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Anxiety sensitivity and dependency in clinical and nonclinical panickers and controls

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Abstract

The personality traits of anxiety sensitivity and dependency and their relationship to the experience of panic anxiety and panic disorder with agoraphobia were investigated. The Anxiety Sensitivity Index (ASI) and the Interpersonal Dependency Inventory (IDI) were completed by 116 university students and 23 clinical panic disorder (with agoraphobia) patients. Nineteen percent of the college control sample reported prior experience with spontaneous panic attacks. Patients scored significantly higher than controls on the ASI, total IDI, and the “lack of social self-confidence” subscale of the IDI. Non-clinical student panickers and non-panickers failed to differ significantly on any of the personality measures, suggesting that dependency and anxiety sensitivity may be more likely results of repeated experiences of panic over time and agoraphobic avoidance than they are predisposing factors. The ASI scores were found to correlate significantly with the IDI and with two of its subscales, suggesting that anxiety sensitive individuals tend to be low in social self-confidence and highly reliant on significant others.

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... Individuals with high anxiety sensitivity are more likely to develop other problems as well, such as chronic pain [84,85], alcoholism [86,87] and depression [88] to name a few. Asmundson and colleagues [84] reported that patients with recurring headaches demonstrated scores on the ASI that approached or even exceeded scores detected in anxiety disorders. ...
... Schmidt, Lerew and Joiner [89] did not arrive at the same conclusions but they found that high scores on the ASI were more likely to exacerbate depressive symptoms in the context of anxiety. Finally, Samoluk and colleagues [86] confirmed previous research (e.g., [87,90]) by demonstrating the important role anxiety sensitivity has on alcohol consumption. Participants with high anxiety sensitivity were more likely to consume greater amounts of alcohol in solitary situations than those with low anxiety sensitivity or individuals drinking in a social context. ...
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For more than 60 years, researchers have been interested in determining the impact of expectations on treatment outcome. Earlier studies mostly focused on two types of expectations: prognostic and process expectations. Aims: To review how four different types of expectations (prognostic, process, anxiety expectancy and anxiety sensitivity) contribute to psychotherapy outcome, and to the development of clinical disorders, especially anxiety. Conclusions: First, the role of process and prognostic expectancies in clinical disorders and psychotherapy outcome should be clarified by addressing the methodological flaws of the earlier expectancy studies. Second, studies, especially those on anxiety disorders, may benefit from evaluating the four different types of expectations to determine their relative impact on outcome, and on the development and maintenance of these disorders. Third, possible links with other clinical disorders should be further explored. Finally, expectancies should be assessed prior to treatment and after several sessions to determine the extent to which the treatment's failure in modifying initial low expectancies contribute to a poor outcome.
... PD patients were reported to have high scores for anxiety sensitivity. 15 Anxiety sensitivity has also been suggested as a possible cognitive mechanism that governs fear behavior. 16 In addition, individuals with IBS have also been reported to have high scores for anxiety sensitivity. ...
... These studies have also observed high anxiety sensitivity in PD patients. 15,26,27 The lack of a significant difference in anxiety sensitivity between PD/IBS[+] and PD/ IBS [-] individuals might therefore indicate the absence of an interactive effect of PD and IBS on anxiety sensitivity. The second purpose of this study was to investigate how the cognition of IBS is related to the severity of anxiety sensitivity, anticipatory anxiety, and agoraphobia in PD patients with IBS. ...
Article
The present study examined the effect of irritable bowel syndrome (IBS), cognitive appraisal of IBS, and anxiety sensitivity on anticipatory anxiety (AA) and agoraphobia (AG) in patients with panic disorder (PD). We examined 244 PD patients who completed a set of questionnaires that included the Rome II Modular Questionnaire to assess the presence of IBS, the Anxiety Sensitivity Index (ASI), the Cognitive Appraisal Rating Scale (CARS; assessing the cognitive appraisal of abdominal symptoms in four dimensions: commitment, appraisal of effect, appraisal of threat, and controllability), and items about the severity of AA and AG. The Mini International Neuropsychiatric Interview was used to diagnose AG and PD. After excluding individuals with possible organic gastrointestinal diseases by using 'red flag items,' valid data were obtained from 174 participants, including 110 PD patients without IBS (PD/IBS[-]) and 64 with IBS (PD/IBS[+]). The PD/IBS[+] group had higher AA and higher comorbidity with AG than the PD/IBS[-] group. In the PD/IBS[+] group, the controllability score of CARS was significantly correlated with AA and ASI. Multiple regression analysis showed a significant effect of ASI but not of controllability on AA in PD/IBS[+] subjects. This study suggested that the presence of IBS may be related to agoraphobia and anticipatory anxiety in PD patients. Cognitive appraisal could be partly related to anticipatory anxiety in PD patients with IBS with anxiety sensitivity mediating this correlation.
... tween measures of the constructs have ranged from 0% to 36% (McNally, 1996). High levels of AS are associated with many of the anxiety disorders, particularly panic disorder (Stewart et al., 1992; Taylor et al., 1992). Extremely high AS levels distinguish panic disorder patients from generalized anxiety disorder patients (Taylor et al., 1992). ...
... There are several possible interpretations—not necessarily mutually exclusive— of the reduced reported fear in response to hyperventilation among the high-AS/alcohol participants. First, alcohol may directly reduce anxious responding among high-AS individuals through alcohol's physiological effects in enhancing inhibitory GABA-ergic neural transmission in brain regions associated with anxiety production (Stewart et al., 1992). Second, a cognitivemediation model proposed by Levenson et al. (1980) states that alcohol may disrupt the processes involved in evaluating a situation as threatening. ...
Article
Background: Previous research suggests that high levels of anxiety sensitivity (AS; fear of anxiety symptoms) may constitute a risk factor for alcohol abuse. The present study evaluated the hypothesis that high AS levels may increase risk for alcohol abuse by promoting a heightened sober reactivity to theoretically relevant stressors and heightened sensitivity to alcohol's emotional reactivity dampening effects, which would negatively reinforce drinking in this population. Methods: One hundred and two undergraduate participants (51 high AS, 51 low AS) with no history of panic disorder were assigned to either a placebo, low‐dose alcohol, or high‐dose alcohol beverage condition (17 high AS, 17 low AS per beverage condition). After beverage consumption and absorption, participants underwent a 3 min voluntary hyperventilation challenge. Results and Conclusions: High‐AS/placebo participants displayed greater affective and cognitive reactivity to the challenge than low‐AS/placebo participants, which indicated increased fear and negative thoughts (e.g., “losing control”) during hyperventilation among sober high AS individuals. Dose‐dependent alcohol dampening of affective and cognitive reactivity to hyperventilation was observed only among high‐AS participants, which suggested that high‐AS individuals may be particularly sensitive to alcohol‐induced reductions in their degree of fear and negative thinking in response to the experience of physical arousal sensations. In contrast, dose‐dependent alcohol dampening of self‐reported somatic reactivity was observed among both high‐ and low‐AS participants. We discuss implications of these results for understanding risk for alcohol abuse in high‐AS individuals, as well as directions for future research.
... Mindfulness-based interventions and acknowledgement of genuine fears have likewise shown a guarantee of lessening uneasiness, especially by upgrading profound guideline abilities (Goldin & Gross, 2010). Meta-examinations of mediation studies propose that joining numerous strategies, like CBT with care or openness treatment, can yield considerably more huge enhancements in decreasing public speaking tension among grown-ups with speech debilitations (Stewart et al., 1992). Given these discoveries, further examination is justified to advance intercession methodologies, guaranteeing they are customized to the novel necessities of people with speech weaknesses and analyzing long haul results to help support uneasiness decrease and work on open speaking abilities. ...
Article
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This study aimed to evaluate the effectiveness of psychological interventions, specifically cognitive-behavioural therapy (CBT), mindfulness-based stress reduction (MBSR), and exposure therapy, in reducing public speaking anxiety in adults with speech impairments. Public speaking anxiety is prevalent in this population, often exacerbated by communication challenges, which limit participation in social and professional contexts. Previous research supports the effectiveness of these interventions for general social anxiety, but limited evidence exists on their specific application for individuals with speech impairments. A quantitative, randomized, controlled design was employed with a sample of n=100 adults diagnosed with speech impairments and public speaking anxiety. Participants were randomly assigned to one of the three intervention groups or a control group, with data collected at baseline, post-intervention, and follow-up using the Public Speaking Anxiety Scale (PSAS), Brief Fear of Negative Evaluation Scale (BFNE), and Connor-Davidson 2023 Resilience Scale (CD-RISC). Results indicated significant reductions in anxiety across all intervention groups compared to the control, with CBT showing the largest effect (F(2, 188) = 85.3, p < .001). The findings highlight the potential of psychological interventions to reduce public speaking anxiety and improve resilience in adults with speech impairments, emphasizing the need for integrated treatment approaches. Future research should explore combined therapeutic approaches and include qualitative data for a more comprehensive understanding. Key Words: Public Speaking Anxiety, Speech Impairments, Cognitive Behavioural Therapy, Mindfulness, Exposure Therapy
... In collaboration with former clinical psychology graduate students Brigitte Sabourin and Christopher DeWolfe, who had interests at the intersection of clinical psychology with health psychology and sport psychology, respectively, we examined links of AS to involvement in physical activity/formal exercise. Illustrating how one's clinical work with clients can point to unaddressed research topics of potential importance, I had noticed in my part time private practice that many of my clients with panic disorder (a clinical group with particularly high levels of AS; e.g., Stewart et al., 1992) avoided physical activity and formal exercise. Given that high AS individuals, by definition, fear arousal-related bodily sensations that accompany an anxious state (e.g., rapid heart rate, sweating, shortness of breath), my students and I reasoned that this fear might promote avoidance of activities like physical exercise that bring on similar bodily arousal 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.
... Lastly, higher MDD, GAD, and PD severity predicted lower self-reliance (independence) and vice versa. Individuals with these disorders may tend to be more interpersonally dependent (Sanathara et al., 2003;Stewart et al., 1992;Yoon & Zinbarg, 2007). Additionally, heightened psychopathology may lead to lower valuation of self-reliance through feelings of helplessness and worthlessness, which may be antecedents of chronic and recurrent depression and anxiety (Joshanloo, 2023;Meuret et al., 2010;Sowislo & Orth, 2013;Wiersma et al., 2011). ...
