxiety symptoms as dangerous and tend to respond to them with fear. In a retrospective questionnaire study, we explored childhood and adolescent learning experiences with respect to somatic symptoms of panickers. Compared to normal controls (N = 61), patients with panic disorder (N = 121), infrequent panickers (N = 86) and patients with other anxiety disorders (N = 38) reported more frequent instances prior to age 18 when they had experienced symptoms like dizziness, shortness of breath, palpitations or nausea, accompanied by special attention from their parents and instructions to restrain from strenuous or social activities. The differences were due to higher symptom frequencies in the anxiety groups. All anxiety groups reported more frequent uncontrolled behavior of their parents than controls. Patients with panic disorder and infrequent panickers reported that their parents had suffered more frequently from physical symptoms typical of anxiety than patients with other anxiety disorders or normal controls. Panickers, but not patients with other anxiety disorders, had observed sick-role behavior related to panic symptoms in their parents more often than controls. Panic attack Ss reported a higher number of household members suffering from chronic illnesses than controls and patients with other anxiety disorders. No group differences were found in the reported behavior of parents when Ss had colds. Overall, the results point to the role of severe illnesses and physical symptoms typical of anxiety in significant others in the history of Ss with panic attacks. These experiences during childhood and adolescence may contribute to their belief that physical symptoms are dangerous. In contrast, there was no specificity for panic with respect to the Ss' own physical symptoms or cold-related symptoms.
Article
This essay describes the current status of our conceptualization and assessment of catastrophic thoughts in panic disorder, an area that is more heterogeneous than may first appear. It is suggested that a heuristic approach would involve assessing both 'state' catastrophic cognitions (automatic thoughts) and the underlying 'trait' cognitive factors (beliefs). The cognitive symptoms listed in the DSM-IV and the self-report Anxiety Sensitivity Index serve as useful preliminary measures for assessing these respective domains. The trait cognitive domain is seen as multidimensional and congruence is required with internal or external stimuli in producing state catastrophic thoughts and accompanying panic attacks. Pressing challenges and controversies in this field are also highlighted and strategies for potentially resolving these issues are offered. Accordingly, several directions for future investigation are presented throughout the paper. Examples of innovative assessment techniques are briefly described.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related bodily sensations, arising from beliefs that the sensations have harmful consequences. There has been a good deal of research on the role of AS in anxiety disorders, and only recently have investigators begun to assess its role in other conditions. In a preliminary report, Asmundson and Norton (1995) found that chronic back-pain patients with high AS (n = 14), compared to those with lower AS (n = 56), reported greater pain-related fear, and tended to have greater avoidance. The present study further investigated the role of AS in pain-related fear and escape/avoidance. Patients with chronic musculoskeletal pain (N = 259) completed measures of AS, pain severity, and pain-related fear and escape/avoidance. Structural equation modeling supported the prediction that AS directly exacerbates fear of pain, even after controlling for the effects of pain severity on fear of pain. Support also was found for the prediction that AS indirectly promotes pain-related escape/avoidance via its influence on fear of pain. This indirect effect was significant even when controlling for the direct influence of pain severity on pain-related escape/avoidance. These results suggest that AS plays an important role in pain-related fear and escape/avoidance in people with chronic pain.
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.
Article
In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO2 sensitivity). A heretofore unexplored possibility is that a psychological characteristic that predisposes to panic-anxiety sensitivity-might be inherited. In this study, the authors examined the heritability of anxiety sensitivity through use of a twin group. Scores on the Anxiety Sensitivity Index were examined in a group of 179 monozygotic and 158 dizygotic twin pairs. Biometrical model fitting was conducted through use of standard statistical methods. Broad heritability estimate of the Anxiety Sensitivity Index as a unifactorial construct was 45%. Additive genetic effects and unique environmental effects emerged as the primary influences on anxiety sensitivity. There was no evidence of genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index. This study suggests that one psychological risk factor for the development of panic disorder-anxiety sensitivity-may have a heritable component. As such, anxiety sensitivity should be considered in future research on the heritability of panic disorder.
Article
The Illness Attitudes Scale (IAS) is a self-rated measure that consists of nine subscales designed to assess fears, attitudes and beliefs associated with hypochondriacal concerns and abnormal illness behavior [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger; Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico]. The purposes of the present study were to explore the hierarchical factor structure of the IAS in a nonclinical sample of young adult volunteers and to examine the relations of each illness attitudes dimension to a set of anxiety-related measures. One-hundred and ninety-seven undergraduate university students (156 F, 41 M; mean age = 21.9 years) completed the IAS as well as measures of anxiety sensitivity, trait anxiety and panic attack history. The results of principal components analyses with oblique (Oblimin) rotation suggested that the IAS is best conceptualized as a four-factor measure at the lower order level (with lower-order dimensions tapping illness-related Fears, Behavior, Beliefs and Effects, respectively), and a unifactorial measure at the higher-order level (i.e. higher-order dimension tapping General Hypochondriacal Concerns). The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986, 1987), as well as with the factor structures identified in previously-tested clinical and nonclinical samples [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469; Hadjistavropoulos, H. D. & Asmundson, G. J. G. (1998). Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behaviour Research and Therapy, 36, 1185-1195; Hadjistavropoulos, H. D., Frombach, I. & Asmundson, G. J. G. (in press). Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample. Behaviour Research and Therapy; Speckens, A. E., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95-104]. The Fears, Beliefs and Effects lower-order factors and the General Hypochondriacal Concerns higher-order factor, were shown to be strongly associated with anxiety sensitivity, even after accounting for trait anxiety and panic history. Implications for understanding the high degree of comorbidity between the diagnoses of panic disorder and hypochondriasis, as well as future research directions for exploring the utility of various IAS dimensions in predicting responses to lab-based bodily symptom-induction procedures, are discussed.
Article
the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.
Anxiety Sensitivity Index Manual, Second Edition — Revised
  • R A Peterson
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Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index Manual, Second Edition — Revised. Worthington, OH: International Diagnostic Services.
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Steiger, J. H. (1989). EZPath: a supplementary module for SYSTAT and SYGRAPH. Evanston IL: SYSTAT, Inc.
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Cox, B. J., Norton, G. R., & Swinson, R. P. (1992). The Panic Attack Questionnaire, Revised. Toronto, ON: Clarke Institute of Psychiatry.
Development of an expanded Anxiety Sensitivity Index: multiple dimensions and their correlates
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Cox, B. J., Taylor, S., Borger, S., Fuentes, K., & Ross, L. (1996). Development of an expanded Anxiety Sensitivity Index: multiple dimensions and their correlates. In S. Taylor, New Studies on the Psychopathology of Anxiety Sensitivity. Symposium Presented at the Thirtieth Annual Meeting of the Association for Advancement of Behavior Therapy, November, New York.
Development of an expanded Anxiety Sensitivity Index: multiple dimensions and their correlates
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Soziales lernen and panikanfalle
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