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Selective Processing Biases in Anxiety-sensitive Men and Women
Cognition and Emotion
Abstract and Figures
Two studies were designed to establish whether high anxiety sensitive (AS) university students selectively process threat cues pertaining to their feared catastrophic consequences of anxiety, and to examine potential gender differences in the selective processing of such threat cues among high versus low AS subjects. Forty students (20 M; 20 F) participated in Study 1. Half were high AS and half low AS, according to scores on the Anxiety Sensitivity Index (ASI). Subjects completed a computerised Stroop colournaming task involving social/psychological threat (e.g. EMBARRASS; CRAZY), physical threat (e.g. CORONARY; SUFFOCATED), and neutral (e.g. MOTEL; TOWEL) target words. High AS subjects demonstrated more threat-related interference in colour-naming than did low AS subjects, overall. High AS menevidencedgreater interference relative to low AS men only for the social/psychological threat stimuli; highAS women evidencedgreater interference relative to low AS women only for the physical threat stimuli. Study 2 was designed to replicate and extend the novel Study 1 finding of a cognitive bias favouring the processing of social/psychological threat cues among high AS men. Participants were 20 male university students (10 high AS; 10 low AS). In addition to social/psychological threat, physical threat, and neutral words, a category of positive emotional words (e.g. HAPPINESS; CELEBRATION) was included as a supplementary control on the Stroop. Consistent with Study 1, high AS males evidenced greater Stroop interference than did low AS males, but only for social/psychological threat words. No AS group differences in Stroop interference were revealed for the physical threat or positive words. Clinical implications, and potential theoretical explanations for the gender differences, are discussed.
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... In a collaboration with my former graduate student Susan Buffett-Jerrott, we reasoned that the selective attention to physical threat words on the Stroop observed in the Stewart et al.'s (1998) study should translate into selective attention to internal arousal sensations among high AS individuals, and hence greater interoceptive sensitivity (Stewart, Buffett-Jerrott, et al., 2001). We studied this in the lab through a heartrate awareness task with high and low AS individuals selected according to scores on the original ASI (Peterson & Reiss, 1992). ...
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.
... According to previous research, students with high anxiety sensitivity levels have a cognitive bias in processing social and psychological stimuli [34]. This could be related to a strong feeling of threat and stress from school, which would end up generating burnout, as both factors (anxiety and depression) have been found to be predictors of emotional exhaustion [35]. ...
(1) Background: Increased stress and study overload during adolescence could be related to academic burnout. Anxiety sensitivity of students seems to affect burnout levels, while emotional intelligence enables emotion management under stressful conditions. The objective of this study is to analyze the roles of anxiety sensitivity and emotional intelligence in academic burnout. (2) Methods: In this quantitative cross-sectional study conducted in Spain, the sample comprised 1287 high school students aged 14 to 18 who filled out the Maslach Burnout Inventory-General Survey, the Spanish version adapted for high school students of the Anxiety Sensitivity Index-3, and Brief Emotional Intelligence Inventory. (3) Results: Anxiety sensitivity was significantly higher in cynicism and emotional exhaustion. Furthermore, the mediation analysis showed that high anxiety sensitivity directly affected student exhaustion, cynicism, and efficacy levels. These effects were mediated mainly through stress management but also through the effect of stress management on mood, both emotional intelligence factors. (4) Conclusions: The academic changes that occur during high school hinder engagement and performance. Promoting the development of emotional skills would enable young people to manage their emotions when they become overwhelming and diminish their lack of interest and exhaustion in the classroom.
... In line with this, McNally (1990) asserts that anxiety sensitivity (AS) is a distinct component from that of general trait anxiety. There may be some effect of gender though, as Stewart, Conrod, Gignac and Pihl (1998) found that males high in AS showed attentional bias toward social/psychological threat as well as health threat, whereas females high in AS showed attentional bias toward health threat only. The participants were predominantly females in this study. ...
