No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Laboratory Test of a Novel Structural Model of Anxiety Sensitivity and Panic Vulnerability
Abstract
The current study evaluated a novel latent structural model of anxiety sensitivity (AS) in relation to panic vulnerability among a sample of young adults (N=216). AS was measured using the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and panic vulnerability was indexed by panic attack responding to a single administration of a 4-minute, 10% CO(2) challenge. As predicted, vulnerability for panic attack responding to biological challenge was associated with dichotomous individual differences between taxonic AS classes and continuous within-taxon class individual differences in AS physical concerns. Findings supported the AS taxonic-dimensional hypothesis of AS latent structure and panic vulnerability. These findings are discussed in terms of their theoretical and clinical implications.
... 12 Additionally, AS-cognitive concerns and AS-social concerns significantly interacted with cannabis cravings to prospectively predict subsequent cannabis use. 14 A major limitation of this corpus of work is that it has been conducted with primarily White samples 10,11,14,17,18 with little attention to race other than reporting demographic variables. Yet Black individuals are more likely to report experiencing greater and more intense somatic symptoms when experiencing anxiety than White individuals. ...
Background and objectives:
Cannabis is the most widely used illicit substance among young adults. Anxiety sensitivity (AS; ie, fear of anxiety-related symptoms) is positively related to coping motives for cannabis use (which are robustly positively linked to cannabis-related problems). However, AS is unrelated to cannabis use-related problems. Yet, extant studies have been conducted on primarily White samples. It may be that among Black students, AS-physical concerns (ie, fear of physical anxiety-related sensations) are related to cannabis problems given that Black individuals are more likely than White individuals to report experiencing greater and more intense somatic symptoms when experiencing anxiety. Black individuals may rely on cannabis to cope with fear of these somatic symptoms, continuing to use despite cannabis-related problems.
Methods:
The current study tested whether race moderated the relation between AS-physical concerns and cannabis problems among 102 (85.3% female) current cannabis using undergraduates who were either non-Hispanic Black (n = 51) or non-Hispanic White (n = 51).
Results:
After controlling for frequency of cannabis use, income, and gender, race significantly moderated the relation between AS-physical concerns and cannabis use-related problems such that AS-physical concerns significantly predicted cannabis-related problems among Black and not White individuals.
Discussion and conclusions:
Findings highlight the importance of considering race in identifying psychosocial predictors of cannabis-related problems.
Scientific significance:
Intervention strategies for Black cannabis users may benefit from examining and targeting AS-physical concerns. (Am J Addict 2017;26:209-214).
... Concentrations of CO 2enriched air used in research with human subjects typically range from 2.2% to 65%, with higher concentrations of CO 2 producing more anxiety symptoms. The present study employed a CO 2 concentration of 15% based on previous studies that have successfully employed CO 2 concentrations below 20% as a proxy for anxiety symptoms (e.g., Bernstein, Zvolensky, Zvolensky, & Schmidt, 2009;Olatunji, Wolitzky-Taylor, Babson, & Feldner, 2009). The stressor entailed a 90-s challenge phase and a 90-s recovery phase that were administered continuously. ...
... AS was originally conceptualized as an individual difference factor that contributed to the etiology and maintenance of panic disorder (PD) (McNally, 2002). Indeed, research has shown that AS is elevated in first-degree relatives of probands with PD relative to healthy controls (van Beek & Griez, 2003) and prospectively predicts panic attacks (Maller & Reiss, 1992;Schmidt, Lerew, & Jackson, 1999), panic symptoms (Cox et al., 2008), and panic response to a CO 2 challenge (Bernstein et al., 2009;Blechert et al., 2013). However, AS has also been linked to several other psychopathological behaviors and conditions (Deacon & Abramowitz, 2006;Taylor et al., 1996), including alcohol use (Allan, Albanese, Norr, Zvolensky, & Schmidt, 2014;Schmidt, Buckner, & Keough, 2007), depression (Allan, Capron, et al., 2014;Viana & Rabian, 2009), generalized anxiety disorder (GAD; Allan, Macatee, et al., 2014), and suicide (Capron, Cougle, Ribeiro, Joiner, & Schmidt, 2012;Medley, Capron, Korte, & Schmidt, 2013). ...
There is growing evidence that heightened sensitivity to unpredictable threat is a core mechanism of dysfunction in anxiety disorders. However, it is unclear whether anxiety sensitivity is also associated with sensitivity to unpredictable threat. In the present study, 131 participants completed the Anxiety Sensitivity Index-3, which includes physical concerns (PC), social concerns (SC), and cognitive concerns (CC) subscales, and a predictable vs. unpredictable threat-of-shock task. Startle eyeblink and ERP responses (N100, P300) to the acoustic startle probes were measured during the task. PC and CC were associated with heightened and attenuated, respectively, startle for the unpredictable (but not predictable) condition. CC were also associated with attenuated probe N100 for the unpredictable condition only, and PC were associated with increased P300 suppression across the predictable and unpredictable conditions. This study provides novel evidence that the different anxiety sensitivity dimensions demonstrate unique relationships with the RDoC domains "acute" and "potential" threat.
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Although a local sample was used, there was no method to determine the length of time an individual has been in the United States. Also, it would be desirable to conduct a CFA across racial groups in a clinical sample in order to determine if the results were similar to the analog sample in another population that may be qualitatively distinct (Bernstein et al., 2009). This study also lacks a measure of acculturation. ...
Anxiety sensitivity (AS), the fear of anxious cognitive and physiological experiences, is multidimensional and adds incrementally to the prediction of relationships of panic and relevant phenomenology. Many agree upon the content of the dimensions, but there is less agreement about the factor structure of the anxiety sensitivity index (ASI), a widely used measure of AS, across cultural groups. Anxiety disorders vary in their epidemiology and phenomenology across ethnoracial groups. This investigation adds clarity to research in the psychometric properties of the ASI across four cultural groups. Results from a confirmatory factor analysis support invariance across groups with the exception of three psychometrically questionable items assessing fear of gastrointestinal symptoms. The convergent and divergent validity are consistent with cross-group invariance as well. Clinical implications are discussed.
... Although anxiety sensitivity was initially conceptualized as a continuous dimension of vulnerability, some researchers (e.g., Bernstein et al., 2007) have proposed that anxiety sensitivity is best conceptualized in terms of dimensions of vulnerability within distinct latent taxonic classes. However, evidence for a categorical dimensional model is mixed, as although some recent studies have supported this conceptualization of anxiety sensitivity (e.g., Bernstein, Zvolensky, Marshall, & Schmidt, 2009;Bernstein, Stickle, & Schmidt, 2013), a recent taxometric investigation of anxiety sensitivity provided consistent support for a dimensional conceptualization of anxiety sensitivity (Broman-Fulks et al., 2010). We chose to model anxiety sensitivity as a continuous latent dimension for all analyses in the present study. ...
