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Predictors of Self-Reported Anxiety and Panic Symptoms: An Evaluation of Anxiety Sensitivity, Suffocation Fear, Heart-Focused Anxiety, and Breath-Holding Duration
Abstract
The purpose of this study was to examine the extent to which anxiety-related individual difference variables predict anxious responding when individuals experience aversive bodily sensations. Thus, we explore several psychological and behavioral predictors of response to a single 25-sec inhalation of 20% carbon dioxide-enriched air in 70 nonclinical participants. Predictor variables included anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Multiple regression analyses indicated that only anxiety sensitivity significantly predicted postchallenge panic symptoms, whereas both anxiety sensitivity and suffocation fear predicted postchallenge anxiety. These data are in accord with current models of panic disorder that emphasize the role of “fear of fear” in producing heightened anxiety and panic symptoms and help clarify specific predictors of anxiety-related responding to biological challenge.
... It has been demonstrated that specific psychological self-report and biobehavioral variables predict inter-individual differences in anxious responding during exposure to feared bodily symptoms. In previous symptom provocation studies trait-like psychological variables such as anxiety sensitivity (AS) and fear of suffocation (SF) but not trait anxiety (TA) have been identified to specifically predict increased anxiety and symptom reports during exposure to feared bodily symptoms (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Norton, Pidlubny, & Norton, 1999;Rapee & Medoro, 1994;Rassovsky, Kushner, Schwarze, & Wangensteen, 2000;Shipherd, Beck, & Ohtake, 2001). AS is defined as the tendency to fear body sensations driven by concerns about potentially harmful consequences of such body sensations (McNally, 2002). ...
... The association between BHT and avoidance behavior was moderated by AS in that persons with a lower BHT only exhibited increased avoidance behavior when also reporting high AS. Several studies demonstrated that AS is a strong predictor of subjective and physiological responses to experimentally induced feared bodily symptoms (Eifert et al., 1999;Rassovsky et al., 2000;Shipherd et al., 2001). The present data extend these findings in demonstrating that AS is also related to avoidance behavior aiming to terminate unpleasant feelings of dyspnea. ...
... This corresponds to experimental evidence indicating that subjective and physiological responses to exposure to feared bodily symptoms are better explained by AS than TA (Carter, Suchday, & Gore, 2001; or SF (Shipherd et al., 2001). In contrast to this evidence are studies indicating that SF is related to subjective and physiological indicators of anxious responding to respiratory threat (Alius et al., 2013;Benke et al., 2017Benke et al., , 2018Eifert et al., 1999;Rassovsky et al., 2000). In the light of previous evidence and our present results, SF is possibly associated with subjective and physiological anxious responses but not with overt anxious behavior during respiratory threat. ...
Excessive anxiety and avoidance during provocation of body symptoms are core features of anxiety-related disorders and might contribute to the development and maintenance of these disorders. Previous studies examined psychological (anxiety sensitivity, fear of suffocation and trait anxiety) and biobehavioral (breath-holding time) predictors of reported anxiety during symptom provocation. However, the role of these predictors on avoidance of feared body symptoms remains unclear. Therefore, the present work aimed at investigating the main and interactive effects of psychological and biobehavioral variables in predicting avoidance during provocation of dyspnea that successively increased in severity. 28 of 69 participants prematurely terminated the provocation sequence, thus preventing further progression of symptom provocation. Logistic regressions revealed that higher anxiety sensitivity and lower breath-holding time were significantly associated with avoidance during exposure. Suffocation fear and trait anxiety were not related to avoidance. Moreover, there was a significant interaction between breath-holding time and anxiety sensitivity in predicting avoidance. Participants with a lower breath-holding time showed more avoidance behavior when reporting high as compared to low anxiety sensitivity. The data suggest that anxiety sensitivity and breath-holding time increase the risk to show avoidance and thus might contribute to the development and maintenance of anxiety-related disorders.
... Paivio (1985)'s conceptual framework was updated at the scope of recent applications of MI practice in sport sciences and rehabilitation where the complementarities between "Cognitive" and "Motivational" functions of MI are necessary to implement effective training interventions . Fear and anxiety negatively affect breath-holding performance (Eke and McNally, 1996, Roth et al., 1998, Eifert et al., 1999, Brandt et al., 2012. Barwood et al. (2006) reported that 2 weeks of psychological intervention including MI practice, goal-settings, and coping strategies (i.e., selftalk and relaxation) significantly increased breath-holding durations in cold water immersion, without altering breath-holding performance in normal, nonthreatening air environment. ...
... Yet, it could also be considered that MI also interferes with central system adaptive responses mediating defense mechanisms (e.g., artificial delay of the breath-holding breakpoint). For instance, distress tolerance, known as the "behavioral act of withstanding distressing internal states elicited by some type of stressor" , is frequently measured by means of breath-holding tasks (Eke and McNally, 1996, Eifert et al., 1999, Brown et al., 2002, Johnson et al., 2012. ...
The main purpose of the present work was to add substantial data regarding the psychophysiological correlates of action with respective mental representation. A total of six experimental protocols were developed to understand the mechanisms of using motor imagery concomitant and after actual practice, and the effects of exercise on motor imagery ability. According to our findings, motor imagery can very be usefull when performed concomitant with actual practice and even after an exercise session, when fatigue is most present. We demonstrate that higher levels of motor imagery ability are not always linked with greater performance enhancement. Unprecedentedly, we reported that an exercise session might even be beneficial for motor imagery ability of high-automated task. In addition, prolonged intermittent exercise session are more likely to impair motor imagery ability in comparison with continuous exercise. These findings are of special interest of sports coaches and rehabilitation professionals, which usually incorporate motor imagery into their physical training sessions
... To address this issue, this study evaluated the relation of the different subscales of the PASS with established indices of chronic pain distress (i.e., behavioral interference, perceived lack of control, affective distress, and pain severity; Coft et al., 1995), as well as other theoreticallyrelevant variables of pain duration, surgical history, lumbar range of motion, sensory experience of pain, and demographic variables. Consistent with contemporary cognitive-behavioral models of chronic pain (Asmundson, 1999) and anxiety-related disorders (Clark et al., 1989;Eifert et al., 1999), it was hypothesized that cognitive symptoms dimension of the PASS would be uniquely predictive of cognitive-affective aspects of chronic pain. In contrast, the escape and avoidance dimension of the PASS would be more predictive of behavioral interference in life activities because of the pain condition. ...
... In particular, the higher the level of correspondence between the particular pain-related anxiety domain and aspects of the pain problem that closely match that fear, the better particular pain indices of distress can be predicted. It is important to note that these findings converge with a larger body of literature in the area of anxiety-related disorders, whereby elevated anxiety is primarily produced when triggered by cues that closely match the object/event of concern (e.g., Clark et al., 1989;Cox, 1996;Eifert et al., 1999;McNally and Eke, 1996). Accordingly, it is becoming increasingly apparent that the specific tendency to respond in an anxious and fearful manner to pain-related events should be more predictive of certain cognitive and behavioral dimensions of chronic pain problems than others. ...