p>The literature review explores the nature of health anxiety or hypochondriasis, and discusses theoretical models of the disorder. The focus is upon cognitive-behavioural formulations of health anxiety, including attentional processes and the role of linguistic and pictorial information. Attentional bias toward threatening stimuli in other anxiety disorders is discussed. This includes consideration of the non-unitary nature of attentional bias where processes of vigilance towards, and maintenance of attention upon, threat stimuli are differentiated. Given that cognitive-behavioural models of hypochondriasis conceptualise the disorder as an anxiety about health, it is argued that exploration of attentional bias in health anxiety is also useful. The empirical study examines the occurrence of attentional bias toward health-threat stimuli in non-clinical student participants, who are anxious or non- anxious about health-related matters. The study also investigates whether format of the health-threat stimuli (word or pictorial) and duration of stimulus presentation has an effect, in terms of attentional bias. Results indicate the occurrence of attentional bias toward briefly presented health-threat pictures, but only when groups were separated according to a measure of fear of autonomic arousal-related symptoms (the Anxiety Sensitivity Index; Peterson & Reiss, 1992). No evidence of attentional bias toward health-threat stimuli was found when groups were separated according to a conventional measure of hypochondriasis (Illness Attitudes Scale; Kellner, 1986, 1987). The results are discussed in relation to literature on health-related fears. Clinical implications and suggestions for future research are also highlighted.</p
Although control over aversive events maintains a central role in contemporary models of anxiety pathology, particularly panic disorder, there is little understanding about the emotional consequences of specific types of control processes. In the present study, offset control over 8 20% carbon dioxide-enriched air administrations was experimentally manipulated in a large nonclinical population (n = 96) varying in anxiety sensitivity (high or low) and gender. Dependent measures included self-reported anxiety, affective reports of valence, arousal, emotional control, and physiological indices of heart rate and skin conductance. High anxiety-sensitive participants who lacked offset control reported significantly greater elevations in self-reported anxiety, emotional displeasure, arousal, and dyscontrol relative to their yoked counterparts with offset control. In contrast, low anxiety-sensitive individuals responded with similar levels of cognitive and affective distress regardless of the offset control manipulation. Although the provocation procedure reliably produced bodily arousal relative to baseline, at a physiological level of analysis, no significant differences emerged across conditions. These findings are discussed in relation to offset control during recurrent interoceptive arousal, with implications for better understanding anxiety about abrupt bodily sensations.
Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety ( r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety ( r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety ( r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.
Although stressful life events increase risk for symptoms of Generalised Anxiety Disorder (GAD), we know little about mechanisms that increase GAD symptoms during times of stress. Despite evidence that self-referential processing contributes to other forms of psychopathology, namely depression, it is unknown whether self-referential processing also contributes to symptoms of GAD. Thus, we examined the association of self-referential processing with GAD symptoms in response to a naturalistic stressor (Study 1; n=135) and with anxiety-tension in response to a laboratory stressor (Study 2; n=56). In Study 1, participants completed the self-referential encoding task (SRET) in their initial weeks of university, and we assessed GAD symptoms four times across the semester. In Study 2, participants completed the SRET immediately before a laboratory stressor, and we assessed moment-to-moment changes in anxiety-tension. Greater negatively biased self-referential processing was associated with higher GAD symptoms at the start of university and greater reactivity to the laboratory stressor. In contrast, greater positively biased self-referential processing served as a protective factor associated with greater decline in symptoms over time. This study is the first to demonstrate that there are valence-specific effects of self-referential processing on anxiety, suggesting that self-referential processing may be relevant to GAD.
Background
Anxiety sensitivity (AS), or the fear of anxious arousal, is a transdiagnostic risk factor. Despite the proliferation of self-report research showing AS is related to anxiety, cognitive processes underlying AS are poorly understood. Specifically, AS may reflect processes related to early attentional orientation and response monitoring (reflecting automatic processes), or later engagement and assigning emotional salience towards stimuli (reflecting conscious processes).
Methods
To elucidate cognitive processes underlying AS, event-related potential (ERP) components were elicited in the current study during a novel implicit association task (IAT) in which participants paired self (versus other) words with anxious arousal (versus calm) words. Analyses were then conducted in a sample of community adults (N = 67; M age 39.43, SD = 15.33, 61.2% female) to investigate the association between AS and ERP markers indicative of cognitive processing derived during the IAT.
Results
AS was not related to performance on the arousal-IAT and that ERP components did not differ by IAT condition. AS predicted overall late positive potential (LPP) amplitude, particularly in the me/anxiety condition. Elevated IAT scores (reflecting greater ease pairing self-words with anxiety-words) predicted greater P300 amplitude in the me/anxiety condition.
Limitations
The sample was relatively small, and bottom-up processes were not assessed.