The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.
... Concentrations of CO 2enriched air used in research with human subjects typically range from 2.2% to 65%, with higher concentrations of CO 2 producing more anxiety symptoms. The present study employed a CO 2 concentration of 15% based on previous studies that have successfully employed CO 2 concentrations below 20% as a proxy for anxiety symptoms (e.g., Bernstein, Zvolensky, Zvolensky, & Schmidt, 2009;Olatunji, Wolitzky-Taylor, Babson, & Feldner, 2009). The stressor entailed a 90-s challenge phase and a 90-s recovery phase that were administered continuously. ...
... Based upon previous work on the neural substrates of fear conditioning in general (Sehlmeyer et al. 2009), and altered safety signal processing in PD ( Tuescher et al. 2011), we expected patients to exhibit enhanced neural activity in fear circuit structures according to the above-described conditioning processes encompassing the amygdala, thalamus, midbrain, insula, ACC and prefrontal cortex (PFC) when compared to controls. A positive association with anxiety sensitivity, which has been suggested as a subclinical trait marker of PD ( Schmidt et al. 2006;Bernstein et al. 2009), was expected. ...
Background:
Although several neurophysiological models have been proposed for panic disorder with agoraphobia (PD/AG), there is limited evidence from functional magnetic resonance imaging (fMRI) studies on key neural networks in PD/AG. Fear conditioning has been proposed to represent a central pathway for the development and maintenance of this disorder; however, its neural substrates remain elusive. The present study aimed to investigate the neural correlates of fear conditioning in PD/AG patients.
Method:
The blood oxygen level-dependent (BOLD) response was measured using fMRI during a fear conditioning task. Indicators of differential conditioning, simple conditioning and safety signal processing were investigated in 60 PD/AG patients and 60 matched healthy controls.
Results:
Differential conditioning was associated with enhanced activation of the bilateral dorsal inferior frontal gyrus (IFG) whereas simple conditioning and safety signal processing were related to increased midbrain activation in PD/AG patients versus controls. Anxiety sensitivity was associated positively with the magnitude of midbrain activation.
Conclusions:
The results suggest changes in top-down and bottom-up processes during fear conditioning in PD/AG that can be interpreted within a neural framework of defensive reactions mediating threat through distal (forebrain) versus proximal (midbrain) brain structures. Evidence is accumulating that this network plays a key role in the aetiopathogenesis of panic disorder.
... SCL was assessed in micromhos by using a Coulbourn S71-23 isolated coupler, and collected by placing Ag–AgCl electrodes filled with electrode paste to the medial phalanxes of the third and fourth fingers of the nondominant hand. SCL was used because prior studies have shown changes in SCL across a biological challenge (e.g., Bernstein et al. 2009). Any non-readable data (i.e., missing data due to electrode falling off a participant) was eliminated following standard data reduction strategies employed in past biological challenge studies (Zvolensky et al. 1998). ...
The current study examined the interactive effects of anxiety sensitivity (AS; fear of anxiety and anxiety-related sensations) and menstrual cycle phase (premenstrual phase vs. follicular phase) on panic-relevant responding (i.e., cognitive and physical panic symptoms, subjective anxiety, and skin conductance level). Women completed a baseline session and underwent a 3-min 10 % CO2-enriched air biological challenge paradigm during her premenstrual and follicular menstrual cycle phases. Participants were 55 women with no current or past history of panic disorder recruited from the general community (M
age = 26.18, SD = 8.9) who completed the biological challenge during both the premenstrual and follicular cycle phases. Results revealed that women higher on AS demonstrated increased cognitive panic symptoms in response to the challenge during the premenstrual phase as compared to the follicular phase, and as compared to women lower on AS assessed in either cycle phase. However, the interaction of AS and menstrual cycle phase did not significantly predict physical panic attack symptoms, subjective ratings of anxiety, or skin conductance level in response to the challenge. Results are discussed in the context of premenstrual exacerbations of cognitive, as opposed to physical, panic attack symptoms for high AS women, and the clinical implications of these findings.
... The anxiety sensitivity (AS) construct, originated by Reiss and McNally (Reiss, 1991), describes how sensitive a person is to the sensations of anxiety due to their belief that such sensations may result in harmful cognitive, physical, or social consequences. AS demonstrates a significant, positive correlation with anxiety disorder symptoms and diagnoses for both children/adolescents (Cox et al., 2001;Muris, Schmidt, Merckelbach, & Schouten, 2001) and adults (Bernstein, Zvolensky, Marshall, & Schmidt, 2009;Olatunji & Wolitzky-Taylor, 2009;Schmid, Zvolensky, & Maner, 2006). Indeed, the results of a recent meta-analytic review of 117 studies suggest that AS is most strongly associated with posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic/agoraphobia (Naragon-Gainey, 2010). ...
There is a well-established and clinically meaningful relation between the cognitive-affective-based construct of anxiety sensitivity (AS) and risk for the development and maintenance of anxiety psychopathology (B. J. Cox, Fuentes, Borger, & Taylor, 2001). Research findings within this area have revealed mixed results; however, there is evidence to suggest that some individuals with anxiety disorder diagnoses may demonstrate enhanced subcortical arousal (e.g., exaggerated startle response to unexpected, aversive stimuli [A. M. Waters et al., 2008], and deficient prepulse inhibition [PPI; S. Ludewig, Ludewig, Geyer, Hell, & Vollenweider, 2002]), it is presently unclear whether these differences are found within the general population. To address this gap in the extant literature, the current investigation examined the impact of AS on acoustic startle response magnitude and PPI. Results indicated that individuals high and low in AS differ with regard to subcortical measures of arousal, with individuals expressing high levels of AS demonstrating enhanced startle response and deficient PPI. Results are discussed in terms of the role of the cognitive-affective-based factor of AS in the context of physiologic markers for vulnerability for anxiety psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
... The challenge was a single 4-minute administration of 10% CO 2 -enriched air (10% CO 2 , 21% O 2 , 69% NO 2 ). This time period has been successfully employed in past challenge work (Bernstein, Zvolensky, Marshall, & Schmidt, 2009), and 10% CO 2 is a validated dosage, as indexed by pre-post change in physiological arousal indices and selfreported distress (Zvolensky & Eifert, 2000). An automated and well-established apparatus was used for CO 2 delivery (Lejuez et al., 1998). ...