This study evaluated the relation of particular aspects of pain-related anxiety to characteristics of chronic pain distress in a sample of 76 individuals with low-back pain. Consistent with contemporary cognitive-behavioral models of chronic pain, the cognitive dimension of the Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert, and Gross, 1992, Pain 50:67-73) was uniquely predictive of cognitive-affective aspects of chronic pain, including affective distress, perceived lack of control, and pain severity. In contrast, the escape and avoidance dimension of the PASS was more predictive of behavioral interference in life activities. Overall, the findings are discussed within the context of identifying particular pain-related anxiety mechanisms contributing to differential aspects of pain-related distress and clinical impairment.
... Research has indicated that heightened anxiety sensitivity levels, as measured by the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), longitudinally predict panic attacks in the natural environment (Schmidt, Lerew, & Jackson, 1999) and elevated anxious responding in the laboratory (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Rassovsky, Kushner, Schwarze, & Wangensteen, 2000). Given that anxiety sensitivity is associated with heightened risk for panic attacks (Schmidt et al., 1999), it is important to clarify whether this variable is differentially affected by offset control manipulations. ...
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.
... to trait level negative affect across decades of research (Eifert et al. 1999;Schmidt et al. 2006;Zvolensky et al. 2005Zvolensky et al. , 2019. ...
Background
The novel 2019 SARS2-Coronavirus (COVID-19) has had a devastating physical health, mental health, and economic impact, causing millions of infections and hundreds of thousands of deaths. While COVID-19 has impacted the entire world, COVID-19 has disproportionately impacted low-income countries, particularly in South America, causing not only increased mortality but also increased associated mental health complaints. Anxiety sensitivity (AS), reflecting fear of anxiety-related physical sensations, may be particularly important to understand COVID-19 mental health effects among Latinx individuals in South America (Argentina). Past work suggests that Latinx individuals report greater somatization of mental health symptoms, and AS has been specifically linked to greater mental health symptoms. Yet, to date, no work has examined AS as a vulnerability factor for the negative mental health effects of COVID-19.
Method
Therefore, the current manuscript examined the association of AS with COVID-19 worry, functional impairment, anxiety, and symptom severity across two samples of adults in Argentina: a community sample (n = 105, Mage = 38.58, SD = 14.07, 69.5% female) and a clinical sample comprised of individuals with an anxiety disorder (n = 99, Mage = 34.99, SD = 10.83, 66.7% female).
Results
Results from the current study provide support for AS as a potential vulnerability factor for COVID-19-related mental health problems across both samples, and these effects were evident over and above the variance accounted for by age, sex, pre-existing medical conditions, and COVID-19 exposure.
Conclusions
These data identify AS as a potential intervention target to reduce COVID-19 mental health burden among adults in Argentina.
... There are well-accepted complementarities between cognitive and motivational functions of MI accounting for the benefits of training interventions [12]. Fear and anxiety negatively affect breath-hold performance [43][44][45][46]. Barwood et al. [47] reported that 2 weeks of experimental intervention including MI, goal-settings, and coping strategies such as self-talk and relaxation significantly increased breath-hold durations in cold water immersion without concomitant alterations of breath-hold performance in a normal, non-threatening air environment. ...
We aimed at studying the effect of Motor Imagery (MI), i.e., the mental representation of a movement without executing it, on breath-holding performance. Classical guidelines for efficient MI interventions advocate for a congruent MI practice with regards to the requirements of the physical performance, specifically in terms of physiological arousal. We specifically aimed at studying whether an incongruent form of MI practice might enhance the breath-hold performance. In a counterbalanced design including three experimental sessions, participants engaged in maximal breath-hold trials while concomitantly performing i) MI of breathing, ii) MI of breath-hold, and iii) an "ecological" breath-hold trial, i.e., without specific instructions of MI practice. In addition to breath-hold durations, we measured the cardiac activity and blood oxygen saturation. Performance was improved during MI of breathing (73.06 s ± 24.53) compared to both MI of breath-hold (70.57 s ± 18.15) and the control condition (67.67 s ± 19.27) (p < 0.05). The mechanisms underlying breath-hold performance improvements during MI of breathing remain uncertain. MI of breathing might participate to decrease the threat perception associated with breath-holding, presumably due to psychological and physiological effects associated with the internal simulation of a breathing body state.
... Thus, while these findings suggest a central role for the AS general factor in the symptom presentations of depression, suicidality, anxious arousal, and social anxiety relative to the AS specific factors, more work is needed examining the relation of AS general and specific factors with affective symptomology within a bifactor model of the ASI-3. This work is particularly important given past work that has shown domain specificity of the AS construct across diverse methodology, including biologic challenge paradigms (Eifert et al., 1999;Zvolensky et al., 2002). ...
The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; Mage = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African-Americans, Asian Americans, and sexual minorities.
... In contrast to the study of Schroijen et al. (2016), in the present study, it was demonstrated that higher SF scores are associated with greater context-associated defensive responding during unpredictable respiratory threat. This finding of the present study goes in line with evidence demonstrating that persons reporting high SF including persons with PD showed stronger defensive response mobilization during anticipation of (unpredictable) threat as well as during provocation of strong suffocation sensations ( Taylor and Rachman, 1994;Eke and McNally, 1996;McNally and Eke, 1996;Eifert et al., 1999;Melzig et al., 2007;Grillon et al., 2008;Alius et al., 2013;Benke et al., 2017a). Of clinical relevance is that contextual-induced anxious apprehension and cued fear may further potentiate defensive responses and behaviors, thus increasing the risk for the culmination of symptoms into panic ( Bouton et al., 2001;Barlow, 2002). ...
Interoceptive threats play a crucial role in the etiology of panic disorder (PD). While body sensations may become conditioned stimuli (CS) when paired with such interoceptive threats (cue conditioning), the environment in which such interoceptive threats occur may also be learned as a predictor of threat (context conditioning). Suffocation fear (SF) might facilitate these associative learning processes if threats of suffocation become relevant as unconditioned stimuli (US). To investigate whether SF affects associative learning during such respiratory threat, we used mild dyspnea as CS that predicted the occurrence of strong dyspnea (US) in one context (predictable), was not related to the occurrence of the US in another context (unpredictable) or was presented in a different context (safe) in which no US was delivered. Startle eyeblink responses and subjective reports were assessed in 34 participants during learning. Individuals reporting high SF showed a clear potentiation of the startle response during the interoceptive CS predicting the occurrence of interoceptive threat (US). Such startle potentiation was not observed when the CS remained unpaired (safe or unpredictable context). Moreover, high SF persons also showed a significant startle potentiation to the threatening context, when the CS did not predict the onset of the US. No such learning effects were observed for low SF individuals. The data support the view that defensive response mobilization can be triggered by cues but also by contexts that predict the occurrence of interoceptive threats if these threats are relevant for the individuals, supporting learning accounts for the development of PD.