Article
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BACKGROUND: Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal influences in understanding the association between self-construal and psychopathology components. METHODS: Middle-aged and older community-dwelling adults (n = 3,294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates. RESULTS: Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race. LIMITATIONS: DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups. CONCLUSIONS: Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.
... Both tactics are maladaptive (Habke & Flynn, 2002). In previous research, high scores on the Interpersonal Dependency Inventory (IDI) (Hirshfeld et al., 1977), which measures emotional reliance on others, lack of self-confidence, and the assertion of autonomy, have been consistently related to elevated scores on measures of depression (Hirshfeld et al., 1977;Overholser, 1990;Franche & Dobson, 1992), anxiety (Sterwart, Knize, & Pihl, 1992;Hirshfeld et al., 1977), interpersonal sensitivity (Richman & Flaherty, 1987;Hirshfeld et al., 1977), neuroticism (Hirshfeld et al., 1977), and loneliness (Mahon, 1982). Consistent with previous research on dependency, we expect women to report higher IDI (Hirshfeld et al., 1977;Bornstein, 1997Bornstein, , 1998. ...
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This paper combines two related studies. First, we evaluated general interpersonal issues and perfectionism. Second, we expanded on the first study and Mitchelson and Burns' (1998) findings concerning the consequences of these interpersonal variables and perfectionism upon relationship satisfaction. Results indicated a tendency among positive perfectionists to believe in their ability to succeed and enjoy the intellectual challenge of healthy disagreement. Negative perfectionists reported significant avoidance, need for approval, self-silencing behaviors, and self-monitoring. Furthermore, negative perfectionism, the self-silencing construct, and self-monitoring proved important predictors of decreased relationship satisfaction. Significant differences by gender were observed.
... However, it is important to emphasize that it is equally plausible that primary anxiety promotes the development of dependent personality traits. Stewart et al. (1992) reasoned that anxiety engenders feelings of helplessness that increase measured levels of dependency. We encourage other researchers to test these alternatives empirically. ...
... Hooten et al. (2005) found that high scores on neuroticism (tendency to experience negative affect, including anxiety) were associated with poorer outcomes from the tobacco treatment (i.e., lower rates of abstinence). Similarly, Stewart et al. (2006) examined the relationship between anxiety sensitivity (fear of anxiety-related sensations), an important personality risk factor for anxiety disorders (Stewart, Knize, & Pihl, 1992), and smoking cessation outcome in a group of smokers who took part in a structured, 4-week tobacco intervention program. Results showed that anxiety sensitivity levels were associated with more state anxiety during the first week of smoking cessation and poorer short-term outcome, with high anxiety sensitive smokers being at greater risk for relapse to smoking at one month follow-up. ...
Chapter
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Co-morbidity is defined as the presence of any co-occurring condition in a patient with an index disease (Kranzler & Rosenthal, 2003). Epidemiologic surveys of psychopathology in the United States have found that while approximately half of the general population will experience a major psychiatric illness at some point over their lifetime, the majority of affected individuals will simultaneously meet diagnostic criteria for two or more disorders (Kessler et al., 1994). Co-morbidity has important clinical implications including: more severe symptoms, more functional disability, longer illness duration, and higher treatment service utilization (see de Graaf, Bijl, ten Have, Beekman, & Vollebergh, 2004). One of the most common co-morbid conditions is anxiety disorder cooccurring with substance use disorder. Studies that have examined rates of alcohol dependence in anxiety disorder outpatient samples suggest ranges from 15% to 30% depending on the particular anxiety disorders (see Barlow, 1997). Other epidemiologic studies cite lifetime prevalence rates of clinically significant anxiety disorders in patients with alcohol dependence as ranging from 25% to 45% (Kushner et al., 2005). These rates of alcohol dependence in anxiety disorder patients, and of anxiety disorders in alcoholism patients, are markedly elevated relative to base-rates in the general population. Nonetheless, co-morbidity studies with patient populations can lead to overestimates of co-morbidity due to the issue of ‘‘Berkson’s bias’’ – the fact that individuals with more than one disorder may be more likely to seek treatment than those with only one disorder (Galbaud du Fort, Newman, & Bland, 1993). Thus, population-based studies are important to examine ‘‘true’’ rates of co-morbidity of anxiety and substance use disorders. In the Epidemiological Catchment Area Survey (ECA), which included more than 20,000 respondents from five communities in the United States, alcoholics were significantly more apt to have a co-morbid anxiety disorder than non-alcoholics (19.4% vs. 13.1%) (Regier et al., 1990). Moreover, the ECA survey found that individuals with any anxiety disorder had a 50% increase in the odds of being diagnosed with a lifetime alcohol use disorder (alcohol abuse or dependence). Co-morbid psychiatric symptoms, such as anxiety, can make accurate assessment of substance use more difficult and is associated with a poorer substance use outcome following treatment (Kranzler & Rosenthal, 2003). Indeed, anxiety disorders may especially complicate the treatment of substance use disorders in that they have been found to take significantly longer to remit as compared to mood disorders (Wagner, Krampe, & Stawicki, 2004). Another issue relates to whether the anxiety disorder is seen as being ‘‘independent’’ of the substance use disorder or ‘‘substance-induced’’. The former views onset of an anxiety disorder occurring before that of an alcohol disorder and/or persisting after the substance abuse is resolved and in need of specific treatment. The latter views onset of an anxiety disorder occurring after that of an alcohol disorder due to substance intoxication and/or withdrawal and not in need of specific treatment; rather, substance-induced anxiety disorders will resolve as the substance abuse is brought under control. Using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) in a large epidemiologic survey, Grant et al. (2004) concluded that the vast majority of the anxiety disorders found in the general population and in alcoholism treatment settings are independent of substance abuse (see chapter 1).
... We generated several sets of a priori hypotheses derived from research on overdependence, detachment, and healthy dependency (e.g., Baltes, 1996;Birtchnell, 1987;Bornstein, 1993Bornstein, , 2005Bornstein, , 2012aBornstein, , 2012bCogswell, 2008;Cross et al., 2000;Fiori, Consedine, & Magai, 2008;Kantor, 1993;Rude & Burnham, 1995). We expected that somatic complains (Bornstein, 1998), anxiety (Stewart, Knize, & Pihl, 1992), depression (Bornstein, 2012a(Bornstein, , 2012bRude & Burnham, 1995), psychotic or unusual thought processes (Lysaker, Wickett, Lancaster, Campbell, & Davis, 2004), interpersonal warmth and dominance (Pincus & Wilson, 2001), interpersonal sensitivity (Pincus & Wilson, 2001), suicidality (Birtchnell, 1981;Bornstein & O'Neill, 2000;Epstein, Thomas, Shaffer, & Perlin, 1973), borderline personality pathology (Baity, Blais, Hilsenroth, Fowler, & Padawar 2009;Birtchnell, 1981;Cawood & Huprich, 2011;Coen, 1992), and attachment style (Bornstein, Geiselman, Eisenhart, & Languirand, 2002;Haggerty et al., 2010) would be related to unhealthy dependency. We broadly expected that healthy dependency would be negatively correlated to psychopathology. ...
Article
This study assessed the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003) with a substance abuse sample. One hundred-eight substance abuse patients completed the RPT, Experiences in Close Relationships Scale (ECR-SF; Wei, Russell, Mallinckrodt, & Vogel, 2007), Personality Assessment Inventory (PAI; Morey, 1991), and Symptom Checklist-90-Revised (SCL-90-R: Derogatis 1983). Results suggest that the RPT has good construct validity when compared against theoretically related broadband measures of personality, psychopathology and adult attachment. Overall, health hependency was negatively related to measures of psychopathology and insecure attachment, and overdependence was positively related to measures of psychopathology and attachment anxiety. Many of the predictions regarding RPT detachment and the criterion measures were not supported. Implications of these findings are discussed.
... Moreover, causal links between DPD and AD syndromes remain largely unexamined, and it is not clear whether the onset of AD symptoms typically precedes increases in dependency, or whether the presence of dependent personality traits leads to elevations in anxiety. It may be that both pathways occur, with some patients showing AD increases secondary to underlying dependency (e.g., Mavissakalian & Hamann, 1992), and other patients showing increases in dependency following AD onset (e.g., Stewart, Knize, & Pihl, 1992). 2 The finding that DPD-AD links did not differ as a function of comparison group suggests that the modest increases in anxiety in dependent patients cannot be attributed entirely to generalized dysfunction and disturbance associated with personality pathology. ...
Article
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The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that individuals with a dependent personality are at increased risk for anxiety disorders. Meta-analysis of 53 studies examining the comorbidity of dependent personality disorder (DPD) and one or more anxiety disorders (ADs) revealed that the overall DPD-AD relationship is modest in magnitude (mean r = .11) and holds for some ADs but not others. Follow-up analyses indicated that the DPD-AD link was not moderated by diagnostic system, assessment method, or comparison group (other personality-disordered patients versus non-personality-disordered controls). Given these findings, future versions of the DSM may need a more tentative and qualified description of DPD-AD comorbidity.
... Nonclinical panickers have been identified as having a heightened risk of developing subsequent panic disorder (Ehlers, 1995). Their study has enabled the investigation of possible causative agents or risk factors for the transition from nonclinical panic to panic disorder (Stewart, Knize, & Phil, 1992;Telch, Lucas, & Nelson, 1989). Wilson et al. (1992) identified two subgroups of nonclinical panickers on the basis of existing levels of fear of panic, restriction of lifestyle due to panic, selfmedication, and global psychopathology. ...
Article
Cognitive bias in the misinterpretation of ambiguous interoceptive stimuli has been demonstrated in panic disorder. This study investigated whether this cognitive bias also occurs in people with nonclinical panic who are at risk of developing panic disorder. The responses of 25 people with nonclinical panic were compared to those of 20 people with panic disorder and 69 nonpanic controls on a measure of interpretive bias, the Brief Body Sensations Interpretation Questionnaire. There was evidence for interpretive cognitive bias for ambiguous interoceptive stimuli among the nonclinical panickers which did not differ from that of the people with panic disorder, but which differed from the nonpanic controls. High anxiety sensitivity predicted interpretive bias toward both interoceptive and external stimuli. Results therefore suggest that interpretive cognitive bias for ambiguous interoceptive stimuli may be a risk factor for the development of panic disorder.