Conclusions
These findings are inconsistent with the claim that AS is related to top-down cognitive processes driving self-arousal automatic associations. Instead, AS may relate to cognitive processes regulating emotional engagement with stimuli. Further investigations of cognitive processes underlying AS are needed to inform novel interventions targeting AS.
El presente estudio tiene como objetivo analizar los sesgos atencionales que se desencadenan en sujetos vulnerables a mostrar fobia a las arañas. A una muestra de sujetos con alta y baja vulnerabilidad a la aracnofobia se le administraron dos pruebas: 1- Tarea Stroop clásico y 2- Tarea Stroop emocional formada por tres láminas: palabras neutras, palabras emocionales de carácter aversivo y palabras relacionadas con fobia a las arañas. Los resultados demostraron que los sujetos con alta vulnerabilidad no presentan sesgos atencionales para palabras relacionadas con su fobia. Tampoco se encontraron sesgos en atención en ansiedad rasgo-estado respecto a palabras. Por otro lado, cabe destacar que el sesgo atencional no se vio influenciado por la variable sexo de la muestra, aunque se produjeron diferencias respecto al color en que se presentaron los estímulos en las tres láminas del Stroop emocional, siendo el color negro el que produciría más interferencia debido que el color del estímulo atraería más recursos atencionales ya que se asemeja a la característica perceptiva del color negro de alguno de estos insectos.
High rates of comorbidity have been reported between PTSD and musculoskeletal pain (e.g., Asmundson & Hadjistavropolous, 2006; Asmundson et al., 1998). Comorbid PTSD and chronic pain have been associated with elevated levels of affective distress, greater perceptions of pain, interference in daily activities, and high rates of disability (Otis et al., 2003; Sherman et al., 2000). Overall, comorbid conditions of PTSD and chronic pain are associated with large personal costs for the individual and economic costs for society. The triple vulnerability model was originally proposed to account for anxiety symptoms in general, and it was later applied to the specific development of PTSD (Barlow, 2000; Barlow, 2002; Keane & Barlow, 2002). Otis and colleagues (2003) further proposed that the triple vulnerability model may account for the relationship between PTSD and chronic pain. According to the triple vulnerability model, individuals must present with a generalized biological, generalized psychological, and a specific psychological vulnerability for either of these conditions to develop (Keane & Barlow, 2002; Otis et al., 2003). In the current study, aspects of the triple vulnerability model were examined within the following groups of women: women who have PTSD without chronic pain (n = 11), women who have musculoskeletal pain without PTSD (n = 10), women with both PTSD and musculoskeletal pain (n = 10), and women without PTSD and chronic pain (n = 15). Cortisol reactivity and anxious mood were assessed before and after the Trier Social Stress Task (TSST). Participants also completed questionnaires to assess for other potential indicators of the triple vulnerability model. Results indicate that: 1) the roles of generalized biological, generalized psychological, and specific psychological vulnerabilities toward developing PTSD were supported; 2) limited findings supported the potential role of these vulnerabilities toward developing chronic pain; however, results of these measures were not similar to that of PTSD (e.g., family history of chronic pain); 3) it is not thought that PTSD and chronic pain are associated with the same vulnerabilities; 4) having a diagnosis of PTSD and chronic pain was associated with an increase in symptoms across many measures utilized in the current study.
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 study investigated selective processing of emotional information in anxiety and depression using a modified Stroop color naming task. Anxious (n = 19), depressed (n = 18), and normal control (n = 18) subjects were required to name the background colors of anxiety-related, depression-related, positive, categorized, and uncategorized neutral words. Half of the words were presented supraliminally, half subliminally. Anxious subjects, compared with depressed and normal subjects, showed relatively slower color naming for both supraliminal and subliminal negative words. The results suggest a preattentive processing bias for negative information in anxiety.
Most investigators of nonclinical panic have used paper-and-pencil measures to assess the prevalence and phenomenology of panic in nonpatient samples. Although a high past-year prevalence of panic (up to 40%) has been consistently observed in these studies, the concern is raised as to whether these estimates may be inflated due to the use of questionnaire methods. To address this issue, the present study surveyed a large, adult nonclinical sample (N = 509) using the original and a modified version of the Panic Attack Questionnaire (PAQ; Norton, Dorward, & Cox, 1986), a measure frequently used in nonclinical panic research. Both PAQ versions included descriptions of a panic attack derived from DSM-III-R and questions regarding the frequency and phenomenology of past panic episodes. The Modified PAQ differed from the Original PAQ in that it embellished the panic attack description with additional information to facilitate differential self-diagnosis. Whereas the prevalence and phenomenology of panic closely approximated results of previous studies when the Original PAQ version was employed, it was found that use of the Modified PAQ resulted in significantly lower panic prevalence estimates. It is suggested that researchers exercise caution in the use of questionnaires in the assessment of panic in nonclinical samples.