... For example, the defensive respiratory pattern in reaction to dyspnea is altered in anxious individuals with high suffocation fear (SF) paralleling those of patients with PD. Numerous studies have demonstrated that high SF and a history of suffocation experiences is associated with automated negative evaluation of suffocation sensations, increased autonomic arousal, as well as reports of greater anxiety and panic symptoms during provocation of dyspnea (Alius et al., 2013;Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Kroeze et al., 2005;Ogliari et al., 2010). Moreover, experimental studies demonstrated that, while persons low in SF show a typical compensatory decrease in breathing frequency when breathing against an inspiratory resistive load (Harver & Mahler, 1998;Iber, Berssenbrugge, Skatrud, & Dempsey, 1982), high SF individuals were characterized by an increase in respiratory rate (Alius et al., 2013;, thus increasing their exposure frequency to the loaded inspiration. ...
In patients with anxiety and/or respiratory diseases, body sensations, particularly from the respiratory system, may increase in intensity and aversiveness and thus lead into defensive action (e.g., escape) or panic. The processes, however, that might contribute to the culmination of symptoms and the switch into defensive action have not been well understood yet. The current study aimed at evaluating an experimental paradigm to characterize the dynamics of defensive mobilization to body sensations increasing in intensity and aversiveness. Persons reporting low and high suffocation fear (SF; N = 69) were exposed to increasingly unpleasant feelings of dyspnea induced by inspiratory resistive loads and a breathing occlusion requiring voluntary breath holding. Respiratory responses were assessed along with subjective reports of anxiety and panic symptoms. Presentation of respiratory loads with increasing physical resistance led to increasingly unpleasant feelings of dyspnea. Twenty-eight participants terminated the exposure prematurely at least once. When dyspnea was severe, high compared to low SF persons exhibited an increased respiratory rate that was accompanied by reports of more intense panic symptoms. Premature terminations of exposure were preceded by a surge in anxiety, breathing frequency, and mouth pressure, and a decrease in tidal volume. We successfully established an experimental paradigm to assess changes in defensive responding with increasing intensity of an interoceptive threat. The current data foster our understanding of behavioral expression patterns observed in patients with anxiety and/or respiratory diseases and the processes involved in the culmination of bodily sensations and anxiety into panic.
... Anxiety sensitivity is a personality feature that occurs to a greater or lesser degree in people with anxiety . It defines how fearful one is to the sensations of anxiety (Eifert, Zvolensky, Sorrell, & Hopko, 1999;. Persons with high anxiety sensitivity believe that the sensation of anxiety signals impending death which drives their response to anxiety provoking situations (Clark, 1986;. ...
People with Chronic Obstructive Pulmonary Disease (COPD) have a high incidence of anxiety. This pilot study established feasibility and examined potential effects of mindfulness based stress reduction, modified for people with COPD. Primary outcomes included; sense of coherence, mindfulness, emotional function, mastery of disease, symptoms of dyspnea, fatigue and breathing patterns.
Methods: Subjects with COPD were recruited from pulmonary rehabilitation programs and randomized to 8 weeks of modified Mindfulness Based Stress Reduction (MBSR) or waitlist control. The following measures were taken before and after the intervention: Anxiety Sensitivity Index (ASI-3), Friedburg Mindfulness Inventory (FMI), Sense of Coherence (SOC), Chronic Respiratory Disease Questionnaire (CRQ) and breathing timing parameters via inductive plethysmography.
Results: Forty-eight subjects were enrolled, 6 were dropped due to low enrollment at their site. Three chose to drop out of the study (N = 36). There were significant interaction effects (time X group) for the FMI (P = 0.02) and respiratory rate (P = 0.05). The treatment group decreased FMI and increased respiratory rate and the control group increased FMI with no change in respiratory rate. CRQ Emotion correlated with the number of classes attended (r = .347, P = 0.05). Those attending 1 meditation class: ASI-3 (41.50 vs 17.73, P = 0.00); CRQ Mastery (2.81 vs 4.9, P = 0.00); CRQ Emotion (2.81; mean vs 4.89, P = 0.00); CRQ Fatigue (2.35 vs 4.09, P = 0.01) SOC (51.85 (13.17) vs 66.41 (12.82), P = 0.01); FMI (33.71 (8.16) vs 41.42 (8.05), P = 0.03). .
Discussion: The decline in mindfulness scores and the increase in respiratory rate in the treatment group were unexpected but likely indicate that a longer intervention is needed. The differences between attenders and non-attenders could indicate a need for a longer time spent introducing beginning meditation skills. These results combined with other evidence from this study will aid in designing future meditation programs for persons with COPD.
... As such, the Breath Holding Task, which induces sensations that mimic anxious arousal, should be more predictive of panic symptomatology than other anxiety disorders, such as generalized anxiety disorder, obsessive-compulsive disorder, and social phobia. However, most studies have failed to support the specificity of this model (e.g., Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;McNally & Eke, 1996;Van der Does, 1997). Specific distress tolerance models of this kind may fail because they are based on an assumption that stimuli that share the same form (e.g., physical sensations associated with breath holding and physical sensations associated with panic) predict the same responses and consequences regardless of other contextual features. ...
... Similarly, eifert (1992) proposed that heart-focused anxiety was a specific kind of anxiety that might be present in panic-related problems involving people with panic disorder, cardiophobia, and/or chronic chest pain. the construct of heart-focused anxiety is the fear of cardiac-related stimuli and is based on the perceived harmful consequences (eifert, Zvolensky, Sorrell, hopko, & lejuez, 1999). eifert (1992 and eifert and forsyth (1996) suggested that heart-focused anxiety is correlated more strongly than other psychological factors that have been implicated in the development and maintenance of emotional distress, such as anxiety sensitivity. ...
... In one study, for example, high AS subjects gave higher, and more accurate, estimates of their own heart rates than their low AS counterparts although the actual heart rates for both groups were nearly identical (Sturges & Goetsch, 1996). When combined with trait anxiety, AS has been linked to the development of panic disorder, for which the most prevalent physical symptom is elevated heart rate (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Richards & Bertram, 2000). Previous scholars consistently report that the initial moment of a speech produces greater heart rate acceleration than any other before, during, or after the presentation (e.g., Behnke & Carlile, 1971). ...
Previous empirical studies of anxiety patterns associated with public speaking performance have exhibited major differences between the psychological and physiological waveforms. Moreover, current research indicates that, in physiological studies of public speaking anxiety, several different patterns are embedded in the overall pattern, thereby demonstrating the importance of discovering the proper differentiated pattern for any given speaker. In the present study, the general psychological anxiety pattern for public speakers was examined in order to attempt to discover if independent, differentiated, patterns reside within the global pattern. A primary and a secondary pattern emerged. These sub‐patterns are significantly different from one another at all major moments or milestones of the experience. In a second study, these patterns were identified by differing levels of anxiety sensitivity. Theoretical, pedagogical, and therapeutic implications of the findings are discussed.