... The enhanced sensitivity to anxiety amplifies fear arousal and often, results in over-reactions to anxious symptoms (Taylor 1999). Past cross-sectional research has indicated that higher levels of anxiety sensitivity is associated with higher levels of anxious symptoms in non-clinical samples (Muris et al. 2001) as well as a wide range of anxiety disorders in clinical samples (Stewart et al. 1992;Taylor et al. 1992). Similarly, longitudinal research has found that greater anxiety sensitivity in non-clinical populations prospectively predicted the development of anxious symptoms (Maller and Reiss 1992;Plehn and Peterson 2002;Schmidt et al. 1997). ...
Article
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The aim of the current study was to examine the symptom specificity of anxiety sensitivity as well as understand the role that neuroticism played in shaping anxiety sensitivity and subsequent symptomology in a sample of Chinese university students (n=206). We utilized a 6months multi-wave, longitudinal design, and results of idiographic, multilevel modeling indicated that higher levels of anxiety sensitivity predicted higher levels of anxious, but not depressive, symptoms. Further, results suggested that higher levels of anxiety sensitivity mediated the relationship between higher levels of neuroticism and anxious, but not depressive, symptoms. In contrast to past research, the present findings suggested that anxiety sensitivity differentially predicted anxious as opposed to depressive symptomology indicating model specificity. KeywordsAnxiety sensitivity–Anxiety–Depression–Neuroticism–China
... Hooten et al. (2005) found that high scores on neuroticism (tendency to experience negative affect, including anxiety) were associated with poorer outcomes from the tobacco treatment (i.e., lower rates of abstinence). Similarly, Stewart et al. (2006) examined the relationship between anxiety sensitivity (fear of anxiety-related sensations), an important personality risk factor for anxiety disorders (Stewart, Knize, & Pihl, 1992), and smoking cessation outcome in a group of smokers who took part in a structured, 4-week tobacco intervention program. Results showed that anxiety sensitivity levels were associated with more state anxiety during the first week of smoking cessation and poorer short-term outcome, with high anxiety sensitive smokers being at greater risk for relapse to smoking at one month follow-up. ...
... High levels of AS have been shown to be characteristic of the anxiety disorders, particularly panic disorder with or without agoraphobia (e.g. Stewart et al., 1992;. Prior to the proposition of Reiss' expectancy model, many researchers viewed the fear of anxiety as a secondary consequence of panic attacks (e.g. ...
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.
... Finally, individuals high in somatic distress often demonstrate heightened anxiety sensitivity (AS), defined as the belief that anxiety symptoms (autonomic hyperarousal) will have dangerous or harmful consequences such as illness, loss of control, or more anxiety (Noyes et al., 2005;Schmidt et al., 1997;Stewart et al., 1992). Individuals high in AS may also develop a fear of hyperarousal, in which anxiety itself becomes the anxiety-provoking stimulus. ...
Article
Despite an abundant literature on disturbed dreaming (DD) incidence and psychopathology, little is known about the pathogenesis of these dream disturbances. Recent work strongly suggests that DD distress may be the primary determinant of the relationship between DD and waking psychological impairment. This is the first empirical investigation of the possible role of somatic distress as a crucial pathway in this relationship. A total of 313 college undergraduates completed 3 measures of somatic distress (SCL-90-R Somatization scale, Somatic Interpretations Questionnaire and the Anxiety Sensitivity Index) and then monitored their DD incidence and distress for 21 consecutive days. It was predicted that high levels of somatic distress would be associated with heightened levels of both DD incidence and distress. Although the results were somewhat mixed, individuals who reported more incidents of both bad dreams and nightmares did indeed report higher levels of somatic distress. The results were largely consistent with our predictions and the findings are discussed with regard to recent modeling by in identifying key cognitive diatheses for the development of DD.
... AS is characterized by a set of beliefs that anxiety symptoms are signs of catastrophic consequences, such as loss of control and illness (Peterson & Reiss, 1992). In addition to being strongly associated with the diagnoses of panic disorder and post-traumatic stress disorder (e.g., Reiss, Peterson, Gursky, & McNally, 1986;Stewart, 1996: Stewart, Knize, & Pihl, 1992. high levels of AS have also been associated with the use/ abuse of certain drugs (see reviews by McNally. ...
Article
Two studies examined the relationships between anxiety sensitivity (AS), drug use, and reasons for drug use. In Study 1, 229 university students (57% F) completed the Anxiety Sensitivity Index (ASI) and a drug use survey, assessing use of a variety of drugs within the last month, and coping reasons for drug use. Consistent with a modified tension-reduction hypothesis, ASI scores were positively correlated with the number of both anxiety- and depression-related reasons for drug use endorsed. In Study 2, 219 university students (74% F) completed the ASI and a drug use survey, assessing use of several drugs (e.g., alcohol, cigarettes, caffeine, and marijuana/hashish) within the last year, and primary reasons (coping, affiliative, or enhancement) for the use of each drug. Marijuana/hashish users reported lower ASI scores than non-users supporting a negative relation between AS and the use of cannabis. ASI scores were positively correlated with the use of alcohol primarily to cope, and negatively correlated with the use of alcohol primarily to affiliate, among both gender groups, and ASI scores were positively correlated with the use of nicotine primarily to cope among the females. Implications of these findings for understanding risk for abuse of stress-response-dampening drugs by high AS individuals are discussed.
... Kellner et al., 1987b) and panic disorder patients in the case of the ASI (e.g. Stewart, Knize & Pihl, 1992; see also review by Peterson and Reiss (1992)) Ð future research is needed to more de®nitively evaluate the meaning of the high correlations observed between ASI and IAS scores in the present and previous studies. Future research might bene®t by examining relations between anxiety sensitivity levels and responses to speci®c IAS items (e.g. ...
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
Bu çalışma Hirschfeld ve diğerleri (1977) tarafından geliştirilen ve Türkçe’ye uyarlanmış olan Kişilerarası Bağımlılık Ölçeği’nin kısa formunu geliştirmeyi amaçlamaktadır. Ölçeğin geçerliliği, yapı ve ölçüt bağıntılı geçerliliğine bakılarak incelenmiştir. Ölçeğin orijinal formu yaşları 17-52 arasında 581 üniversite öğrencisinden oluşan birinci örnekleme uygulanmış ve elde edilen veriler üzerinde açımlayıcı faktör analizi gerçekleştirilmiştir. Açımlayıcı faktör analizi sonucunda ortaya çıkan 12 maddelik kısa form, yaşları 19-51 arasında değişen toplam 385 üniversite öğrencisinden oluşan ikinci örnekleme uygulanmış ve elde edilen veriler üzerinde doğrulayıcı faktör analizi gerçekleştirilmiştir. Yapılan analizler sonucunda 12 maddelik kısa formun, üç boyutlu yapısı doğrulanmıştır. Ölçüt bağıntılı geçerlik kapsamında anksiyete, depresyon, kişilerarası duyarlılık ve otonomi değişkenleri ile Kişilerarası Bağımlılık Ölçeği Kısa Formu arasında hesaplanan korelasyon değerleri, önceki çalışmalardan elde edilen bulgularla benzerlik göstermiştir. Ölçeğin güvenirliği kapsamında, iç tutarlılığı hesaplanmış ve ölçeğin toplam puanı için Cronbach alfa güvenirlik katsayısı .60 olarak hesaplanmıştır. Mevcut çalışma kapsamında elde edilen bulgular, Kişilerarası Bağımlılık Ölçeği Kısa Formu’nun geçerli ve güvenilir bir ölçme aracı olarak kullanılabileceğini göstermektedir.
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Resumen El Inventario de Dependencia Interpersonal constaba de tres subescalas llamadas: Dependencia emocional de otra persona (DE), Falta de confianza social en sí mismo (FCS) y Aserción de autonomía (AUT). Se han desarrollado varias fórmulas para derivar puntuaciones de la escala entera. El propósito del estudio en 621 sujetos con adicción era determinar la mejor fórmula utilizando el tras-torno de la personalidad por dependencia del DSM-IV como norma áurea. La fórmula 3DE + FCS -AUT produjo los mejores valores de sensibilidad y especificidad.
Thesis
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Chapter
Various pharmacological agents (e.g., carbon dioxide (CO2), sodium lactate, yohimbine) are known to provoke symptoms associated with panic disorder in human subjects. Moreover, there are marked interindividual differences in behavioral sensitivity to these agents. In particular, the effectiveness of these agents in provoking panic attacks is more evident in panic disorder patients relative to healthy volunteers (for review see ref. 1). Although variation in behavioral sensitivity to panicogens is believed to reflect alterations in the neurochemistry instrumental to the expression of clinical panic attacks, some investigators have argued that psychological variables including anticipatory anxiety, interoceptive sensitivity, appraisal of threat or harm, perception of control and panic expectancy, among other variables, play a more salient role in the induction of anxious/fearful feelings (for review see refs. 2 and 3).
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The Diagnostic and Statistical Manual of Mental Disorders states that individuals with a dependent personality are at increased risk for anxiety disorders. Meta-analysis of 53 studies examining the comorbidity of dependent personality disorder (DPD) and one or more anxiety disorders (ADs) revealed that the overall DPD-AD relationship is modest in magnitude (mean r = .11) and holds for some ADs but not others. Follow-up analyses indicated that the DPD-AD link was not moderated by diagnostic system, assessment method, or comparison group (other personality-disordered patients versus non-personality-disordered controls). Given these findings, future versions of the DSM may need a more tentative and qualified description of DPD-AD comorbidity. © The Author 2005. Published by Oxford University Press on behalf of the Psychological Association D12. All rights reserved.
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The psychological models of panic disorder predict that people with this anxiety disorder are able to accurately estimate changes in somatic sensations. This study investigated whether nonclinical panickers, at risk for developing panic disorder, demonstrate enhanced interoceptive ability for changes in sympathetic arousal. Twenty people with nonclinical panic and 36 nonpanic controls estimated changes in overall sympathetic arousal, as measured by pulse transit time. A greater proportion of the nonclinical panickers than nonpanic controls met criterion for accurate interoceptive ability. As a group, nonclinical panickers also demonstrated more accurate perception of sympathetic arousal but only when it changed in predictable ways. Anxiety sensitivity and trait anxiety also appeared related to enhanced interoception, particularly in people who had experienced nonclinical panic. People who are at risk for the development of panic disorder may therefore demonstrate enhanced interoceptive ability for sympathetic arousal.