Subjects performed an idiographic, computerised version of the modified Stroop colour-naming task after having undergone a film-induced mood manipulation designed to produce either anxiety, elation, or a neutral mood. The Stroop stimuli were words related either to the subject's positive current concerns (e.g. goals, interests), to the subject's negative current concerns (e.g. personal worries), or to neither. The results indicated that words strongly related to subject's positive as well as to negative current concerns produced significantly more Stroop interference than did words unrelated or weakly related to their current concerns. Although the films strongly influenced the subjects' moods in predicted directions initially, mood changes were largely not maintained throughout the experiment. Thus, it is not surprising that no significant interactions with word type were found. These results indicate that the “emotional Stroop effect” occurs in normal subjects as well as in anxious patients, and occurs with positive as well as with negative material of strong personal relevance.
Two groups of individuals, one high in trait anxiety and the other low in trait anxiety, performed a Stroop task in which threat, neutral, and pleasant words were presented. The results indicated clear differences between the high- and low-trait groups in their performance on this task. The low-trait group's performance was similar for all three types of sitmuli, whereas the high-trait group's responses were fastest for pleasant stimuli and slowest for threat-related stimuli. A recognition task to examine incidental learning of the “irrelevant” Stroop words showed that whilst the high-trait group had a stronger tendency to respond positively to all trials (critical and distractor) than the low-trait group, there were no differences in sensitivity between the two groups.
Previous research has demonstrated that patients with generalised anxiety disorder, phobias, and obsessive-compulsive disorder show an attentional bias towards threat cues related to their respective disorders. Two studies are presented that used a modified Stroop colour naming task to assess attentional bias in subjects with panic attacks. In Study 1, 24 panic disorder patients and 24 normal controls were presented three cards containing threat words related to physical harm, separation, or social embarrassment. Colour naming times were compared between these cards and control cards containing matched non-threat words. Reaction time differences in the two groups were in opposite directions, patients tending to be slower in colour naming threat words, and controls, faster. In Study 2, 18 non-clinical panickers and 18 controls were presented cards containing physical threat words, neutral control words, or colour words, respectively. Panickers showed greater interference than controls in colour naming threat words but not in colour naming colour words. The results are consistent with an attentional bias for threat-related material in subjects with panic attacks. Implications for psychophysiological models of 'spontaneous' panic attacks are discussed.
The present article has two related aims. First, to reply to the recent claims made by Lilienfeld, Turner, and Jacob. Second, as part of my reply I will present an integrative review of the current status of research on the nature and measurement of anxiety sensitivity (AS). In contrast to the largely unsubstantiated claims by Lilienfeld et al., there are empirical, methodological, and conceptual bases for drawing the following conclusions: (a) there are theoretical grounds for proposing that AS predicts fear-proneness; (b) correlations between the Anxiety Sensitivity Index (ASI) and measures of common fears are not artifacts of overlapping content; (c) the ASI is not a measure of panic symptoms; it measures the fear of anxiety- and panic-related sensations; (d) the factorial structure of the ASI is highly relevant to the construct validity of this instrument; (e) a unifactorial ASI is the most reliable (replicable) factor structure. However, several studies have found support for multidimensional structures. There is growing evidence that the construct of AS is probably multidimensional, consisting of at least three dimensions: fear of somatic sensations, fear of cognitive sensations, and fear of publicly observable sensations; (f) The hypothesis that the AS-by-trait anxiety interaction predicts fear proneness received partial support from a methodologically flawed study. The hypothesis was not supported by methodologically sound research. These conclusions are supported by the available literature and by new findings presented here for the first time.
This investigation attempts to establish what behaviors are both predictive and persistent throughout the developmental span. Repeated ratings of a wide variety of behaviors shown by normal children from age 5 to 16 were analyzed. The measures which at all times and for both sexes were most general (predictive) and persistent were found to group into three dimensions: withdrawal-expressiveness, reactivity-placidity, and passivity-dominance. Sex differences and over-time changes in the pattern of correlates of the three dimensions suggest that both their meaning and their expression may vary as a function of shifting developmental demands.