... 24 The Subjective Units of Distress Scale (SUDS) assessed overall distress during the task; this widely used, highly reliable single-item question measures the intensity of current distress on a scale from 0 to 100. 25,[26][27][28] To assess the participants'evaluation of their speech, we used the 10-item self-report Self-Statements during Public Speaking scale (SSPS), which consists of two 5-item subscales, the "Positive Self-Statements" (SSPS-P, e.g. "I can handle everything") and the "Negative Self-Statements" subscale (SSPS-N, e.g. ...
Objective:
Mindfulness meditation has met increasing interest as a therapeutic strategy for anxiety disorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for generalized anxiety disorder (GAD), a disorder characterized by chronic worry and physiologic hyperarousal symptoms.
Method:
Ninety-three individuals with DSM-IV-diagnosed GAD were randomly assigned to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME), between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HAMA; primary outcome measure), the Clinical Global Impressions-Severity of Illness and -Improvement scales (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pretreatment and posttreatment administration of the Trier Social Stress Test (TSST).
Results:
A modified intent-to-treat analysis including participants who completed at least 1 session of MBSR (n = 48) or SME (n = 41) showed that both interventions led to significant (P < .0001) reductions in HAMA scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all P values < .05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P < .05) and a greater increase in positive self-statements (P = .004).
Conclusions:
These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity and coping as measured in a laboratory stress challenge.
Trial registration:
ClinicalTrials.gov identifier: NCT01033851.
... The lower order factors represent physical, psychological, and social concerns, and the higher order factor represents the global anxiety sensitivity construct (Stewart, Taylor, & Baker, 1997; Zinbarg, Mohlman, & Hong, 1999). There is emerging evidence that the greater the degree of specificity between pre-existing fear about bodily sensations and symptoms experienced, the better self-reported anxiety-related responding can be predicted (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999; Rachman & Taylor, 1993). For instance, Schmidt (1999) recently found that cardiopulmonary fears, a subcomponent of anxiety sensitivity physical concerns, was the only dimension that predicted reported anxiety and bodily sensations during 35% CO 2 inhalation in panic disorder patients. ...
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.
... were asked to refrain from any type of substance (e.g., caffeine, nicotine, alcohol) on the days of their two laboratory visits to avoid confounding the effect of the challenge with other substances. Upon arriving to the laboratory, participants were seated in a 9×10-ft room and participants received an overview of the CO 2 procedure, including possible side effects of breathing CO 2 -enriched air (e.g., breathlessness , dizziness, chest pain, and tachycardia; Eifert et al. 1999). Then, a positive pressure Downs C-PAP mask and electrodes for measuring skin conductance were attached. ...
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.
... A second way in which elevated heart-focused anxiety may lead to increased levels of anxiety and pain is through the occurrence of states of negative affect. There is evidence that persons with elevated heart-focused anxiety are more emotionally distressed (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999). This association between heart-focused anxiety and negative affect-including subjective pain, anxiety, and perhaps over time depression-may contribute to "response competition." ...
This article reviews the concept of heart-focused anxiety that may occur in response to cardiac-related stimuli and sensations. Our aim was to examine the relation between chest pain, panic, and heart-focused anxiety in persons with and without heart disease. We identify a preoccupation with the heart and its functioning based on the belief that it will lead to negative consequences (e.g., death, pain) as an important psychological variable in the production of anxious and fearful responding. We then discuss heart-focused anxiety in relation to other clinically relevant variables in anxiety-related problems such as hypochondriacal concerns, including physical symptoms, disease fear, disease conviction, and safety-seeking behavior. Finally, we briefly discuss the clinical importance of heart-focused anxiety in the assessment and treatment of certain anxiety and cardiac-related problems.
... In a nonclinical population, persons scoring high on fear of suffocation, as measured with the Fear of Suffocation subscale of the Claustrophobia Questionnaire (CLQ; Radomsky et al., 2001), react with greater subjective fear to laboratory challenges that induce respiratory discomfort and dyspnea (e.g., Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Eke & McNally, 1996;Rassovsky, Kushner, Schwarze, & Wangensteen 2000;Shipherd, Beck, & Ohtake, 2001). ...
We aimed to investigate whether fear of suffocation predicts healthy persons' respiratory and affective responses to obstructed breathing as evoked by inspiratory resistive loads. Participants (N = 27 women, ages between 18 and 21 years) completed the Fear of Suffocation scale and underwent 16 trials in which an inspiratory resistive load of 15 cmH(2)O/l/s (small) or 40 cmH(2)O/l/s (large) was added to the breathing circuit for 40 s. Fear of suffocation was associated with higher arousal ratings for both loads. Loaded breathing was associated with a decrease in minute ventilation, but progressively less so for participants scoring higher on fear of suffocation when breathing against the large load. The present findings document a potentially panicogenic mechanism that may maintain and worsen respiratory discomfort in persons with fear of suffocation.
... Similarly, eifert (1992) proposed that heart-focused anxiety was a specific kind of anxiety that might be present in panic-related problems involving people with panic disorder, cardiophobia, and/or chronic chest pain. the construct of heart-focused anxiety is the fear of cardiac-related stimuli and is based on the perceived harmful consequences (eifert, Zvolensky, Sorrell, hopko, & lejuez, 1999). eifert (1992 and eifert and forsyth (1996) suggested that heart-focused anxiety is correlated more strongly than other psychological factors that have been implicated in the development and maintenance of emotional distress, such as anxiety sensitivity. ...
The present study assesses the psychometric properties and factor structure of the Greek version of the Cardiac Anxiety Questionnaire (CAQ). The questionnaire was administered to 598 healthy individuals from 15 different regions of Greece with a measure of socioeconomic characteristics and the Symptom Checklist-90-Revised (SCL-90-R). The sample was split into two random halves, and exploratory factor analysis indicated a three-factor solution. This solution was tested using a confirmatory factor analysis on the second half of the sample. In terms of latent dimensions, the Greek version retains the three-factor structure as proposed by the initial authors. However, adequate fit was achieved only after omitting eight items. The shorter (10-item) version was submitted to further analysis. The shorter version provided satisfactory internal reliability and evidence indicating the validity of the scale with respect to SCL-90-R subscales. The stability of the questionnaire was verified by a high test-retest reliability over a 3-mo. period (r = .86). Sex and age differences were assessed. The 10-item version appears to be a practical, brief tool for clinical use.
... Breath-holding duration, conceptualized as an index for tolerance of suffocation sensations, also has been explored as a marker of vulnerability for anxiety disorders (Asmundson & Stein, 1994). Although some work has found evidence that breath-holding duration is related to panic psychopathology to a greater extent than some other anxiety states or conditions (e.g., social phobia; Asmundson & Stein, 1994), other work has not found evidence of such specificity (e.g., Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999; McNally & Eke, 1996; Van der Does, 1997). Overall, lesser tolerance to tasks that induce abrupt anxious arousal sensations suggests that such indices may mark a greater vulnerability to incur problems abstaining from substance use among active users, especially early in the quit attempts (when bodily sensations and interoceptive distress are generally most evident). ...