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Differences in personality between nonclinical panickers and nonpanickers in a college population were examined in two studies. In Study 1, 590 undergraduate students completed the Panic Attack Questionnaire (PAQ), the Structured Clinical Interview for the DSM-III-R Personality Disorders-II Self Report (SCID-II), and the Milton Clinical Multiaxial Inventory (MCMI). Nonclinical panickers evidenced more personality disorder symptomatology than nonpanickers on both the MCMI and SCID-II inventories. In Study 2, 288 undergraduates completed the SCID-II inventory, the Eysenck Personality Inventory (EPI), the MMPI anxiety subscale (MMPI-A), the State Trait Anxiety Inventory (STAI), the Barratt Impulsiveness Scale (BIS), the Eysenck Impulsiveness Scale version 7 (I.7), and the Beck Depression Inventory (BDI). Personality profiles of nonclinical panickers are discussed, as well as the ability of these personality measures to discriminate between nonclinical panickers and nonpanickers.
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The purpose of the present study was to determine the extent to which anxiety sensitivity and speech trait anxiety serve as predictors of state anxiety during public speaking. A model is proposed and tested, in which anxiety sensitivity and speech trait anxiety are found to be significant predictors of state anxiety during public speaking. The model accounted for 43.1% of the variance in the dependent variable. Anxiety sensitivity, or fear of physical sensations or consequences, contributes unique variance to anxiety during public speaking beyond that of trait anxiety alone. Implications for theory development, instruction, and therapy are examined.
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Eighty undergraduate students (40 women and 40 men) completed the Interpersonal Dependency Inventory (IDI) twice, with the two testing sessions separated by an 84-week interval. Retest reliability coefficients for IDI whole-scale scores, r = .71, and subscale scores (rs ranged from .60 to .72) were similar to those obtained in IDI retest reliability studies that used shorter intertest intervals. Gender differences in IDI scores in the present sample paralleled those obtained in previous investigations involving clinical and nonclinical participants. Implications of these results for the construct validity of the IDI as a measure of interpersonal dependency are discussed.
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Examined the effects of anxiety-sensitivity (AS) levels, and 1.00 ml/kg alcohol, on autonomic and subjective-emotional responses to aversive stimulation (i.e., noise bursts). Ss were 30 university women divided into 3 AS groups (high, moderate, and low), on the basis of Anxiety Sensitivity Index (ASI) scores. When sober, high-AS women provided higher emotional arousal ratings while anticipating the noise bursts than did low-AS women. Alcohol dampened the noise burst-anticipation ratings, particularly in the high-AS group. ASI scores were positively correlated with degree of sober skin conductance level (SCL) reactivity and with degree of alcohol dampening of SCL reactivity. Thus, high-AS women may use alcohol to normalize their anticipatory emotional and electrodermal overreactivity to threat. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Selon plusieurs auteurs, les relations interpersonnelles occupent un rôle important dans le développement, le maintien et le traitement comportemental de l'agoraphobie. Les conclusions des recherches sont rapportées afin de documenter les liens entre l'agoraphobie et différentes variables interpersonnelles, notamment les aspects familiaux caractérisant l'enfance des personnes agoraphobes, leur fonctionnement social, et leur relation conjugale. Une analyse critique des écrits suggère que les relations interpersonnelles occupent parfois une certaine importance dans l'agoraphobie, notamment en ce qui concerne l'apparition du trouble et la présence d'anxiété sociale. Cependant, cette place est beaucoup moins importante que certains auteurs le suggèrent.
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Dependency among bereaved individuals has been hypothesized to be an important predictor of severe and enduring grief reactions. However, although there are a number of instruments that assess interpersonal dependency as a personality trait or style, no scales are available to assess bereavement-related dependency. Data from 170 widowed participants in a community-based longitudinal investigation, who had been bereaved for an average of 10.8 months, were used to investigate the reliability and validity of the Bereavement Dependency Scale (BDS), an instrument that was developed to assess dependency on the deceased among bereaved persons. Results indicated that the BDS demonstrated acceptable internal reliability and satisfactory convergent, discriminant, and construct validity. The BDS may be a clinically useful predictor of enduring and complicated grief reactions, major depressive disorder, and suicidality among recently bereaved individuals.
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A dependent personality orientation is associated with increased risk for a broad array of Axis I and Axis II disorders. Although traditional treatment interventions have modest ameliorative effects on problematic dependency, the multifaceted nature of dependency suggests that integrated treatment strategies may hold more promise than traditional treatment approaches. This article outlines one potentially useful integrated treatment strategy, combining elements of cognitive and existential therapy to alter dependency-related thought, behavior, and emotional responding. Procedures for implementing an integrated cognitive-existential treatment model are outlined, and challenges in use of the model are discussed.
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We examined whether certain “risky” drinking motives mediate the previously established relation between elevated anxiety sensitivity (AS) and increased drinking behavior in college student drinkers (n=109 women, 73 men). Specifically, we administered the Anxiety Sensitivity Index (ASI), Revised Drinking Motives Questionnaire, and a quantity-frequency measure of typical drinking levels. Participants were parceled according to high (n=30), moderate (n=29), and low (n=34) AS levels. As expected, high AS participants reported a higher typical weekly drinking frequency than the low and moderate AS students regardless of gender. Similarly, high AS participants (particularly high AS men) reported a higher yearly excessive drinking frequency than low AS students. Only the negative reinforcement motives of Coping and Conformity were found to independently mediate the relations between AS and increased drinking behavior in the total sample. High AS women's greater drinking behavior was largely explained by their elevated Coping Motives, while heightened Conformity Motives explained the increased drinking behavior of high AS men. Finally, associations between AS and increased drinking behavior in university students were largely attributable to the “social concerns” component of the ASI. We discuss the observed relations with respect to the psychological functions of drinking behavior that may portend the development of alcohol problems in young adult high AS men and women.
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The literature on drinking motives suggests that individuals drink for three distinct reasons: coping motives (CM: to reduce and/or avoid negative emotional states); social motives (SM: to affiliate with others); and enhancement motives (EM: to facilitate positive emotions). Cooper, Russell, Skinner and Windle (1992) [Psychological Assessment, 4, 123–132] developed a 3-dimensional self-report instrument, the Drinking Motives Questionnaire (DMQ), with subscales designed to assess relative frequency of drinking for each of these three motives. This study was designed to examine the psychometric properties of the DMQ in a large sample of young adult university students. Three hundred and fourteen students voluntarily served as subjects; 266 students (85% of the total sample; 196F and 70M) reported drinking on the DMQ. These students were divided into two age groups [20 yr and under (n = 117); 21 yr and older (n = 149)]. Analyses of variance indicated: (a) main effects of gender, with men scoring significantly higher on the DMQ-EM subscale and tending to score higher on the DMQ-SM subscale when compared to women; (b) a main effect of age group on the DMQ-EM subscale, with younger students scoring significantly higher than older students; and (c) a significant main effect of drinking motive, with the most relatively frequent drinking reported for SM and the least for CM overall. Although mild-to-moderate shared variance between subscales was noted, the three subscales of the DMQ were found to possess adequate-to-high levels of internal consistency. A confirmatory factor analysis (CFA) showed that the hypothesized 3-factor model provided a better fit than either a unidimensional or 2-factor model in explaining the underlying structure of the DMQ. Some suggestions for improvements in DMQ item content are made. The present results replicate and extend previous findings by Cooper and colleagues to a sample of university students, and support the utility of using the DMQ in future investigations of the drinking motives of young adults.
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We investigated relationships between anxiety sensitivity, physiological arousal, and interpersonal functioning in conflict situations following relaxation and hyperventilation in a 2 × 2 × 2 repeated-measures experimental design. High (n = 32) and low (n = 32) anxiety-sensitive (AS) women were obtained from the top and bottom 25% of 900 respondents. Participants were exposed to 5-min inductions of either relaxation or hyperventilation, followed by a 5-min role-play of a conflict scenario with their boyfriends, who were coached to act in either an approving or a disapproving manner. Following the interaction, participants rated their self-perception, perception of partner, projections about how partner was viewing them, and feelings about the interaction. The women then underwent the same breathing manipulation as previously and engaged in a second scenario with their boyfriends, who acted in the manner opposite to that of the first scenario. Order of support versus disapproval was randomly counter-balanced across couples. A pattern of significant triple interactions and tendencies toward significant triple interactions revealed that high-AS women who hyperventilated and experienced disapproval were most self-derogatory, most likely to perceive their partners as evaluating them unfavorably, and most likely to influence their partners to devalue them. In addition, experiencing relaxation and approval from their partners did not diminish the subjectively reported anxiety and depression in high-AS women as much as expected relative to low-AS women.
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The present study was designed to examine the relationship between anxiety sensitivity (AS; fear of anxiety symptoms) and alcohol use motives. The Anxiety Sensitivity Index (ASI), the State-Trait Anxiety Inventory-Trait Subscale (STAI-T), and the Drinking Motives Questionnaire (DMQ) were administered to 314 university students. Higher ASI scores were found to be significantly associated with greater scores on the Coping Motives (CM) subscale of the DMQ, particularly in the female subjects. In contrast, ASI scores were not found to be related in a linear fashion to scores on either the Enhancement Motives (EM) or Social Motives (SM) subscales of the DMQ. A regression equation involving a weighted linear combination of scores on the ASI and STAI-T significantly predicted scores on the CM subscale of the DMQ; the regression equation was significantly better at predicting the frequency of coping-related drinking in women than men. When “primary” motives were examined, a significantly greater percentage of high than low AS subjects (particularly high AS women) were found to drink primarily for coping-related motives, and a significantly greater percentage of low than high AS subjects were found to drink primarily for social-affiliative motives. This pattern of drinking motives points to potential difficulties with alcohol in individuals (particularly women) who are high in both AS and trait anxiety, since drinking primarily for CM as opposed to SM has previously been shown to be associated with more drinking alone, heavier alcohol consumption, and more severe alcohol-related problems.