The current study examined sex differences in psychological (i.e., self-reported anxiety, panic symptoms, and avoidance) and physiological (i.e., heart rate and skin conductance level) response to, and recovery from, a laboratory biological challenge. Participants were a community-recruited sample of 128 adults (63.3% women; M(age)=23.2 years, SD=8.9) who underwent a 4-min 10% CO(2)-enriched air biological challenge. As predicted, women reported more severe physical panic symptoms and avoidance (i.e., less willingness to participate in another challenge) and demonstrated increased heart rate as compared to men above and beyond the variance accounted for by other theoretically relevant variables (recent panic attack history, neuroticism, and anxiety sensitivity). Additionally, women demonstrated a faster rate of recovery with respect to heart rate compared to men. These results are in line with literature documenting sex-specific differences in panic psychopathology, and results are discussed in the context of possible mechanisms underlying sex differences in panic vulnerability.
... The second phase involved a 4-min 10% CO 2 -enriched air biological challenge (see Lejuez, Forsyth, & Eifert, 1998), a commonly employed tactic that effectively elicits fear responses (Abrams et al., 2008; Zvolensky & Eifert, 2001). This CO 2 concentration has been used successfully in past work to elicit anxious and fearful responding to bodily sensations (Bernstein, Zvolensky, Marshall, & Schmidt, 2009), although it is not fully clear what mechanisms contribute to such effects (Abrams et al.). The third phase consisted of a 5-min postchallenge recovery period. ...
The present investigation examined the main and interactive effects of posttraumatic stress symptom severity and 12-hr cigarette deprivation (cf. smoking as usual) in the prediction of anxious responding during a 4-min 10% carbon dioxide (CO₂)-enriched air laboratory challenge. It was hypothesized that 12-hr cigarette deprivation would exacerbate the effects of posttraumatic stress symptom severity with regard to anxious responding during the challenge.
Participants were 63 daily smokers (46.0% women; M(age) = 30.79, SD = 13.12, range = 18-60) who reported experiencing one or more traumatic events. The study consisted of two laboratory sessions. At the first session, participants were administered a structured diagnostic interview and completed self-reported measures. Eligible participants were randomly assigned to one of two conditions for the second session: (a) 12-hr cigarette deprivation or (b) noncigarette deprivation (i.e., smoking as usual). At the second session, participants' smoking status was biochemically verified, and all eligible participants then were administered the 10% CO₂-enriched air laboratory challenge protocol.
The main and interactive effects of posttraumatic stress symptom severity and the smoking-as-usual condition--not the hypothesized 12-hr cigarette deprivation condition--were significantly predictive of peri-challenge anxiety. The interactive effect of posttraumatic stress by smoking as usual was significant at Minutes 3 and 4 of the challenge specifically.
The present investigation provided novel findings related to the roles of cigarette deprivation and smoking with regard to self-reported anxious responding, among trauma-exposed smokers, during a challenge paradigm.
... For example, the hallmark of GAD – chronic, excessive and uncontrollable worry and anxiety – can be challenging to study in laboratory conditions. By contrast, the laboratory context has been used repeatedly to provoke and study panic attacks using the CO 2 challenge (e.g., Bernstein, Zvolensky, Marshall, & Schmidt, 2009) as well as compulsive checking GAD Publications 1998-2008 12 behavior using virtual environments (e.g., van den Hout & Kindt, 2003). We suggest, however, that the factors presented above only make the study of GAD more challenging, at least from a comprehensive biopsychosocial perspective. ...
The purpose of this study was to extend previous work examining publication rates for the anxiety disorders and publication topics for generalized anxiety disorder (GAD). Specifically, we examined anxiety disorder publication rates in MEDLINE and PsycINFO from 1998 to 2008. The results show: (1) that with the exception of panic disorder, there was a significant increase in the annual rate of publications for every anxiety disorder; (2) that GAD had the second lowest annual rate of publications in every year - with no more than 8% of anxiety disorder publications devoted to GAD in any given year; and (3) that GAD publications focused more often on treatment (44%) than on descriptive issues (26%), process issues (22%), and general reviews (8%). Given that citation analysis appears to be a valid indicator of research progress, the current findings suggest that research on GAD continues to lag behind research on most other anxiety disorders.
... Participants in the current report are part of a larger investigation focused on substance use behavior and emotional vulnerability. 26 The present data have not been reported before, and hence, are a novel contribution. In the current study, participants were recruited from the greater Burlington, Vermont community and college student population via newspaper advertisements and flyers that described a laboratory study on "emotion." ...
The present investigation examined marijuana use, abuse, and dependence in relation to self-reported marijuana use behaviors and motives, as well as concurrent cigarette and problematic alcohol use among a sample of young adult current marijuana users (n = 200; 44.5% women; M(age) = 21.48, SD = 6.54). Preliminary results broadly indicated that more severe forms of marijuana use (eg, dependence) were associated with a more problematic pattern of marijuana use behavior, polysubstance use, and greater motivation to use marijuana for multiple reasons. Results are discussed in relation to better understanding the underlying nature of marijuana use and its disorders among young adults.
Evidence suggests that smoking to cope among adolescents is associated with a number of problematic outcomes (e.g., greater smoking frequency, higher rates of dependence). It is thus imperative to better understand factors that may increase the likelihood of smoking to cope among adolescents. Research suggests anxiety sensitivity (AS) is associated with smoking to cope among adults, although the link between AS and coping motives for cigarette use among youth is less clear. Gender differences have also been noted in AS. The current study investigates this association using a biological challenge paradigm. Specifically, the indirect effects of anxious reactivity to bodily arousal on the relation between the physical and mental AS factors and coping motives for cigarette smoking were examined within a sample of 108 adolescent cigarette smokers. Gender was examined as a moderator. Results suggested significant indirect effects of self-reported anxiety in response to bodily arousal on the relation between physical AS and coping motives for cigarette smoking. This indirect effect was moderated by gender, such that it was significant for females but not males. Models examining AS mental concerns and psychophysiological responding to the challenge were not significant. These results suggest that, relative to their low AS counterparts, female adolescents high in physical concerns respond with elevated anxiety in response to interoceptive arousal and, in turn, endorse elevated coping-related smoking motives. Findings are discussed in terms of implications for understanding the nature and origins of coping-related smoking motives and how such information can be used to inform intervention efforts. (PsycINFO Database Record
Appetitive and defensive motivation account for a good deal of variance in personality and mental health, but whether individual differences in these systems are correlated or orthogonal has not been conclusively established. Previous investigations have generally relied on self-report and have yielded conflicting results. We therefore assessed the relation between psychophysiological indices of appetitive and defensive motivation during elicitation of these motivational states: specifically, frontal electroencephalogram asymmetry during reward anticipation and startle response during anticipation of predictable or unpredictable threat of shock. Results in a sample of psychopathology-free community members (n=63), an independent sample of undergraduates with a range of internalising symptoms (n=64), and the combination of these samples (n=127) revealed that differences in responding to the two tasks were not significantly correlated. Average coefficients approached zero in all three samples (community: .04, undergraduate: -.01, combined: .06). Implications of these findings for research on normal and abnormal personality are discussed.