We review theory and empirical study of distress tolerance, an emerging risk factor candidate for various forms of psychopathology. Despite the long-standing interest in and promise of work on distress tolerance for understanding adult psychopathology, there has not been a comprehensive review of the extant empirical literature focused on the construct. As a result, a comprehensive synthesis of theoretical and empirical scholarship on distress tolerance, including integration of extant research on the relations between distress tolerance and psychopathology, is lacking. Inspection of the scientific literature indicates that there are a number of promising ways to conceptualize and measure distress tolerance, as well as documented relations between distress tolerance factors and psychopathological symptoms and disorders. Although promising, there also is notable conceptual and operational heterogeneity across the distress tolerance literature. Moreover, a number of basic questions remain unanswered regarding the associations between distress tolerance and other risk and protective factors and processes, as well as its putative role(s) in vulnerability for and resilience to psychopathology. Thus, the current article provides a comprehensive review of past and contemporary theory and research and proposes key areas for future empirical study of this construct.
... However, only a limited number of studies have addressed the question whether the suffocation and restriction scales of the CLQ can differentially predict fear experienced in restriction and suffocation situations, respectively. Whereas several studies show that the suffocation scale is predictive of anxious responding to laboratory challenges inducing breathlessness (e.g., Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Eke & McNally, 1996;Rassovsky, Kushner, Schwarze, & Wangensteen, 2000;Shipherd, Beck, & Ohtake, 2001) less is known on the specific predictive validity of the restriction scale. In a study by Van Diest et al. (2005) participants completed a Dutch ad-hoc translation of six items loading high on the restriction scale and six other items loading high on the suffocation scale of the English version of the CLQ (Radomsky et al., 2001). ...
Fear of suffocation and fear of restriction are thought to underlie claustrophobia and can be assessed with the Claustrophobia Questionnaire (CLQ; Radomsky et al., 2001). A first study tested the psychometric properties of a Dutch version of the CLQ. Students (N=363) completed a Dutch translation of the CLQ and a set of other questionnaires assessing other specific fears, anxiety or depression. Results confirmed the two-factor structure and showed that the Dutch version of the CLQ has good psychometric properties. A second study tested the predictive validity of the Dutch CLQ. Participants (N=23) were exposed each to nine claustrophobic situations with elements of suffocation, restriction or both. The Dutch CLQ was found to be a significant predictor of fear and respiratory reactivity during claustrophobic exposure. It can be concluded that the Dutch version of the CLQ is a reliable and valid instrument to assess claustrophobic fear.
Background and Objectives
Anxiety sensitivity (AS) is the fear of consequences of anxiety-related sensations, and has been linked to the development of panic symptoms. Distress tolerance (DT) encompasses one’s behavioral or self-perceived ability to handle aversive states. We examined whether higher DT buffers the relationship between AS and changes in panic symptoms across two timepoints, spaced ∼three weeks apart.
Design and Methods
At Time 1, 208 participants completed questionnaires and a physical DT task (breath-holding duration), a cognitive DT task (anagram persistence), and a self-report measure of DT (perceived DT). Panic symptoms were assessed at both timepoints. Structural equation modeling was used to evaluate two models in which AS and DT predicted changes in panic.
Results
Contrary to hypotheses, for those with longer breath-holding duration (higher physical DT), higher fears of physical anxiety-related sensations (higher physical AS) were associated with worse panic outcomes over time.
Conclusions
Findings suggest that those with lower physical DT may have been less willing to engage with difficult tasks in the short-term. Although disengagement in the short-term may provide temporary relief, it is possible that averse psychopathological consequences stemming from rigid or habitual avoidance of distressing states may develop over longer periods of time.
Neuroanatomical models of panic disorder (PD) implicate neural activity within an “extended fear network” of brain structures in the physiological symptomology leading up to a panic attack (PA). Here, a voluntary breath-holding paradigm was used to compare brain activity during induction of a hypercapnia state. Blood oxygen level-dependent (BOLD) response was compared between 21 PD individuals and 21 low anxiety matched controls at the peak (12-18 s) of a series of breath-holds. In comparison to the resting condition, BOLD activation at the peak of the breath-hold was greater within a group of structures implicated in the extended fear network including hippocampus, thalamus, and brainstem, but also included cortical structures involved in interoceptive awareness and self-referential processing such as the right insula, middle frontal gyrus and precuneus/posterior cingulate region. Our findings suggest that following a voluntary breath-hold challenge, individuals prone to PA show elevated activity in brainstem and cortical structures involved in processing neurovisceral interoceptive processing, self-referential processing and contextual memory.
Cannabis is among the most widely used psychoactive substances in the United States, and rates of cannabis use and cannabis-related problems are increasing. Anxiety sensitivity, or the fear of aversive interoceptive sensations, may be relevant to better understanding cannabis use problems and other significant cannabis use processes (e.g., beliefs about quitting). Previous research has primarily focused on the global anxiety sensitivity construct; however, anxiety sensitivity lower-order facets (Cognitive Concerns, Physical Concerns, and Social Concerns) tend to be differentially related to substance use processes in non-cannabis specific studies. The current study therefore explored anxiety sensitivity lower-order facets in relation to cannabis use problems, perceived barriers for cannabis cessation, and abstinence phobia (fear of not using cannabis) among a community sample of 203 cannabis-using adults. Results indicated that anxiety sensitivity Cognitive Concerns were significantly associated with each of the dependent measures and these effects were not explained by shared variance with the other lower-order factors or a range of other covariates (e.g., tobacco use). The present findings suggest future work may benefit from focusing on the role of anxiety sensitivity Cognitive Concerns in the maintenance of cannabis use.
Respiratory problems and posttraumatic stress disorder (PTSD) are the signature health consequences associated with the September 11, 2001 (9/11), World Trade Center disaster and frequently co-occur. The reasons for this comorbidity, however, remain unknown. Anxiety sensitivity is a transdiagnostic trait that is associated with both PTSD and respiratory symptoms. The present study explored whether anxiety sensitivity could explain the experience of respiratory symptoms in trauma-exposed smokers with PTSD symptoms. Participants (N = 135; Mage = 49.18 years, SD = 10.01) were 9/11-exposed daily smokers. Cross-sectional self-report measures were used to assess PTSD symptoms, anxiety sensitivity, and respiratory symptoms. After controlling for covariates and PTSD symptoms, anxiety sensitivity accounted for significant additional variance in respiratory symptoms (ΔR(2) = .04 to .08). This effect was specific to the somatic concerns dimension (β = .29, p = .020); somatic concerns contributed significantly to accounting for the overlap between PTSD and respiratory symptoms, b = 0.03, 95% CI [0.01, 0.07]. These findings suggest that the somatic dimension of anxiety sensitivity is important in understanding respiratory symptoms in individuals with PTSD symptoms. These findings also suggest that it may be critical to address anxiety sensitivity when treating patients with comorbid respiratory problems and PTSD.