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A growing literature suggests a significant relationship between “anxiety sensitivity” (AS; fear of anxiety symptoms) and alcohol use/abuse. The present study examined the relationship between levels of AS and self-reported rates of weekly alcohol consumption and frequency of “excessive drinking” (i.e., number of times legally intoxicated per year). Subjects were 30 nonalcoholic university women, divided into three AS groups (high, moderate, and low) based upon scores on the Anxiety Sensitivity Index (ASI). High AS women reported consuming significantly more alcoholic beverages on a weekly basis and drinking to excess more times per year than low AS controls. ASI scores were found to be significantly positively correlated with both measures of self-reported alcohol consumption. The results support the hypothesis of a positive relationship between AS levels in young adult women and extent of excessive alcohol use.
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Anxiety sensitivity (AS) is the fear of anxiety-related sensations arising from beliefs that these sensations have harmful physical, psychological, or social consequences. AS is measured using the Anxiety Sensitivity Index (ASI), a 16-item self-report questionnaire. Little is known about the origins of AS, although social learning experiences (including sex-role socialization experiences) may be important. The present study examined whether there were gender differences in: (a) the lower- or higher-order factor structure of the ASI; and/or (b) pattern of ASI factor scores. The ASI was completed by 818 university students (290 males; 528 females). Separate principal components analyses on the ASI items of the total sample, males, and females revealed nearly identical lower-order three-factor structures for all groups, with factors pertaining to fears about the anticipated (a) physical, (b) psychological, and (c) social consequences of anxiety. Separate principal components analyses on the lower-order factor scores of the three samples revealed similar unidimensional higher-order solutions for all groups. Gender × AS dimension analyses on ASI lower-order factor scores showed that: females scored higher than males only on the physical concerns factor; females scored higher on the physical concerns factor relative to their scores on the social and psychological concerns factors; and males scored higher on the social and psychological concerns factors relative to their scores on the physical concerns factor. Finally, females scored higher than males on the higher-order factor representing the global AS construct. The present study provides further support for the empirical distinction of the three lower-order dimensions of AS, and additional evidence for the theoretical hierarchical structure of the ASI. Results also suggest that males and females differ on these various AS dimensions in ways consistent with sex role socialization practices.
Article
The construct of anxiety sensitivity (AS) has occupied an increasingly important place in theorizing and research on anxiety and anxiety disorders. Although a number of recent studies have provided support for the construct validity of the principal operationalization of AS, the Anxiety Sensitivity Index (ASI), the relation of the AS construct and the ASI to trait anxiety continues to be a source of controversy. Key issues in the AS-trait anxiety debate include the assimilative nature of traits and the concept of incremental validity. Recent research on AS lends some support to the claim that trait anxiety cannot fully account for AS findings. Important areas for future AS research include (1) demonstrating that AS is a risk factor for panic disorder and related conditions, lather than simply a consequence of these conditions, (2) developing and utilizing multiple operationalizations of constructs, (3) minimizing the impact of potentially inapplicable items, (4) testing for interactions between AS and other variables, and (5) testing hierarchical factor models that allow trait anxiety and AS to coexist as higher- and lower-order factors, respectively. Researchers in this area will need to develop alternative measures of the AS construct, recognize the distinction between different levels of trait specificity, clarify a number of theoretical issues relevant to the AS construct, and continue to subject predictions to stringent theoretical risks.
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Anxiety sensitivity is proposed as an individual difference variable distinguishable from anxiety. Theoretically, individuals with high levels of anxiety sensitivity believe the experiences of anxiety are harmful and monitor their physiological responses by focusing attention to their internal stimuli. The current study assessed four groups of subjects: those with high and low levels of anxiety sensitivity; and those with or without recent experiences of panic attacks. Subjects completed a physiological protocol and reported their cognitions and subjective distress. Results support physiological change; however, reactions to the change did not differ significantly by ASI groupings, but were impacted by prior experiences with panic. Results are discussed in terms of support for a conditioning paradigm, with no apparent contribution from the postulated trait of anxiety sensitivity.
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We investigated relationships between anxiety sensitivity and perceptions of facial emotions following relaxation and hyperventilation. The Anxiety Sensitivity Index was administered to 606 female college undergraduates and samples of high (n = 30) and low (n = 25) scorers were obtained from the top and bottom 15% of the distribution. Following exposure to randomly counterbalanced 5-minute relaxation and hyperventilation instructions, participants rated the intensity of seven basic emotions in photographs of faces using a standardized test of affect-receiving ability. High ASI scorers perceived significantly more intense fear and anger than did low ASI respondents and reported relatively larger increases in ratings of sadness and fear following hyperventilation. ASI was significantly correlated with heightened state anxiety and vigilance prior to beginning the experiment, and these affects mediated interpersonal perceptions. Results suggest that high ASI scorers may manifest a chronic state of vigilance that triggers heightened anxiety in ambiguous situations. The combination of high anxiety sensitivity and state anxiety appears to foster greater sensitivity to interpersonal stimuli.
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Anxiety sensitivity (AS; fear of arousal sensations) is a risk factor for mental and physical health problems, including physical inactivity. Because of the many mental and physical health benefits of exercise, it is important to better understand why high-AS individuals may be less likely to exercise. The present study's aim was to understand the role of barriers to exercise in explaining lower levels of physical exercise in high-AS individuals. Participants were undergraduate women who were selected as high (n = 82) or low (n = 72) AS. High-AS women participated in less physical exercise and perceived themselves as less fit than low-AS women. Mediation analyses revealed that barriers to exercise accounted for the inverse relationships between AS group and physical exercise/fitness levels. Findings suggest that efforts to increase physical exercise in at-risk populations, such as high-AS individuals, should not focus exclusively on benefits to exercise but should also target reasons why these individuals are exercising less.
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There has been significant interest in the role of anxiety sensitivity (AS) in the anxiety disorders. In this meta-analysis, we empirically evaluate differences in AS between anxiety disorders, mood disorders, and nonclinical controls. A total of 38 published studies (N = 20,146) were included in the analysis. The results yielded a large effect size indicating greater AS among anxiety disorder patients versus nonclinical controls (d = 1.61). However, this effect was maintained only for panic disorder patients compared to mood disorder patients (d = 0.85). Panic disorder was also associated with greater AS compared to other anxiety disorders except for posttraumatic stress disorder (d = 0.04). Otherwise the anxiety disorders generally did not differ from each other in AS. Although these findings suggest that AS is central to the phenomenology of panic disorder and posttraumatic stress disorder, causal inferences regarding the role of AS in these anxiety disorders cannot be made. Moderator analyses showed that a greater proportion of female participants was associated with larger differences in AS between anxiety and nonclinical control groups. However, more female participants were associated with a smaller AS difference between anxiety and mood disorder groups. This finding suggests that AS is less robust in distinguishing anxiety from mood disorders among women. Age also moderated some observed effects such that AS was more strongly associated with anxiety disorders in adults compared to children. Type of AS measure used also moderated some effects. Implications of these findings for the conceptualization of AS in anxiety-related disorders are discussed.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related sensations, which arises from beliefs that these sensations have harmful somatic, psychological or social consequences. According to Reiss (1991), AS is one of three fundamental fears that amplify or cause many common fears. AS also is thought to play an important role in causing panic attacks. The purpose of the present article is to review recent findings concerning the construct of AS and its place in the nomological network outlined by Reiss. Although the weight of evidence supports a unifactorial model of AS, recent findings suggest AS is multifactorial at the level of first-order factors, and these factors load on a single higher-order factor. People with elevated AS, compared to those with low AS, are more likely to have histories of panic attacks. AS is factorially distinct from other fundamental fears, and is more strongly related to agoraphobia than other common fears. AS can be regarded as a subfactor of trait anxiety, and is more strongly related to agoraphobia than other common fears. AS can be regarded as a subfactor of trait anxiety, although the question arises as to whether AS is a cause of trait anxiety. Important questions for further investigation concern the etiology of AS and whether it can be reduced to still more basic fears.
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The authors determined whether fear of anxiety symptoms mediates panicogenic responses to cholecystokinin tetrapeptide (CCK-4) in healthy subjects. Individuals with a preexisting high level of anxiety sensitivity (N = 10) experienced significantly more catastrophic cognitions and fear of somatic symptoms than did subjects with low (N = 9) or medium (N = 17) anxiety sensitivity, but they were not more susceptible to experiencing a panic attack. Thus, cognitive factors do not appear to be critical determinants of CCK-4-induced panic attacks.
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In this article, the author critically reviews studies on the relationship between exposure to trauma, posttraumatic stress disorder (PTSD), and alcohol abuse. After establishing that strong relationships exist between exposure to traumatic events and alcohol problems, and particularly between the diagnoses of PTSD and alcoholism, the author discusses various factors, theories, and possible mechanisms to account for these associations. Moreover, she discusses applications of these findings to the assessment and treatment of people exposed to trauma who abuse alcohol. Finally, the author outlines novel methods for testing theoretical hypotheses and makes suggestions for methodological improvements in future research.
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Sensitivity theory holds that people differ in both the types of reinforcement they desire and in the amounts of reinforcement they need to satiate. People who crave too much love, too much attention, too much acceptance, too much companionship, or too much of some other fundamental reinforcer are at risk for aberrant behavior because normative behavior does not produce the desired amounts of reinforcement. People who are intolerant of even everyday amounts of anxiety or frustration also are at risk for aberrant behavior. Individual differences in desired amounts of particular reinforcers may predict person-environment interactions, risk factors for psychopathology, and the occurrence of generalized and durable therapy effects versus the occurrence of relapses. Parallel predictions are made for individual differences in tolerance of aversive stimuli. Implications are discussed for applied behavior analysis, the development of psychopathology, and treatment strategies.
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Undergraduate women who scored in the top (n = 24) and bottom 15% (n = 24) on the Anxiety Sensitivity Index viewed randomly counterbalanced sets of three neutral and three dysphoric faces after having either hyperventilated or relaxed. Participants rated the amount of change they experienced in Happiness, Sadness, Fear, Anger, Surprise, Disgust, and Contempt after viewing each face. High Anxiety Sensitive (AS) women reported significantly greater changes on six of the seven emotions, even though pretreatment differences in somatically experienced anxiety were covaried out. Significant three-way interactions were found for participants self-rated changes in Fear and Surprise, with tendencies toward significance (p < .10) also emerging for Anger and Disgust. The pattern of interactions was identical for all four variables. Low AS women manifested greater reductions in these four emotions when viewing neutral as opposed to dysphoric faces, regardless of whether they hyperventilated or relaxed. High AS women who relaxed manifested similar discriminative abilities. High AS women who hyperventilated, however, reported no relative changes in emotional arousal to both dysphoric and neutral faces. The blunted discrimination shown by high AS women who hyperventilated suggests that, when these individuals are in a physiologically challenged state, they may be less responsive to "early warning" indicators of social distress displayed by others which may, in turn, cause them to experience subsequent interpersonal difficulties.