The aim of the present study was to evaluate a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) (Bernstein et al. Behavior Therapy 41:515-521, 2010), as measured by the ASI-3 (Taylor et al. Psychological Assessment 19:176-188, 2007), in regard to panic attacks, anxiety symptoms, and behavioral impairment among a university sample (N = 150, n
females
= 107, M
age = 21.3 years, SD = 4.3) and a clinical sample (N = 150, n
females
= 102, M
age = 39.0 years, SD = 12.0) from Mexico City, Mexico. Findings demonstrated cross-national support for the conceptual and operational utility of the AS taxonic-dimensional hypothesis (Bernstein et al. Journal of Anxiety Disorders 20:1-22, 2007b). Specifically, (1) the FMM-based AS taxon class base rate was significantly greater among the clinical relative to the university sample; (2) risk for panic attacks was significantly greater among the AS taxon class relative to the AS normative class; and (3) continuous individual differences in AS physical and psychological concerns, within the AS taxon class, were associated with level of risk for panic attacks, as well as panic attack severity and anxiety symptom levels. Similar AS taxonic-dimensional effects were observed in relation to degree of behavioral impairment across domains of functioning. The study results are discussed with respect to their implications for better understanding the nature of AS-related cognitive vulnerability for panic and related anxiety psychopathology.
BACKGROUND: The purpose of the present study was to shed light on the latent structure and nature of individual differences in anxiety sensitivity (AS) and related risk for psychopathology. METHODS: The present study evaluated the latent structure of AS using factor mixture modeling (FMM; Lubke and Muthén, 2005) and tested the relations between the observed FMM-based model of AS and psychopathology in a large, diverse adult clinical research sample (N=481; 57.6% women; M(SD)(age)=36.6(15.0) years). RESULTS: Findings showed that a two-class three-factor partially invariant model of AS demonstrated significantly better fit than a one-class dimensional model and more complex multi-class models. As predicted, risk conferred by AS taxonicity was specific to anxiety psychopathology, and not to other forms of psychopathology. LIMITATIONS: The sample was not epidemiologic, self-report and psychiatric interview data were used to index AS and psychopathology, and a cross-sectional design limited inference regarding the directionality of observed relations between AS and anxiety psychopathology. CONCLUSIONS: Findings are discussed with respect to the nature of AS and related anxiety psychopathology vulnerability specifically, as well as the implications of factor mixture modeling for advancing taxonomy of vulnerability and psychopathology more broadly.
Anxiety sensitivity (AS) is a trait-like characteristic capturing fears of the experience of anxiety and the potential psychological, somatic, or social consequences associated with anxiety. Recently, research has provided evidence for the latent structure of AS suggesting two discrete types, i.e. a taxonic class and a complement class. Investigations have identified combinations from the 16-items of the Anxiety Sensitivity Index (ASI) that are able to predict the taxon class of AS, referred to as the ASI taxon scales.
The current study investigated the ability of a new ASI taxon scale, comprised of the seven overlapping items of the previously identified ASI taxon scales, to predict CO(2) challenge responses. This was examined in a sample of 387 nonclinical participants presenting for an AS treatment program. Participants completed a battery of questionnaires and a 20% CO(2) challenge as part of the program.
Analyses indicated that the ASI taxon scale uniquely predicted CO(2) challenge response, whereas the complement scale did not have a significant association.
The present study provides the first evidence of the AS taxon having the ability to predict an exaggerated fear response to a novel stressor known to be associated with anxiety psychopathology. Implications of these findings are discussed.
The aim of this study was to evaluate the associations between a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) and posttraumatic stress, panic, generalized anxiety, depression, psychiatric multimorbidity, and quality of life among a young adult sample exposed to traumatic stress (N = 103, n (females) = 66, M (age) = 23.68 years, SD (age) = 9.55). Findings showed support for the conceptual and operational utility of the AS taxonic-dimensional model with respect to concurrent transdiagnostic vulnerability among trauma-exposed adults. Specifically, relative to the low-AS group, the high-AS group demonstrated elevated levels of panic, depressive, and posttraumatic stress symptom severity as well as greater psychiatric multimorbidity and poorer quality of life. Furthermore, past-month MDD, GAD, PTSD, and panic attacks occurred nearly exclusively among the high-AS group. Continuous AS physical and psychological concerns scores were found to be significantly related to levels of panic and posttraumatic stress symptom severity, psychiatric multimorbidity as well as panic attack status only among the high-AS group and not among the low-AS group. Findings are discussed with respect to their implications for the conceptual and operational utility of the FMM-based taxonic-dimensional model of AS, related vulnerability for psychopathology in the context of trauma, and the clinical implications of these findings for assessment and intervention.
The present study tested multiple, competing latent structural models of anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007). Data were collected from 3 sites in North America (N=634). Participants were predominantly university students (M=21.3 years, SD=5.4). ASI-3 data were evaluated using an integration of mixture modeling and confirmatory factor analysis-factor mixture modeling (FMM; Muthén, 2008). Results supported a 2-class 3-factor partially invariant model of AS. Specifically, the FMM analyses indicated that AS is a taxonic (two-class) variable, and that each categorical class has a unique multidimensional factor structure. Consistent with the specific point-prediction regarding the hypothesized parameters of the putative latent class variable, FMM indicated that the putatively "high-risk" subgroup of cases or latent form of AS composed approximately 12% of the studied sample whereas the putatively "normative" subgroup of cases or latent form of AS composed 88% of the sample. In addition, the AS Physical and Psychological Concerns subscales, but not the Social Concerns subscale, most strongly discriminated between the two latent classes. Finally, comparison of continuous levels of AS Physical and Psychological Concerns between FMM-derived AS latent classes and independent clinical samples of patients with anxiety disorders provided empirical support for the theorized taxonic-dimensional model of AS and anxiety psychopathology vulnerability. Findings are discussed in regard to the implications of this and related research into the nature of AS and anxiety psychopathology vulnerability.
The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M(age)=21.0 years, SD=7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.
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)
Anxiety sensitivity (AS) has been defined as the fear of anxiety and anxiety-related sensations, and evidence suggests that AS plays an important role in the psychopathology of panic. It is entirely unclear whether the relation between AS and panic should be attributed to one (or more) of the AS group factors, the general AS factor, or to factors at both levels of the AS hierarchy. The authors reanalyzed data presented earlier by R. M. Rapee, T. A. Brown, M. A. Antony, and D. H. Barlow (1992) to tease apart the contributions of the different levels of the AS hierarchy to fear responses to hyperventilation and 5.5% carbon dioxide challenges. ne results demonstrated that AS-Physical Concerns is the only one of the three AS group factors that contributes to relations with fear responses to these two challenges. However, AS-Mental Incapacitation Concerns had a stronger positive linear association with depressed mood than did AS-Physical Concerns.
Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.
The authors used a semistructured clinical interview and a self-report battery of questionnaires to measure key features of the anxiety disorders in a large sample of patients seeking treatment at an outpatient anxiety disorders clinic and in a no mental disorder group. Results were consistent with hierarchical models of anxiety and the anxiety disorders such as the model implicit in American Psychiatric Association (1987, 1994) and trait models positing a trait diathesis common to all the anxiety disorders. A higher order general factor differentiated each of the patient groups from the no mental disorder group. Several lower order factors provided the basis for differentiation among the patient groups. Conclusions regarding the degree to which models predicting a hierarchical structure of anxiety and the anxiety disorders are empirically supported must await replication of these results with additional samples.
The present study explored psychological predictors of response to a series of three 25 second inhalations of 20% carbon dioxide-enriched air in 60 nonclinical participants. Multiple regression analyses indicated that only anxiety sensitivity physical concerns predicted self-reported fear, whereas both physical anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted affective ratings of emotional arousal. In contrast, the psychological concerns anxiety sensitivity dimension predicted ratings of emotional displeasure (valence), and both psychological anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted emotional dyscontrol. No variables significantly predicted heart rate. These data are in accord with current models of emotional reactivity that highlight the role of cognitive variables in the production of anxious and fearful responding to somatic perturbation, and help further clarify the particular predictors of anxiety-related responding to biological challenge.
The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. O. Lilienfeld, S. M. Turner, and R. G. Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures. In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study tested the notion that a sense of control can mitigate anxiety and panic attacks caused by the inhalation of 5.5% carbon dioxide (CO2)-enriched air. Twenty patients with panic disorder inhaled a mixture of 5.5% CO2-enriched air for 15 minutes. All patients were instructed that illumination of a light directly in front of them would signal that they could decrease the amount of CO2 that they were receiving, if desired, by turning a dial attached to their chair. For ten patients, the light was illuminated during the entire administration of CO2. For the remaining ten patients, the light was never illuminated. In fact, all patients experienced the full CO2 mixture, and the dial was ineffective. When compared with patients who believed they had control, patients who believed they could not control the CO2 administration (1) reported a greater number of DSM-III-revised panic attack symptoms, (2) rated the symptoms as more intense, (3) reported greater subjective anxiety, (4) reported a greater number of catastrophic cognitions, (5) reported a greater resemblance of the overall inhalation experience to a naturally occurring panic attack, and (6) were significantly more likely to report panic attacks. These data illustrate the contribution of psychologic factors to laboratory induction of panic attacks through inhalation of 5.5% CO2-enriched air.
Three studies were conducted to compare the ability of a measure of fear of physical sensations (Anxiety Sensitivity Index; ASI) and a measure of trait anxiety (State-Trait Anxiety Inventory; STAI) to predict response to hyperventilation. In the first study subjects (N = 43) were selected who differed in scores on the ASI but were equated on levels of trait anxiety. Two other studies were conducted in which subjects (ns = 63 and 54) varied randomly on ASI and STAI scores. The results indicate that scores on the ASI account for a significant proportion of variance in the response to hyperventilation that is not accounted for by scores on the STAI.
The authors review various definitions of panic and recent conceptual and empirical evidence that led to the revised definitions of panic in the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV; American Psychiatric Association, 1994). The DSM-IV definitions of panic are more precise and more empirically based than those contained in the DSM-III-R, but are designed primarily for clinicians rather than researchers. Thus, it is possible that definitions of panic used in research under the DSM-IV system will encompass a heterogeneous mix of emotional phenomena. Recommendations on essential components of a conservative definition of panic are proposed for research purposes. Implications of this definition for limited symptom attacks and "non-fearful" panic are elaborated and related to final definitions of panic attacks and panic disorder in the DSM-IV.
Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.
Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.
The question of whether to view psychopathology as categorical or dimensional continues to provoke debate. We review the many facets of this argument. These include the pragmatics of measurement; the needs of clinical practice; our ability to distinguish categories from dimensions empirically; methods of analysis appropriate to each and how they relate; and the potential theoretical biases associated with each approach. We conclude that much of the debate is misconceived in that we do not observe pathology directly; rather, we observe its properties. The same pathology can have some properties that are most easily understood using a dimensional conceptualization while at the same time having other properties that are best understood categorically. We suggest replacing Meehl's analogy involving qualitatively distinct species with an alternative analogy with the "duality" of light, a phenomenon with both wave- and particle-like properties.
Species of the genus Pnigalio Schrank are ectoparasitoids on several pest insects. Most species are polyphagous parasitoids of lepidopteran and dipteran leafminers. Despite their potential economic importance, information on intraspecific phenotypic variability is insufficient. Pnigalio soemius (Walker) was reared at five different temperatures (10, 15, 20, 25, 30 degrees C) on mature larvae of one of its natural hosts, Cosmopterix pulchrimella Chambers (Lepidoptera: Cosmopterigidae), to investigate the influence of temperature on size, colour and other morphological traits, and to measure the range of variation of several characters. Thermal developmental reaction norms, which represent the effect of temperature during growth and development on the value of some adult traits, were produced. The results confirmed the influence of temperature on numerous characters and that these characters had a larger range of variation than realized previously in the construction of taxonomic keys to species. In particular, the number and position of the costulae on the propodeum and colour of the gaster were affected by rearing temperature.
The hypothesis that anxiety sensitivity (AS) is a risk factor for panic genesis has obtained compelling support, but the clinical/practical importance of AS in panic genesis has been questioned. In addition, the association between panic experience and AS increase has not been clearly demonstrated. Through this 1-year longitudinal study among college students, the authors replicated the vulnerability effect of AS on panic onset. By measuring AS according to its hierarchical structure, the authors found an AS subfactor--AS-Mental Incapacitation Concerns--to be a significant predictor of panic onset. The authors also demonstrate that AS is not only statistically significant but also clinically/pragmatically important for the onset of panic. The association between panic and increased AS was confirmed in this study, although it remains for future research to conclude whether this association should be attributed to a "scar effect" of panic. Theoretical and methodological issues regarding tests of the scar effect hypothesis are discussed.
This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), as indexed by the 16-item Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986), by using taxometric and factor-analytic approaches in an integrative manner. Taxometric analyses indicated that AS has a taxonic latent class structure (i.e., a dichotomous latent class structure) in a large sample of North American adults (N=2,515). As predicted, confirmatory factor analyses indicated that a multidimensional 3-factor model of AS provided a good fit for the AS complement class (normative or low-risk form) but not the AS taxon class (high-risk form). Exploratory factor analytic results suggested that the AS taxon may demonstrate a unique, unidimensional factor solution, though there are alternative indications that it may be characterized by a 2-factor solution. Findings suggest that the latent structural nature of AS can be conceptualized as a taxonic latent class structure composed of 2 types or forms of AS, each of these forms characterized by its own unique latent continuity and dimensional structure.
Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.
• The current study tested the notion that a sense of control can mitigate anxiety and panic attacks caused by the inhalation of 5.5% carbon dioxide (CO2)—enriched air. Twenty patients with panic disorder inhaled a mixture of 5.5% CO2-enriched air for 15 minutes. All patients were instructed that illumination of a light directly in front of them would signal that they could decrease the amount of CO2 that they were receiving, if desired, by turning a dial attached to their chair. For ten patients, the light was illuminated during the entire administration of CO2. For the remaining ten patients, the light was never illuminated. In fact, all patients experienced the full CO2 mixture, and the dial was ineffective. When compared with patients who believed they had control, patients who believed they could not control the CO2 administration (1) reported a greater number of DSM-III—revised panic attack symptoms, (2) rated the symptoms as more intense, (3) reported greater subjective anxiety, (4) reported a greater number of catastrophic cognitions, (5) reported a greater resemblance of the overall inhalation experience to a naturally occurring panic attack, and (6) were significantly more likely to report panic attacks. These data illustrate the contribution of psychologic factors to laboratory induction of panic attacks through inhalation of 5.5% CO2enriched air.
Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss’s (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS—the ASI-R—which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss’s expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.
The present investigation evaluated the Anxiety Sensitivity (AS) taxon using the 16-item Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986) and its relation with two theoretically relevant cognitive processes associated with panic vulnerability: bodily vigilance and perceived uncontrollability over anxiety-related events. Taxometric analyses of 589 young adults indicated that the latent structure of AS was taxonic with an estimated base rate ranging between 13% and 14%. As predicted, an 8-item ASI Taxon Scale accounted for significant variance above and beyond that accounted for by the full-scale ASI total score in terms of bodily vigilance and perceived controllability of anxiety-related events. Moreover, after accounting for the variance explained by the full-scale ASI total score, the total score for the 8 ASI items not included in the ASI Taxon Scale was associated with significant variance in these same dependent measures, but it was in the opposite direction from that predicted by contemporary panic disorder theory. Dichotomous taxon membership accounted for significant variance above total ASI scores for bodily vigilance but not perceptions of control for anxiety-related events. These findings are discussed in terms of their theoretical implications for the study of AS and panic vulnerability.
Diathesis-stress models have long been cited in conceptualizations of the etiology of clinical disorders (Meehl, 1962; Rosenthal, 1970). These models suggest that specific types of psychopathology arise from a combination of vulnerability factors (diatheses) and life stress (Fowles, 1992). Despite an accumulating body of evidence demonstrating that specific diatheses, in the context of life stress, predict depressive symptomatology (Metalsky, Joiner, Hardin, and Abramson, 1993; Satterfield, Folkman, and Acree, 2002), few attempts have been made to directly test diathesis-stress models of anxiety disorders. Recent research, however, has indicated anxiety sensitivity (AS), defined as the fear of bodily sensations, interacts with life stress to predict panic-related problems (Zvolensky, Kotov, Antipova, and Schmidt, in press; Zvolensky and Schmidt, 2003). Although promising, extant panic-relevant diathesis-stress research has not addressed recently emerging taxometric research indicating that AS may be characterized by an underlying qualitative discontinuity between normal and pathological groups rather than an evenly graded dimension. Such neglect is unfortunate, as failure to accurately conceptualize the latent structure of the diathetic component of the panic-relevant diathesis-stress model may (1) limit the model's construct valid representation of the panic-relevant diathesis-stress phenomenon; and (2) preclude psychopathologists from further elucidating the specific processes underlying panic vulnerability. To begin to address this gap in the literature, the present study sought to test a panic-relevant diathesis-stress model using a taxometrically-derived categorical index of AS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
151 college students to whom the Anxiety Sensitivity Index (ASI) was administered in 1984 were retested in 1987 for anxiety sensitivity and tested for panic attacks, state-trait anxiety, and anxiety disorder history. ASI scores in 1984 predicted the frequency and intensity of panic attacks in 1987. Compared to Ss with low 1984 ASI scores, Ss with high 1984 ASI scores were 5 times more likely to have an anxiety disorder during the period 1984 to 1987. Test-retest reliability for the ASI across 3 yrs was .71. Data provide evidence for the stability of anxiety sensitivity over time and that the concept of anxiety sensitivity should be considered a personality variable. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book discusses the MAXCOV-HITMAX procedure to reveal the underlying rationale of MAXCOV in simple terms and show how this technique can be used in a variety of disciplines by researchers in their taxonomic work. The misconceptions concerning the psychometric and philosophical status of taxonic constructs are discussed, and several meanings of the term "taxon" and the philosophy of science that has guided the authors' work in this area are reviewed. The authors describe MAXCOV-HITMAX and demonstrate how MAXCOV uses the General Covariance Mixture Theorem to test taxonic hypotheses (using utility programs written in S-Plus to do the taxometric procedures). Two new taxometric procedures are introduced, MAXEIG-HITMAX and L-Mode, for the simultaneous analysis of multiple taxon indicators. These techniques are contrasted with other data clustering and classification methods, such as latent profile analysis and Q-technique factor analysis. Guidelines are provided for corroborating taxonic models and the role of taxometrics in scientific methodology is described. The book is intended for professionals and practitioners in statistics, evaluation, survey research, sociology, psychology, education and communication research, policy studies, management, public health, and nursing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychopathology research is the scientific foundation for legitimate and credible forms of clinical practice and the ethical delivery of mental health services. Experimental psychopathology is a subfield of psychopathology research; its aims are to elucidate variables and processes that contribute, either in whole or in part, to the etiology, exacerbation, or maintenance of abnormal behavior. To date, experimental psychopathology has been poorly understood with regard to its identity, aims, history, and relevance for clinical practice. In this article, we critically review and address the role of experimental psychopathology in the contemporary field of clinical science and practice. Overall, we suggest that experimental psychopathology can maintain its important contributions to the field, and perhaps more important, adapt to the current health care context to have an even larger impact on directing conceptual and empirical analyses of core psychopathology processes.
Taxometrics is a statistical tool that can be used to discern psychopathological categories from continua. In this study,
taxometric analyses were conducted to determine whether a psychopathological category (or taxon) underlies a cognitive vulnerability
to panic (i.e., fear of anxiety symptoms and body vigilance). The construct was operationalized with 3 variables: the Anxiety
Sensitivity Index, the Body Sensations Questionnaire, and the Body Vigilance Scale. The test was performed in a large nonclinical
sample (N = 1,224). Analyses and consistency tests support the taxonic conjecture for the existence of a latent cognitive vulnerability taxon
with a base rate of about 18% in this population. Moreover, tests of the taxon’s utility indicated that taxon membership has
incremental validity in predicting future panic attacks.