The human cerebral vasculature responds to changes in blood pressure and demands for oxygenation via cerebral autoregulation. Changes in cerebrovascular tone (vasoconstriction and vasodilation) also mediate the changes in blood flow measured by the BOLD fMRI signal. This cerebrovascular reactivity is known to vary with age. In two experiments, we demonstrate that cerebral pulse parameters measured using optical imaging can quantify changes in cerebral vascular tone, both globally and locally. In experiment 1, 51 older adults (age range = 55-87) performed a voluntary breath-holding task while cerebral pulse amplitude measures were taken. We found significant pulse amplitude variations across breath-holding periods, indicating vasodilation during, and vasoconstriction after breath holding. The breath-holding index (BHI), a measure of cerebrovascular reactivity (CVR) was derived and found to correlate with age. BHI was also correlated with performance in the Modified Mini-Mental Status Examination, even after controlling for age and education. In experiment 2, the same participants performed a Sternberg task, and changes in regional pulse amplitude between high (set-size 6) and low (set-size 2) task loads were compared. Only task-related areas in the fronto-parietal network (FPN) showed significant reduction in pulse amplitude, indicating vasodilation. Non-task-related areas such as the somatosensory and auditory cortices did not show such reductions. Taken together, these experiments suggest that optical pulse parameters can index changes in brain vascular tone both globally and locally, using both physiological and cognitive load manipulations.
In this exploratory study of the relationship between characteristics of breathing and 3 common psychological issues (i.e., symptoms of anxiety, alexithymia, and depression), 79 college-age adults were examined using self-report, rater observation, and physiological measures. Results indicated significant positive relationships between dysfunctional breath characteristics and symptoms of both anxiety and alexithymia. A significant positive correlation was found between self-reported symptoms of dysfunctional breathing and symptoms of depression, but no significant relationships existed between symptoms of depression and either rater-observed breath characteristics or physiological measures. © 2016 by the American Counseling Association. All rights reserved.
Attentional bias towards threat reliably correlates with clinical anxiety status as well as elevated trait anxiety. Although such findings have led many to posit a potential causative or predictive role of threat-biased attentional processes on anxiety problems, little informative research exists. The present investigation was designed to address the role of threat-biased attentional processes on emotional/fearful responding. Eighty-seven participants provided baseline measures of anxiety vulnerability (i.e., anxiety sensitivity; unmasked/masked emotional Stroop task indices) and then underwent biological challenge procedures (inhalations of 20% carbon dioxide (CO2)-enriched air). Following challenge, participants completed measures of emotional response. Regression analyses indicated that both unmasked and masked attentional bias indices significantly predicted emotional responding above and beyond anxiety sensitivity. Exploratory analyses also revealed a gender effect, with prediction of emotional response largely attributable to females.
The inhalation of 35% carbon dioxide (CO2) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO2 in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO2-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO2-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO2) and dichotomous variables (positive versus negative responses to CO2). Analyses of each outcome measure demonstrated that CO2-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO2-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO2-hyperreactivity, such as anxiety sensitivity, which may account for this study׳s results.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Recent research considers distress (in)tolerance as an essential component in the development of various forms of psychopathology. A behavioral task frequently used to assess distress tolerance is the breath holding task. Although breath holding time (BHT) has been associated with behavioral outcomes related to inhibitory control (e.g., smoking cessation), the relationship among breath holding and direct measures of executive control has not yet been thoroughly examined. The present study aims to assess (a) the BHT-task's test-retest reliability in a 1-year follow-up and (b) the relationship between a series of executive function tasks and breath holding duration. One hundred and thirteen students completed an initial BHT assessment, 58 of which also completed a series of executive function tasks [the Wisconsin Card Sorting Test (WCST), the Parametric Go/No-Go task and the N-back memory updating task]. A subsample of these students (N = 34) repeated the breath holding task in a second session 1 year later. Test-retest reliability of the BHT-task over a 1-year period was high (r = 0.67, p < 0.001), but none of the executive function tasks was significantly associated with BHT. The rather moderate levels of unpleasantness induced by breath holding in our sample may suggest that other processes (physiological, motivational) besides distress tolerance influence BHT. Overall, the current findings do not support the assumption of active inhibitory control in the BHT-task in a healthy sample. Our findings suggest that individual differences (e.g., in interoceptive or anxiety sensitivity) should be taken into account when examining the validity of BHT as a measure of distress tolerance.
The present study evaluated panic-relevant cognitive processes in a sample of persons ( n = 70) who met criteria for either: (a) a positive panic attack history and regular smoking (smoking at least 10 cigarettes per day for S 12 months); (2) a positive panic attack history but no history of smoking; or (3) regular smoking history alone (smoking at least 10 cigarettes per day for S 12 months). As hypothesized, participants in group (a) demonstrated significantly greater bodily vigilance and anxiety sensitivity Mental Incapacitation Concerns compared with persons in either groups (b) or (c). Effects involving other dimensions of anxiety sensitivity, suffocation fear and trait anxiety did not discriminate between panickers as a function of smoking status. The observed effects could not be attributed to self-reported physical health status or history of medical problems. The implication of the present findings for understanding the potential role of smoking in panic pathology is discussed.
We have provided a laboratory evaluation of emotional reactivity to physiological (hyperventilation), cognitive (mental arithmetic), and social (speech) challenge procedures, and investigated how preexperimental levels of perceived stress, anxiety sensitivity, and negative-evaluation sensitivity predicted anxious and fearful responding. Participants were 37 nonclinical individuals. Dependent measures included a multimethod assessment involving self-reported anxiety, frequency and intensity of bodily sensations, and heart rate and blood pressure responses to the challenges. Our results indicated that preexperimental levels of perceived stress were more predictive than other theoretically relevant variables of self-reported anxiety-related reactivity to cognitive and social challenges, whereas anxiety sensitivity was a better predictor of the emotional response to hyperventilation. Collectively, these findings are consistent with theoretical accounts of anxiety pathology, and suggest that perceived stress is an important process variable to consider in understanding the determinants of anxiety-related responding.
Angstsensitivität (AS) bezeichnet die Furcht vor Angst-symptomen, die nach Reiss und Kollegen (Reiss, 1991; Reiss & McNally, 1985) auf Bedenken hinsichtlich deren Schädlichkeit zurückgeht. Personen mit hoher Merkmals-ausprägung neigen dazu, Symptome, die Angstzustände begleiten mit aversiven Konsequenzen zu assoziieren. Sie haben Bedenken hinsichtlich möglicher somatischer, so-zialer oder kognitiver Folgen dieser Symptome. Personen mit hoher Angstsensitivität fürchten beispielsweise einen schnellen Herzschlag als Signal eines bevorstehenden Herzinfarkts, Schwitzen als Vorläufer von Blamage und Gesichtsverlust oder Konzentrationsschwierigkeiten als Vorbote von Kontrollverlust. Nach dem Erwartungsmodell der AS kann AS Furcht, Angst, Panik und Vermeidungsverhalten intensivieren (Reiss, 1991; Reiss & McNally, 1985). Für Personen mit hoher AS haben Angsterfahrungen eine erhöhte negati-ve Valenz, die mit einer leichteren Konditionierbarkeit von Angstreaktionen einhergehen soll (Reiss, Peterson, Gursky & McNally, 1986). Empirische Befunde sind weit-gehend konsistent mit den Annahmen des Erwartungs-modells. So zeigen Angstpatienten im Vergleich zu gesun-den Kontrollpersonen eine erhöhte Ausprägung in AS (Deacon & Abramowitz, 2006; Peterson & Plehn, 1999). Neuere Befunde sprechen dafür, dass AS nicht nur in der Genese und Aufrechterhaltung von Angsterkrankungen eine Rolle spielt (Plehn & Peterson, 2002; Schmidt, 1999), sondern ein genereller Risikofaktor für diverse psychische Störungen sein könnte (Schmidt, Zvolensky & Maner, 2006). Ein wichtiger Befund im Hinblick auf die Prävention von Psychopathologie ist, dass AS offenbar durch geeig-nete Interventionen modifiziert werden kann und dies mit einer Verbesserung der klinischen Symptomatik bei Panik-patienten (Otto & Reilly-Harrington, 1999) oder mit einer im Vergleich zu einer Kontrollgruppe verringerten Inzidenz psychischer Störung bei Gesunden einhergehen kann (Schmidt et al., 2007).