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Trait anxiety began as a psychodynamic concept, poorly tied to observables, and requiring Freudian defense mechanisms to explain recurrent anxiety episodes. Spielberger's thoughtful efforts improved the concept, but some important limitations remained. Lilienfeld, Turner, and Jacob (1989, 1993, 1996) uncritically accepted Spielberger's work on trait anxiety and asserted that it is the standard against which the concept of anxiety sensitivity should be judged (see also Lilienfeld, 1996). Taylor (1996) and McNally (1989, 1996) distinguished anxiety sensitivity from trait anxiety by noting that, whereas trait anxiety predicts future anxiety generally, anxiety sensitivity predicts future fear to anxiety sensations specifically. An important additional difference is that the two constructs use different indicators (past anxiety experiences versus ASI beliefs) to predict future anxiety and fear. Furthermore, only anxiety sensitivity implies that some phobics perceive the feared object to be harmless; what they fear is an uncontrollable anxiety/panic reaction to the stimulus, not the dangerous nature of the stimulus itself.
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The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9-20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.
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Relations between anxiety sensitivity (AS) and the higher-order and lower-order dimensions of the 'Big Five' model of personality were examined in 317 university students. AS was significantly associated with a number of personality domains and facets of the NEO-PI-R. Regression analyses indicated that only the higher-order domains of neuroticism and extraversion (negatively) and the lower-order N facets of anxiety and self-consciousness, significantly predicted AS. Three lower-order factors within AS were identified and were also compared to NEO-PI-R domains and facets. In a hierarchical regression, the three AS factors significantly predicted variance in a measure of panic-related anxiety after the effects of the six N facets were statistically controlled. Results are discussed in the context of previous work with a Big Three taxonomy of personality and implications for understanding the nature and possible origins of AS are outlined.
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This article presents data on the prevalence and symptomatology of panic attacks and panic disorder (PD) in a large nonclinical sample (n = 2,375) of college students. Results showed that approximately 12% of the sample had experienced at least one unexpected panic attack and that 2.36% met DSM-III-R criteria for panic disorder. Although there were no sex differences in overall panic attack prevalence, men reported significantly more panic-related worry than women, and women reported a higher panic frequency than men. Compared to subjects who met DSM-III-R criteria for PD, infrequent panickers presented with fewer panic symptoms, fewer panic episodes, less panic-related worry, lower anxiety sensitivity, and less panic-related avoidance. Moreover, compared with PD subjects, the infrequent panickers were much less likely to report fears of dying, going insane, and derealization during a panic attack. The findings provide preliminary support for the role of anxious apprehension as a psychological vulnerability factor in the pathogenesis of panic disorder.
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Describes the development of the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire, companion measures for assessing aspects of fear of fear (panic attacks) in agoraphobics. The instruments were administered to 175 agoraphobics (mean age 37.64 yrs) and 43 controls (mean age 36.13 yrs) who were similar in sex and marital status to experimental Ss. Results show that the instruments were reliable and fared well on tests of discriminant and construct validity. It is concluded that these questionnaires are useful, inexpensive, and easily scored measures for clinical and research applications and fill a need for valid assessment of this dimension of agoraphobia. (22 ref)
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• One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (<age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
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In considering the etiology, status, and consequences of abnormal fear reactions there is not only a dearth of experimental data, but also lack of clarity in use of the terms involved. Generally, abnormal fear reactions are briefly mentioned in passing as being self-evident. Few hypotheses regarding causal factors and their methods of combination have been attempted. It is hoped that the results of this study may cast some light upon the etiological factors involved in the development of the phobic syndrome. The population used in this experiment consists of three groups of patients who have received at least three months' psychiatric treatment. Each group is composed of 25 adult white females. One group of 25 is composed of phobic patients, i.e., women whose presenting complaint upon admission to treatment was an abnormal fear reaction. Reliability coefficients were computed between the first and second ratings of Judge 1, and the first ratings of Judge 1 and those of Judge 2. These were product-moment correlations with Sheppard's correction. Contingency coefficients were also computed for the comparison of judgments between the diagnoses for the "other characteristics of father and husband." From this study it is concluded that the variables under consideration—namely, (a) lack of an adequate father figure, (b) dominant overprotection by the mother, (c) castration or castration fear, (d) frigidity, (e) rejection of pregnancy, and (f) the fact that the husband, an inadequate individual, leaves or threatens to leave the patient—play an important etiological part in the development of a phobic syndrome, and that such variables are not etiologically significant in the cases of anxiety neurosis and conversion hysteria which were used in this study.
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Constructed a scale designed to measure dependency in 4th, 5th, and 6th graders by means of internal consistency item analysis procedures. 65 true-false items were administered to 219 elementary school children. The analysis yielded 33 cross-validated items. With a new sample, test-retest reliability (2 wk.) was .67 for 4th graders, .87 for 5th graders, and .82 for 6th graders. In subsequent concurrent validity studies, scores on the Children's Dependency Scale were found to decrease with the increasing age of children, to be higher for girls than for boys, and to be higher for children in dependent families. A slight relationship was obtained between scale scores and teacher ratings of dependency. (16 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In a sample of 28 members of an agoraphobia self-help group, each patient reported a history of spontaneous panic attacks. The onset of panic attacks preceded the development of agoraphobic restrictions by an average of 9 yr, and 79% of the sample attributed the development of their agoraphobia to their experience of panics. These results provide the first empirical support for the hypothesis that agoraphobia is secondary to panic attacks.
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The DSM-III narrative remarks suggest that childhood separation anxiety disorder and sudden object loss apparently predispose to the development of adult panic disorder, despite the paucity of empirical studies documenting such a relationship. In an attempt to test the validity of this separation anxiety hypothesis of panic disorder, 14 objective questions pertaining to childhood separation experiences were answered by 23 panic disorder patients and 28 small-animal phobics. Although the panic disorder patients scored higher on 2 of the 14 items, these differences appear to have little clinical meaning. Caution is indicated prior to continued uncritical acceptance of the separation anxiety hypothesis of panic disorder.
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Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the "fear-of-fear" construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made.
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Epidemiology is the study of the distribution and determinants of health conditions. In this article, epidemiological studies of cardiovascular diseases and, more specifically, of coronary heart disease (CHD), are reviewed to document their major public health importance, the changes in mortality during this century, and international comparisons of these trends. The major risk indicators for CHD are reviewed and found to be determined in large part by psychosocial and behavioral mechanisms. More purely psychosocial risk indicators are also reviewed for the consistency with which they predict CHD prevalence and incidence. It seems fair to assert that, although the pathogenetic mechanisms involved are biological, the contributing causes to CHD are primarily behavioral. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study tested the validity of the distinction made in the Diagnostic and Statistical Manual of Mental Disorders (third edition) between the diagnoses of "panic disorder" and "agoraphobia with panic attacks" by examining the pattern of covariation between panic symptoms and agoraphobic fear in a group of individuals presenting with panic attacks as a prominent symptom. Subjects were 72 patients who had previously been diagnosed by expert diagnosticians as having either panic disorder or agoraphobia with panic attacks and who had completed at the time of diagnosis both the Fear Survey Schedule and the Symptom Checklist 90-R. Analyses of the panic-related items and the agoraphobia-related items of these two inventories revealed that irrespective of diagnosis, the degree of panic was highly correlated with the degree of agoraphobic fear. Although panic patients tended to experience more severe panic and milder agoraphobic fear than agoraphobics, the groups overlapped with respect to both kinds of symptoms. The findings are discussed in terms of whether panic disorder and agoraphobia should be classified as qualitatively distinct conditions.
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The authors examined 36 patients with panic disorder, 66 patients with major depression, and 124 control subjects to determine personality differences between them in the ill and the recovered states. The panic and depressed groups did not differ from each other in either state. Both recovered groups had less emotional strength and greater interpersonal dependency than the control subjects. The effect of state on personality measures appears to be similar for anxious and depressed patients. No personality measures that clearly differentiated the recovered panic and depressed patients were found.
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SOUGHT TO IDENTIFY THE COMMON ELEMENTS IN ALL FORMS OF PSYCHOTHERAPY WITH PHOBIC DISORDERS. THE BEHAVIOR PATTERNS CHARACTERISTIC OF PHOBICS ARE EXAGGERATED DEPENDENCY, WHICH THEY PERCEIVE AS INCOMPATIBLE WITH SELF-RELIANCE, AND EXAGGERATED AVOIDANCE OF DIFFICULT, FEAR-EVOKING SITUATIONS. THESE PATTERNS ARE LEARNED AS THE PERSON ADAPTS TO THE EXPECTATIONS OF OVERPROTECTIVE PARENTS. MOST THERAPISTS PARTIALLY RECIPROCATE THE PHOBIC'S DEMANDS FOR PROTECTION AND GUIDANCE, AND SUBSEQUENTLY USE THE INFLUENCE CONFERRED BY THIS RELATIONSHIP AS LEVERAGE TO URGE THE PATIENT TOWARD A DIRECT CONFRONTATION WITH THE PHOBIC STIMULI. BY BEING NEITHER OVERPROTECTIVE NOR HARSH, THE THERAPIST STANDS IN SHARP CONTRAST TO OTHERS IN THE PHOBIC'S LIFE, AND THUS PROVIDES A NEW INTERPERSONAL LEARNING EXPERIENCE THAT MOVES THE PATIENT TOWARD SELF-RELIANCE. (2 P. REF.)