Despite advances in our understanding of the nature of anxiety-related responding during periods of elevated bodily arousal, it is not necessarily evident by what psychological mechanisms anxiety is produced and maintained. To address this issue, researchers have increasingly employed biological challenge procedures to examine how psychological factors affect anxious responding during elevated bodily arousal. Of the challenging procedures, hyperventilation and inhalations of carbon dioxide-enriched air have been among the most frequently employed, and a relatively large body of literature using these procedures has now accumulated. Unfortunately, existing reviews do not comprehensively examine findings from hyperventilation and inhalations of carbon dioxide studies, and only rarely the methodological issues specific to these studies. To address these issues, we review the voluntary hyperventilation and carbon dioxide-enriched air literature in order to identify the primary methodological issues/limitations of this research and address the extent to which psychological variables influence anxious responding to such challenges. Overall, we conclude challenge research is a promising paradigm to examine the influence of psychological variables in anxious responding, and that such work will likely be enhanced with greater attention to psychological process issues.
The present investigation attempted to clarify whether a lack of control affects self-reported anxiety and physiological reactivity during eight administrations of 20% carbon dioxide (CO2)-enriched air. Thirty individuals who reported high levels of suffocation fear were randomly assigned to a condition that either permitted or did not permit control over the offset of CO2 gas inhalation. In contrast to participants with control, participants without control reported significantly more self-reported anxiety and intense panic experiences. Although 20% CO2-enriched air reliably evoked physiological arousal for both groups, no significant between-group differences for peripheral indices of somatic reactivity were observed. We discuss the implications of these findings for understanding how control over aversive environmental stimuli mediates anxious responding in panic disorder.
Although researchers successfully have used carbon dioxide-enriched air in experimental and clinical preparations, its functional properties may differ across laboratories due to procedural differences. Additionally, current procedures may be too simplistic for more complex experimental designs. To address these issues, we present three devices for administering carbon dioxide-enriched air. Although these devices differ concerning variables such as mode of operation, ease and cost of implementation, and complexity of experimental designs that may be undertaken, a reasonable level of standardization may be achieved because the inhalations experienced by participants are functionally equivalent across devices. We discuss advantages and disadvantages of these devices regarding experimental panic provocation and aversive conditioning preparations.
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’.
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)
Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss's (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS--the ASI-R--which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss's expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.
To identify risk factors for onset of panic attacks in adolescents, a prospective cohort design was used to evaluate the following risk factors: negative affectivity, female sex, anxiety sensitivity, and childhood separation anxiety disorder. These risk factors were also evaluated for predicting onset of major depression to test their specificity.
The sample consisted of 2,365 high school students assessed over a 4-year period. Assessments included self-report questionnaires and structured clinical interviews. Cox proportional hazards models were used to evaluate risk.
Consistent with previous studies, prior major depression predicted onset of panic attacks and a history of panic attacks predicted onset of major depression. After adjusting for the effects of prior major depression, negative affectivity and anxiety sensitivity, but not female sex or childhood separation anxiety disorder, predicted onset of 4-symptom panic attacks. However, female sex and negative affectivity but not anxiety sensitivity or childhood separation anxiety disorder predicted onset of major depression after adjustment for the effects of prior panic attacks.
Negative affectivity appears to be a nonspecific risk factor for panic attacks and major depression, whereas anxiety sensitivity appears to be a specific factor that increases the risk for 4-symptom panic attacks in adolescents.
The goal of this study is to test the hypothesis that panic attacks are a marker of core psychopathological processes across mental disorders and that there are distinct syndromal patterns of psychopathology associated with specific subtypes of panic attack that can be distinguished by age and associated fear at onset.
Data were drawn from the National Comorbidity Survey, a community-based household sample (n = 8,098) representative of the United States adult population. Four panic subtypes were identified based on findings from clinical studies and on our hypothesis. Multivariate logistic regression models were used to identify sociodemographic characteristics, panic symptoms and mental disorder correlates of each subtype.
Results of multivariate logistic regression analyses identified distinct sociodemographic characteristics, panic symptoms, psychiatric comorbidity, suicidal behavior and use of services associated with early-onset and late-onset panic with and without fear/anticipatory anxiety at the first attack.
These findings provide support for the hypothesis that panic attacks are a marker of core underlying psychopathological processes and introduce new, preliminary evidence to support the possible existence of different panic subtypes in the general population. While these results need replication, these findings suggest that the specific type of comorbidity among those with panic attacks can be predicted to a large degree by the age and associated fear/anticipatory anxiety at the onset of the panic attacks.
Anxiety sensitivity refers to fears of anxiety-related sensations. Most often measured by the Anxiety Sensitivity Index (ASI), anxiety sensitivity is a dispositional variable especially elevated in people with panic disorder. Regardless of diagnosis, ASI scores often predict panic symptoms in response to biological challenges (e.g., carbon dioxide inhalation) that provoke feared bodily sensations. Prospective longitudinal studies indicate that scores on the ASI predict subsequent spontaneous attacks, indicating that elevated anxiety sensitivity is a risk factor for panic and perhaps panic disorder. Cognitive behavioral treatment reduces anxiety sensitivity in panic patients, perhaps protecting against relapse. Imipramine likewise decreases anxiety sensitivity.
The present investigation evaluated anxious and fearful responding to bodily sensations as a function of panic disorder (PD) and smoking status. Participants completed a voluntary hyperventilation procedure that elicits panic-relevant bodily sensations. Psychophysiological data were collected throughout the study procedures. Assessments of anxiety and bodily distress were conducted pre-challenge baseline, post-hyperventilation, and during a recovery period following the challenge. Results indicated that smokers with PD reported greater levels of anxiety and bodily distress than smokers without PD and than nonsmokers with PD at the post-challenge assessment and recovery period. No differences in autonomic responding were evident during the challenge or in the recovery phase. In terms of rate of recovery, the linear decrease in anxiety, but not bodily distress, was significantly more steep for nonsmokers with PD than for smokers with PD. These findings are discussed in relation to better understanding the potential role that smoking may play in terms of anxious and fearful responding to bodily sensations.
To investigate a cognitive diathesis-stress model, the present study evaluated the main and interactive effects of anxiety sensitivity (AS) and exposure to aversive conditions (past month) in predicting theoretically relevant panic vulnerability variables in an epidemiologically defined sample from Russia (N = 390). Consistent with expectation, findings suggested that the combination of high levels of exposure to aversive conditions and high AS physical concerns predicted panic attacks (past week) and agoraphobic avoidance above and beyond the variance accounted for by negative affect. These findings are discussed in relation to biopsychosocial theories of panic disorder, which emphasize the importance of both a cognitive diathesis and stress component in the pathogenesis of the disorder.