In this article we analyze ways that psychological science can inform the treatment of anxiety disorders. We focus on experimental psychopathology research to describe the structure of anxiety and the functions of danger, safety, predictability and controllability in contributing to disorder. We then address science-based practice in terms of principles of change and the benefits from the self-corrective nature of science, contrasting this form of practice with treatments that are not grounded in basic learning theory. Models for dissemination and implementation of science-based practices are described and related to practitioner attitudes regarding scientific evidence. Finally, we consider practice implications when treatments are, and are not, based on the informative role of clinical psychological science.
The purpose of this chapter is to provide a comprehensive review of what is known about the etiology and pathology of anxiety disorders across the lifespan, highlighting in particular developmental differences in the expression of individual anxiety disorders. Anxiety is implicated heavily across the full range of psychopathology. Anxiety is a future-oriented emotion characterized by marked negative affect, bodily symptoms of tension, and chronic apprehension. Fear, on the other hand, is an immediate alarm reaction to present danger characterized by strong escapist action tendencies. Anxiety, fear, and panic are the building blocks of anxiety disorders, arranging themselves in different ways as they focus on varying internal and external stimuli that have become imbued with threat or danger to form the commonly recognized variants of anxiety disorder. Included within this chapter will be separation anxiety disorder, obsessive-compulsive disorder, specific phobias, social phobia, panic disorder (with and without agoraphobia), and generalized anxiety disorder. Covered for each disorder will be clinical presentation, prevalence, demographics, comorbidity, cultural influences, developmental changes, and etiology.
The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67–73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.
Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index–3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.
An emerging pattern of results from panic-relevant biological challenge studies suggests women respond with greater subjective anxiety than men, but only to relatively abrupt and intense challenge procedures. The current investigation examined the relation between biological sex and self-reported anxious reactivity following biological challenges of varying durations and intensity. Participants were 285 (152 females; M(age) = 21.38; SD = 5.92) nonclinical adults who completed one of three protocols: a 3-min voluntary hyperventilation challenge (VH), a 5-min 10% carbon dioxide-enriched air (CO(2)) challenge, or a 25-s 20% CO(2) challenge. As predicted, results indicated that the 20% CO(2) challenge elicited greater self-reported anxiety than the VH and 10% CO(2) challenges. Moreover, women endorsed greater anxious reactivity than men, but only following the 20% CO(2) challenge. Results are discussed in terms of processes likely to account for sex differences in anxious reactivity following relatively abrupt and intense biological challenges.
System requirements: World Wide Web browser and PDF reader. Mode of access: Available through the Internet. Title from document title page. Document formatted into pages; contains iv, 17 p. Thesis (Ph. D.)--West Virginia University, 2000. Includes abstract. Includes bibliographical references (p. 13-16).
In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to established measures of psychological problems in our sample of patients. Finally, we examined whether fear of pain uniquely and significantly predicts dental fear and psychological distress relative to other theoretically-relevant psychological factors. Our results indicate that fear of severe pain and anxiety-related distress, broadly defined, are particularly elevated in orofacial pain patients relative to matched controls. Additionally, fear of pain shares a significant relation with dental fear but not other general psychological symptomology, and uniquely and significantly predicts dental fear relative to other theoretically-relevant variables. Taken together, these data, in conjunction with other recent studies, suggest greater attention be placed on understanding the fear of pain in orofacial pain patients and its relation to dental fear and anxiety.
In the present study, the Anxiety Sensitivity Index [ASI; Behav. Res. Ther. 24 (1986) 1] was administered to 282 American Indian and Alaska Native college students in a preliminary effort to: (a) evaluate the factor structure and internal consistency of the ASI in a sample of Native Americans; (b) examine whether this group would report greater levels of anxiety sensitivity and gender and age-matched college students from the majority (Caucasian) culture lesser such levels; and (c) explore whether gender differences in anxiety sensitivity dimensions varied by cultural group (Native American vs. Caucasian). Consistent with existing research, results of this investigation indicated that, among Native peoples, the ASI and its subscales had high levels of internal consistency, and a factor structure consisting of three lower-order factors (i.e. Physical, Psychological, and Social Concerns) that all loaded on a single higher-order (global Anxiety Sensitivity) factor. We also found that these Native American college students reported significantly greater overall ASI scores as well as greater levels of Psychological and Social Concerns relative to counterparts from the majority (Caucasian) culture. There were no significant differences detected for ASI physical threat concerns. In regard to gender, we found significant differences between males and females in terms of total and Physical Threat ASI scores, with females reporting greater levels, and males lesser levels, of overall anxiety sensitivity and greater fear of physical sensations; no significant differences emerged between genders for the ASI Psychological and Social Concerns dimensions. These gender differences did not vary by cultural group, indicating they were evident among Caucasian and Native Americans alike. We discuss the results of this investigation in relation to the assessment of anxiety sensitivity in American Indians and Alaska Natives, and offer directions for future research with the ASI in Native peoples.
Fear of bodily sensations has received extensive attention in relation to panic disorder, and more recently, other types of anxiety pathology and chronic pain problems. Extending this work, the present study examined fear of bodily sensations and its underlying dimensions in emergency room patients with Noncardiac Chest Pain (NCCP; n = 63). We posited a "differential specificity" hypothesis, expecting that specific cardiopulmonary fears would be more strongly associated with NCCP symptoms relative to other bodily fears. As hypothesized, participants reported cardiopulmonary sensations as significantly more fear-provoking than numbness, dissociation, and gastrointestinal sensations. Additionally, regression analysis indicated that after accounting for theoretically relevant demographic variables and health status, cardiopulmonary fear was the best predictor of a composite index of cardiac complaints intensity, even after removing variance related to the absolute number of cardiac complaints. We discuss these findings in relation to the specific role for the fear of cardiopulmonary sensations in chest pain complaints, with implications for better understanding the underlying psychological processes involved in NCCP.