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Three hundred fifty-eight undergraduates were divided into five groups based on the frequency and the recency with which they experienced panic attacks. Comparisons amongst Nonpanickers (NP), Limited Symptom Panickers (LP), Infrequent Panickers (IP), Recent Panickers (RP), and Frequent Panickers (FP) showed significant mean differences (p < .01) between groups on the eight subscales of the Hopkins Symptom Check List (HSCL-90), the Beck Depression Inventory (BDI), and the State and Trait scales of the State-Trait Anxiety Inventory (STAI). In addition, there were significant differences (p < .01) among panic groups on severity ratings on 16 of 18 panic symptoms. Planned comparisons showed that, for most symptoms, the LP subjects differed from the other panic groups who did not differ from one another. For most measures of the HSCL-90, the STAI scales, and the BDI, the RP and FP groups' scores were significantly higher than those of the remaining groups. Trend analyses of symptom and psychological test scores showed significant linear trends across groups. There were also significant increases across groups in the number of first-degree relatives reported to have experienced panic attacks.
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We tested the hypothesis that the Anxiety Sensitivity Index (ASI) measures a unitary personality variable. College students (N = 840) were administered the ASI along with a questionnaire assessing panic and anxiety symptomatology. The ASI demonstrated adequate internal reliability (α = .82) and showed modest discrimination on two of three anxiety disorder indices (i.e., anxiety medication usage and panic history). Results of a principal components analysis with varimax rotation revealed a four-factor solution which explained 53.5% of the total variance. Our findings seriously challenge previous claims that the ASI measures a single factor. Rather, our data suggest that the ASI measures several loosely-related cognitive appraisal domains concerned with the anticipated negative consequences of anxiety. The four factors that emerged from our analysis were (a) concern about physical sensations, (b) concern about mental/cognitive incapacitation, (c) concern about loss of control, and (d) concern about heart/lung failure. It is concluded that the ASI is a convenient and reliable instrument for assessing perceived physical consequences of anxiety but that the instrument is lacking in its coverage of anxiety consequences related to social concerns. Implications of the findings for treatment are discussed.
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The purpose of this study was to compare clinical panic disorder patients to nonclinical (not receiving treatment) panickers. Thirty-eight nonclinical students reported one or more panic attacks in the past three weeks (13.8% of total sample), and were compared to 50 outpatients with panic disorder with agoraphobia. Clinical and nonclinical panickers experienced similar attacks (e.g., symptom structure, temporal duration of attacks). Clinical panickers reported significantly higher levels of agoraphobic fears, depression, anxiety sensitivity, and trait anxiety concerning daily routines. Frequency of panic in the past year, prediction of spontaneous panic, anxiety sensitivity, and lifestyle restrictions were significant predictors of clinical status. Results are discussed in terms of a panic-anxiety continuum model. There are both quantitative and qualitative differences between clinical and nonclinical panickers. “Predicting the unpredictable” appears to be a key cognitive element and is theoretically related to perceived lifestyle restriction (i.e., agoraphobia) as a result of panic.
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The purpose of this study was to (a) compare people who experienced recent panic attacks (panickers) with nonpanickers and (b) determine, the factors associated with panic attacks in nonclinical subjects. Two hundred and fifty-six students completed the Panic Attack Questionnaire (PAQ), the State-Trait Anxiety Inventory (STAI), the Beck Depression, Inventory (BDI), the Profile of Mood States (POMS), and two measures of fear/avoidance. Over 22% of the subjects reported one or more panic attacks in the 3 weeks, prior to testing. Comparisons of panickers and nonpanickers showed that panickers (a) scored higher on measures of anxiety, depression, etc., and (b) reported more first-order relatives who have panic attacks. The panic attacks were characterized by (a) having a sudden onset, (b) an average of eight DSM-III symptoms, and (c) occurring in a wide variety of situations (especially social situations). Subjects who experienced unpredictable panic attacks differed, on several measures from subjects with only predictable attacks. Finally, panickers reported experiencing several symptoms not included in DSM-III. Similarities, between panickers and patients with Panic Disorder and Agoraphobia and the assessment of panic-related, disorders are discussed.
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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.
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Ninety phobic patients - 68 agoraphobias, 20 social phobias and 2 specific phobias - were retrospectively considered. Personal and social characteristics largely resemble the Maudsley sample (Marks, 1969). Personality deviance was observed in 77% of the series, social containment in Foulds' sense being noted in three quarters of deviants. Of deviant personality types (Schneider, 1958) only anankasts differed in distribution. Interpersonal problems presented in 90% of patients, in only 10% of whom the patient's personality or neurosis had not played an important part in creating the problem. In 62% of the total sample interpersonal problems stood in temporal relationship with the onset of illness, and this was the most important precipitating factor in one half. Thirty eight per cent of agoraphobics and 25% of social phobics exhibited strong dependency traits, lower figures than recorded by other authors; problems with attitudes to authority were observed in 12% of agoraphobics and 30% of social phobics, these differences just falling short of the 10% level of significance. Just over one third each of agoraphobics and social phobics recorded very unhappy or disrupted childhoods. Precipitation of the phobic illness was elicited in 83% of patients; relationship problems made the most important contribution. 70% of the series were judged to derive psychological gains from their phobic illness; no direct causative role is ascribed to these. Four patients were identified in whom progress was hampered by improvement in the phobia upsetting the equilibrium in an important relationship. In only 14 patients could the illness be considered a 'conditioned' maladaptive response; how these 14 differed from the remainder is described. Response to deconditioning was considered for the agoraphobic group. Deconditioning could operate initially only in 20% of the patients, impediments being eventually overcome in a further 40%. 40% agoraphobics did not respond to deconditioning therapies. Factors implicated in delay or non response are detailed; early and late responders to deconditioning resembled each other, but non responders evinced significantly more relationship problems and comprised an excess of hysterical personalities. The ultimate outcome was slightly more favorable for agoraphobics than for social phobics (68 and 60% respectively); outcome was not significantly influenced by sex, civil status, total duration of illness before inception nor length of therapeutic contact; outcome was adversely affected by the presence of 'uncontained' personality deviance, but favorably influenced by absence of personality deviance. The implications for treatment are discussed. The view that behavior therapy is sufficient as the primary approach for a majority of agoraphobics and social phobics is questioned.
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The clinical impression that phobic patients perceive their parents as being uncaring and overprotective was investigated in a controlled study of eighty-one phobic patients. Those assigned to a social phobic group scored both parents as less caring and as overprotected, while those assigned to an agoraphobic group differed from controls only in reporting less maternal care. Intensity of phobic symptoms in the pooled sample was examined in a separate analysis. Higher agoraphobic scores were associated with less maternal care and less maternal overprotection, while higher social phobic scores were associated with greater maternal care and greater maternal overprotection.
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Synopsis Thirty married agoraphobic women referred to out-patient clinics in Edinburgh were compared with ‘normal’ controls (selected from GP records and screened for the absence of psychiatric symptoms) matched on age, sex, social class and marital status. The agoraphobics' husbands were similarly compared with the husbands of the controls. On most measures of attitudes, behaviour, domestic organization and marital interaction, the 2 groups were strikingly similar.
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By means of a twin study an attempt was made to throw light upon the aetiology and nosology of phobic fears. Factor analyses revealed five factors, namely separation fears, animal fears, mutilation fears, social fears and nature fears. The study demonstrated that, apart from separation fears, genetic factors play a part in the strength as well as content of phobic fears. Environmental factors, affecting the development of dependence, reserve and neurotic traits generally, seemed also to be of some importance. It was further demonstrated that phobic fears were related to emotional and social adjustment and this was true to an even greater extent for separation fears.
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Interpersonal dependency refers to a complex of thoughts, beliefs, feelings, and behaviors revolving around needs to associate closely with valued other people. Its conceptual sources include the psychoanalytic theory of object relations, social learning theories of dependency, and the ethological theory of attachment. A review of existing self-report inventories revealed none that adequately assessed interpersonal dependency. A new 48-item self-report inventory which assesses interpersonal dependency in adults was developed using a sample of 220 normals and 180 psychiatric patients. It was cross-validated on two additional samples. Three components of interpersonal dependency emerged: emotional reliance on another person, lack of social self-confidence, and assertion of autonomy. The relationship of these components with normals and patients was discussed, as well as with the concepts of attachment and dependency.
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A hypothesis of selective predisposition for depression, neurasthenic syndrome and anxiety states has been tested in a prospective study. The primary material for the investigation consisted of 4,000 city inhabitants who had registered a private car. Almost all of these could be invited to a group investigation by questionnaire in the autumn of 1959. Out of those invited, 83% participated, and out of these, 3,019 were males (the secondary material). Six years later, the registers of public psychiatric out- and in-patient units in the city were examined as to the appearance in 1960 or later of the men in the secondary material. One hundred and fourteen of these men were found in the registers. For each of these men ten controls, matched for age, were chosen from the rest of the secondary material. Thirty-seven of the patients had had a depression and 17 a neurasthenic syndrome as the main diagnosis, and 17 had an anxiety state as the main or secondary diagnosis. As independent factors were chosen the Sjöbring personality factors sub-validity (psychasthenic traits), sub-stability (syntonia) and sub-solidity (hysteroid habitual attitude), as well as subclinical phenomena related to the neurasthenic, depressive and anxiety syndromes. It was not possible to show a specific predisposing power of the background factors investigated. Psychasthenic premorbid personality, however, was significantly related to depression, and also showed a strong tendency to an association with neurasthenic syndrome and anxiety, states.
Article
The mothers of 21 agoraphobic children have been evaluated from the psychiatric point of view and tested by a questionnaire on the maternal behavior of the over protected children, using the specially devised 50 item Maternal Overprotection Questionnaire (MOQ). The latter and the IPAT should be adopted as the scales of anxiety. The findings of this study were inconclusive: there was no definite evidence of a relationship between the mothers' over protective behaviour and the child's development of agoraphobia. It was found that the mothers were moderately anxious, phobic and over protective, compared with the accepted normal. The mothers' anxiety was highly significantly correlated with a predominance of fear in their phobic children. The correlation between the MOQ and the psychiatric evaluation of the phobic children was once again statistically significant. The concept of agoraphobia as a fear reaction in the child, and the role of the over protective mother may impede the complete disappearance of these fears. The other factors studied include identification, a greater tendency to anxiety, and a maternal over protectiveness, all play a part in the causation of agoraphobia.
Article
In the present study, we administered the Anxiety Sensitivity Index (ASI) and a modified version of the Panic Attack Questionnaire (PAQ) to 425 college students to determine whether high anxiety sensitivity ('fear of fear') occurs in the absence of a history of unpredictable ('spontaneous') panic attacks, or whether such attacks are a necessary precursor to high anxiety sensitivity. Based on their ASI scores, subjects were assigned to either the high, medium, or low anxiety sensitivity groups. High anxiety sensitivity subjects more frequently reported both a personal and family history of panic than did subjects in the other groups. Nevertheless, two-thirds of the high anxiety sensitivity subjects had never experienced an unpredictable panic attack. This suggests that the fear of anxiety can be acquired in ways other than through personal experience with panic.