This paper extends previous epidemiological findings linking panic attacks with future episodes of depression and examines whether this relationship is independent of the effects of gender and neuroticism.
Composite International Diagnostic Interview (CIDI) DSM-IV diagnoses from a stratified multi-stage population survey of 10,641 Australian adults were analysed using logistic regression to examine the relationship between lifetime panic attacks, gender, neuroticism and mental disorders.
People who experienced full CIDI DSM-IV panic attacks more than 12 months ago were 4 times more likely to meet criteria for current Depressive Disorder than those who reported no attacks. Those with panic attacks in the past 12 months were 13.3 times more likely to report current Depressive Disorders. A similar pattern was also present for non-panic Anxiety Disorders (odds ratio=7.5 for lifetime, but not 12-month panic attacks, and 21.46 for 12-month panic attacks) and for Substance Use Disorders (2.1 and 4.6, respectively) suggesting a broader relationship with psychopathology than previously reported. For each of these groupings of mental disorders, panic attacks accounted for significant variability over and above the effects of gender, neuroticism, and comorbid Anxiety Disorders.
Panic attacks are associated with current and future Anxiety, Depressive, and Substance Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism.
Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity (AS) among 371 youth. Anxiety sensitivity was indexed by the 18-item Childhood Anxiety Sensitivity Index (CASI; Silverman et al., J. Clin. Child Psychol. (1991), 20, 162-168). Two sets of manifest indicators of AS were constructed using the CASI: (1) three item-parcel manifest indicators: disease concerns, unsteady concerns, and mental illness concerns; and (2) nine single-item indicators representing each of these three facets of AS. Results from standard and short-scale MAXCOV procedures, internal consistency tests, analyses of simulated Monte Carlo data, and MAMBAC external consistency tests indicated that the latent structure of anxiety sensitivity among youth was taxonic. Estimated base rate of the observed AS taxon ranged between 13.6 and 16.5%. The present findings are discussed in terms of theoretical implications for the study of AS and vulnerability for anxiety psychopathology.
The present investigation comparatively evaluated the latent class structure and parameters of anxiety sensitivity (AS) among female and male youth using the Childhood Anxiety Sensitivity Index. Participants were 4462 adolescents (2189 females) in grades 7-12 (M(age)=15.6 years). Consistent with prediction, taxometric analyses indicated the latent structure of AS was taxonic in both males and females, demonstrating the taxonic latent structure of AS is similarly observed across gender. Also consistent with prediction, the base rate of the AS taxon differed between genders -- higher for females (12%) compared to males (7%). These findings are discussed in terms of their implications for the study of AS and panic vulnerability among youth.
This study evaluated the anxiety sensitivity taxon using the 16-item Anxiety Sensitivity Index in relation to 2 criteria relevant to post-traumatic stress disorder; post-traumatic stress disorder symptom severity as indexed by the Post-Traumatic Diagnostic Scale, and post-traumatic cognitions as indexed by the Post-Traumatic Cognitions Inventory. Taxometric analyses of data collected from 331 young adults indicated that the latent structure of anxiety sensitivity was taxonic with an estimated base-rate range of 11-12%. As predicted, an 8-item Anxiety Sensitivity Index Taxon Scale accounted for significant variance above and beyond that accounted for by negative affectivity and the full-scale Anxiety Sensitivity Index total score in terms of both criteria. Moreover, after accounting for variance explained by the full-scale Anxiety Sensitivity Index total score and negative affectivity, the sum score for the 8 Anxiety Sensitivity Index items not included in the Anxiety Sensitivity Index Taxon Scale was associated with significant variance in these same dependent measures, but the relation was in the opposite direction to that predicted by theory. These findings are discussed in terms of theoretical and clinical implications for the study of anxiety sensitivity and post-traumatic stress disorder vulnerability.
Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index--Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.
Anxiety-related responding to, and recovery from, a 5-min 10% carbon dioxide-enriched air presentation among 80 participants with no history of psychopathology was examined. Half of participants were instructed to suppress challenge-induced emotional responses, whereas their matched counterparts were instructed to observe such responses. Responding from immediately post-challenge through a 10-min recovery period was analyzed as a function of Anxiety Sensitivity-Physical Concerns and experimental condition using individual growth curve modeling. Anxiety Sensitivity-Physical Concerns moderated the effect of suppression only on emotion valence during recovery. In terms of main effects, suppression resulted in increased heart rate during recovery and Anxiety Sensitivity-Physical Concerns was positively associated with post-challenge self-reported anxiety. Results are discussed in terms of the potential role of inhibition-oriented affect regulation processes in the etiology of panic disorder.
The present investigation evaluated associations between lifetime panic attacks and lifetime alcohol use, abuse, and dependence. Specifically, the relations between lifetime panic attacks and alcohol use, abuse, and dependence were examined after controlling for theoretically relevant variables of comorbid psychopathology and polysubstance use.
Data for this study were obtained from a large statewide survey, the Colorado Social Health Survey. Participants were contacted using randomly sampled household addresses (response rate was 72%) and interviews took place in participants' homes.
The study consisted of a representative sample of the Colorado general adult population (n = 4,745; 52% women).
The Diagnostic Interview Schedule (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [3rd ed]. Washington [DC]: Author. 1980) was administered to obtain Axis I diagnoses.
After controlling for theoretically relevant variables of comorbid psychopathology and polysubstance use, a lifetime history of panic attacks was significantly associated with alcohol dependence but not alcohol use or abuse. In addition, among participants reporting a lifetime history of both panic attacks and alcohol abuse or dependence, the number of participants for whom panic attacks developmentally preceded the onset of alcohol use problems was significantly greater (85.5%) than the number of participants for whom alcohol use problems preceded the onset of panic attacks (13.4%) or the number of participants for whom these problems developed at the same age (2.2%).
These data suggest panic attacks, particularly of early onset, may serve as a risk marker for alcohol dependence.
Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N=404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy 1986; 24: 1-8.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.
The primary aim of this study was to evaluate the individual and combined influence of anxiety sensitivity (AS) and gender on the longitudinal prediction of posttraumatic symptoms. A large nonclinical sample of young adults (n=404) was prospectively followed over approximately 18 months. The primary findings indicated that gender and AS were uniquely associated with posttraumatic symptom levels during the follow-up period. Moreover, AS appeared more strongly (positively) related to posttraumatic stress symptoms during the follow-up period among females than males. These data provide novel prospective evidence regarding the interplay of relatively well-established risk factors implicated in the maintenance of posttraumatic stress symptoms.