Article
This article presents data on the prevalence and symptomatology of panic attacks and panic disorder (PD) in a large nonclinical sample (n = 2,375) of college students. Results showed that approximately 12% of the sample had experienced at least one unexpected panic attack and that 2.36% met DSM-III-R criteria for panic disorder. Although there were no sex differences in overall panic attack prevalence, men reported significantly more panic-related worry than women, and women reported a higher panic frequency than men. Compared to subjects who met DSM-III-R criteria for PD, infrequent panickers presented with fewer panic symptoms, fewer panic episodes, less panic-related worry, lower anxiety sensitivity, and less panic-related avoidance. Moreover, compared with PD subjects, the infrequent panickers were much less likely to report fears of dying, going insane, and derealization during a panic attack. The findings provide preliminary support for the role of anxious apprehension as a psychological vulnerability factor in the pathogenesis of panic disorder.
Article
The authors compared 137 adult patients who had agoraphobia with 81 patients who had either simple or social phobia for a history of childhood and adolescent separation anxiety. Female agoraphobics reported significantly more childhood separation anxiety than female combined simple and social phobics; males showed no significant difference between diagnostic groups. The reported prevalence of separation anxiety in adolescence was relatively low, but agoraphobics of both sexes reported significantly more separation anxiety than combined simple and social phobics. There were no significant differences between groups for parental losses or severe family disruption during childhood. The results suggest that childhood separation anxiety is a risk factor in females but not in males for the later development of agoraphobia.
Article
This study further validated the "Reiss-Epstein-Gursky Anxiety Sensitivity Index" (ASI) as a measure of the fear of anxiety. Agoraphobics scored high on the ASI before, but not after, behavioral treatment. Residual anxiety sensitivity, however, did not predict resurgence of agoraphobic avoidance at six months follow-up. Indeed, anxiety sensitivity continued to decline during the follow-up period. Multiple regression analyses indicated that the ASI predicted the number of fears in agoraphobics beyond that predicted by the level of general anxiety. This finding supports the hypothesis that high anxiety sensitivity enhances fear acquisition; it also suggests that the ASI measures a construct different from that measured by general anxiety scales. Empirical similarities and differences were found between the ASI and two other "fear of fear" measures: the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire.
Article
Sixty agoraphobia with panic patients completed the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess the Axis II personality disorders from the Diagnostic and Statistical Manual of Mental Disorders (ed 3) (DSM-III). Results showed that these agoraphobic patients were more likely to show dependent, avoidant, and histrionic personalities or traits than any other types; however, only 27% of the sample met a personality disorder diagnosis, and even avoidant and dependent traits were not ubiquitous. Cross-validation of the findings was provided by comparison with the Eysenck Personality Inventory (EPI). Patients exhibiting a greater number of personality traits were also significantly more symptomatic on the Hopkins Symptom Checklist.
Article
The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) published by the American Psychiatric Association in 1980, and now translated in many languages, has raised a great interest in the whole world. It has probably had on psychiatric thinking as important an impact as the Treatise of Psychiatry of E. Kraepelin at the beginning of the century. The evolution of psychiatric nosology and the circumstances of the birth of DSM-III are described. In discussing the general principles and the technical aspects, the influence of several currents of thought are emphasized: recent remedicalization of psychiatry in the United States, suspicion about speculative theories, return to an a-theoretical clinical descriptive nosology, influence of quantitative differential psychology and of the models provided by computer diagnosis. The nature of the two basic principles: the necessity of attaining a proven high interjudge reliability in diagnosis, and the descriptive a-theoretical nature of the description of each category is analyzed. From those principles derive the most original features of the DSM-III: the use of stringent diagnostic criteria, of a possible quantitative nature and the adoption of a multi-axial system. Some of the most striking changes introduced are the logical consequences of the principles e.g. the deletion of the term "neurosis". Others changes such as the introduction of new diagnostic categories or changes in the limits of classical ones (especially schizophrenia and manic-depressive psychosis) reflect a reaction against previous trends of American psychiatry and a strict adherence to a pragmatic and empirical thinking. In addition, the flexibility of its structure allows for the incorporation of new empirical results. In spite of many criticisms, either against the general orientation or against specific positions, some of which are presented in the course of this article, it is concluded that the success of the DSM-III results from a trend in psychiatric thinking not confined to the United States. Its controversial nature has stimulated the reappraisal of old concepts, and it can be considered as an important contribution towards a closer integration of psychiatry to medicine.
Article
Eighty-eight panic disorder patients were divided into three groups according to the extent of their phobic avoidance (none, limited, or extensive). These groups were compared on three personality disorder instruments: the Structured Interview for DSM-III Personality Disorders, the Personality Diagnostic Questionnaire, and the Millon Clinical Multiaxial Inventory. Phobic patients were found to have significantly more dependent personality disorder and DSM-III third-cluster personality disorders than nonphobic patients. A subgroup of patients with social phobic symptoms was found to resemble the rest of the phobic group in terms of personality.
Article
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
Article
Male and female outpatient agoraphobic clients were compared on a range of measures of personality and psychopathology related to agoraphobia. Few sex differences emerged. Women were slightly more avoidant when alone, and men reported more concern about hurting someone when anxious. Sex-role inventory measures of masculinity were inversely related to severity of avoidance behavior and other measures of psychopathology, and sex differences on avoidance were accounted for by sex differences on masculinity. Both male and female agoraphobics were lower on masculinity than a normative sample. When response to treatment was compared, men and women showed equivalent improvement with the exception of panic frequency on which women showed a poorer outcome.
Article
It is commonly accepted that early traumatic separation experiences predispose to the development of agoraphobia in adults. This separation anxiety hypothesis has been incorporated into the diagnostic criteria of the DSM-III, despite the absence of substantial empirical support. In the present study, 14 objective questions pertaining to childhood separation anxiety experiences were answered by 44 agoraphobics and a comparison group of 83 simple phobics. In no instance did the agoraphobics report significantly greater separation trauma in childhood than the simple phobics. This suggests that better evidence is needed before acceptance of the separation anxiety hypothesis of agoraphobia. Psychological explanations regarding the etiology of the disorder may need to be discarded in favor of biological factors which are receiving increasing empirical support.
Article
An experimental analysis of fear and safety was conducted on 13 mildly claustrophobic Ss. Panics or near-panics occurred on 67 out of 258 trials. Roughly two-thirds were correctly predicted, but there was a high rate of over-prediction. Panics were followed by increases in predicted fear but not in reported fear. Unexpected panics contributed more to the observed changes than did expected panics. Disconfirmed expectations of panic were followed by reductions in fear. Escape behaviour was associated with panics, high fear and low safety.
Article
A group of 47 phobic patients (92 percent agoraphobic and 8 percent specific phobics) were matched with the same number of controls on age, socio-economic status and education. All subjects were assessed by two independent psychiatrists, on psychometric tests (IPAT, FSS) and on self-assessment of neurotic symptoms and social maladjustment. Among the control group 40 percent were found to have specific phobias and 5 percent agoraphobia; the severity of both being much below that of the patients. The rate of incidence of other neurotic illness (obsessions, alcoholism, depression, and so on) in the families of phobic patients was higher than in the control group. Mothers of phobic patients had a higher incidence of phobic neurosis and were more frequently described as overprotective than were control mothers. Childhood fears were more frequent among the phobic patients (slightly obsessive, worried persons) long before the onset of the phobic neurosis. On the IPAT anxiety scale and on the FSS, agoraphobic patients scored higher than the specific phobics, who scored higher than the controls. Specific phobias in both patient and control groups seemed to have begun in childhood and persisted until treatment. On the other hand, agoraphobia developed much later, and half the patients reported temporary remissions. Other neurotic symptoms (hysterical signs, obsessive symptoms, and so on) while clinically unimportant, were still significantly more frequent in the phobies than in the control group. The agoraphobic syndrome showed surprising uniformity from patient to patient. It was postulated that agoraphobia is due to reactivation of separation anxiety, while specific phobias develop as a conditioned fear response.
Article
The term “agoraphobia” was coined by Westphal, who in 1872 published a monograph Die Agoraphobie (12) in which three male patients were described with the following symptoms: … impossibility of walking through certain streets or squares, or possibility of doing so only with resultant dread of anxiety … no loss of consciousness … vertigo was excluded by all patients … no hallucinations or delusions to cause this strange fear … agony was much increased at those hours when the particular streets dreaded were deserted and the shops closed. The patients experienced great comfort from the companionship of men or even an inanimate object, such as a vehicle or a cane. The use of beer or wine also allowed the patient to pass through the feared locality with comparative comfort. One man even sought, without immoral motives, the companionship of a prostitute as far as his own door … Some localities are more difficult of access than others; the patient walking far in order not to traverse them … Strange to say, in one instance, the open country was less feared than sparsely housed streets in town. Case 3 also had a dislike for crossing a certain bridge. He feared he would fall in the water. In this case there was also apprehension of impending insanity.
Article
Describes the development of the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire, companion measures for assessing aspects of fear of fear (panic attacks) in agoraphobics. The instruments were administered to 175 agoraphobics (mean age 37.64 yrs) and 43 controls (mean age 36.13 yrs) who were similar in sex and marital status to experimental Ss. Results show that the instruments were reliable and fared well on tests of discriminant and construct validity. It is concluded that these questionnaires are useful, inexpensive, and easily scored measures for clinical and research applications and fill a need for valid assessment of this dimension of agoraphobia. (22 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The authors examined the relation between retrospectively reported childhood separation anxiety disorder and adult DSM-III-R anxiety disorders in 252 outpatients at an anxiety disorders research clinic. The prevalence of childhood separation anxiety disorder was significantly greater among patients with two or more lifetime adult anxiety disorder diagnoses than it was among patients with only one anxiety disorder, suggesting that childhood separation anxiety disorder may be a risk factor for multiple anxiety syndromes in adulthood.
Atiety and its disorders: The nature and treatment of anxiety and panic A study of agoraphobic housewives
  • D H Barlow
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