The present cross-sectional study sought to examine the extent to which heart-focused anxiety is associated with the co-occurrence of coronary artery disease (CAD) and a history of regular smoking in a sample of 148 postangiography patients from a cardiology unit. Individuals with CAD who regularly smoked demonstrated significantly greater heart-focused attention, but no greater degree of avoidance and fear of heart-focused sensations, than did nonsmoking persons with CAD and smokers without CAD. We also found evidence that heart-focused attention and fear incrementally predicted (above and beyond demographic variables and body mass index) intensity of average chest pain. Overall, this study provides some of the first empirical evidence that the occurrence of regular smoking and CAD is associated with specific dimensions of health anxiety. We discuss these findings in relation to models of panic pathology and anxious responding to bodily sensations.
The present study evaluated the main and interactive effects of level of smoking (cigarettes per day) and anxiety sensitivity (fear of anxiety and anxiety related sensations) in predicting panic and anxiety variables in an epidemiologically-defined sample of smokers from Moscow (n=95). The combination of high levels of anxiety sensitivity and smoking predicted agoraphobic avoidance, but not frequency of panic attacks during the past week. These findings suggest anxiety sensitivity may moderate the relation between level of smoking and prototypical panic psychopathology variables (panic attacks and agoraphobic avoidance) even after controlling for the theoretically-relevant factors of alcohol abuse and negative affect.
Attentional bias towards threat reliably correlates with clinical anxiety status as well as elevated trait anxiety. Although such findings have led many to posit a potential causative or predictive role of threat-biased attentional processes on anxiety problems, little informative research exists. The present investigation was designed to address the role of threat-biased attentional processes on emotional/fearful responding. Eighty-seven participants provided baseline measures of anxiety vulnerability (i.e., anxiety sensitivity; unmasked/masked emotional Stroop task indices) and then underwent biological challenge procedures (inhalations of 20% carbon dioxide (CO2)-enriched air). Following challenge, participants completed measures of emotional response. Regression analyses indicated that both unmasked and masked attentional bias indices significantly predicted emotional responding above and beyond anxiety sensitivity. Exploratory analyses also revealed a gender effect, with prediction of emotional response largely attributable to females. These findings support attentional bias towards threat as a relatively independent factor predictive of emotional responding.
Fear of arousal symptoms, often referred to as anxiety sensitivity (AS), appears to be associated with risk for anxiety pathology and other Axis I conditions. However, AS is only one of three fundamental components of Reiss' Expectancy Model proposed to account for the development of anxiety problems. Very little research has focused on the other two components of this model (Fear of Negative Evaluation, Illness/Injury Sensitivity) and the specificity of AS, relative to these other two components, has rarely been evaluated. This study evaluated general and unique associations among all three so-called fundamental sensitivities to fearful responding to a biological challenge in a nonclinical sample (N=404). Participants were administered a 20-s inhalation of 20% CO2/balance O2. Consistent with hypothesis, only AS uniquely contributed to increased subjective fear responding to the challenge. These findings are consistent with Expectancy Theory in suggesting that the AS component of the model is specific to amplification of fears to arousal cues.
Research in experimental psychopathology indicates that predictability and controllability of threatening events mediate the development, maintenance, and modification of anxiety disorders. We propose that a more thorough analysis of predictability and controllability requires the explication of danger and safety, and those events that provide such signal functions. Although most research is concerned with the identification of signals that predict danger, relatively little attention has been given to the identification of signals that predict safety. The current manuscript outlines the functional analysis of both danger and safety signals as they relate to the various disorders of anxiety. Consideration of pharmacological treatments suggests that the modification of danger and safety signals may function only as incidental features of the intervention. The potential advantages of cognitive-behavioral interventions that maximize treatment-specific self-control of signal functions are discussed.
Heart-focused anxiety (HFA) is the fear of cardiac-related stimuli and sensations because of their perceived negative consequences. Although HFA is common to a wide variety of persons who experience chest pain and distress, it often is unrecognized and misdiagnosed, particularly in cardiology and emergency room patients without and with heart disease. To address these concerns, this article reports on the development and preliminary psychometric evaluation of the Cardiac Anxiety Questionnaire (CAQ) designed to measure HFA. In Study 1, 188 cardiology patients completed the CAQ. Item and factor analyses indicated a three-factor solution pertaining to heart-related fear, avoidance, and attention. Reliability analysis of the 18-item CAQ revealed good internal consistency of the total and subscale scores. In Study 2, 42 patients completed the CAQ and several other anxiety-related questionnaires to assess its convergent and divergent properties. Although preliminary validity results are promising, further psychometric study is necessary to cross-validate the CAQ, examine its test–retest reliability, and confirm the stability of the factor structure. Taken together, the CAQ appears to assess HFA, and may therefore be a useful instrument for identifying patients with elevated HFA without and with heart disease.
Anxiety disorder patients (n = 198; under criteria of the Diagnostic and Statistical Manual of Mental Disorders; rev. 3rd ed.; American Psychiatric Association, 1987) and nonanxious control subjects (n = 25) underwent challenges of 90 s of voluntary hyperventilation and 15 min of 5.5% carbon dioxide in air. Panic disorder subjects showed a greater subjective response to both challenges than did subjects with other anxiety disorders, who in turn responded more than did control subjects. Furthermore, subjects with panic disorder as an additional diagnosis tended to report more subjective response than did anxiety disorder subjects without panic disorder. The best prechallenge predictor of response to each procedure was a measure of fear of physical symptoms. The findings support previous results that have pointed to a greater fear or anxiety-inducing effect of these challenge procedures in panic disorder patients, as compared with other subjects.
Lilienfeld, Jacob, and Turner (1989) questioned the conceptual and empirical distinction between anxiety sensitivity and trait anxiety, and suggested that results attributed to anxiety sensitivity are more parsimoniously explained by trait anxiety. In the present article, I clarify the theoretical distinction between these constructs, and provide further data that support this distinction.
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.
This study examined the relation between the intensity of CO2-induced psychophysiological responses and content-specific fear conditioning. Sex-balanced groups of undergraduates (N = 96) were assigned to 1 of 3 conditioned stimuli (CSs) differing in fear-relevance, and within each CS, to either 20% or 13% CO2-enriched air (unconditioned stimuli [UCS]). Several psychophysiological measures were assessed before, during, and following conditioning phases. Consistent with expectation, electrodermal and cardiac conditioned responses were larger and more resistant to extinction when associated with fear-relevant compared with fear-irrelevant stimuli, and this overall effect of fear-relevance was more robust to the more intense UCS. Severity and frequency of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) panic symptoms also varied reliably with UCS intensity, and women reported more distress and symptoms than men. Overall, the findings suggest that content-specific fear conditioning is mediated, in part, by the intensity of the bodily response. The authors discuss clinical and theoretical implications for understanding fear onset in the absence of obvious environmental pain or trauma.
Four college students were exposed to a Sidman avoidance procedure to determine if an avoidance contingency involving 20% carbon dioxide-enriched air (CO2) would produce and maintain responding. In Phase 1, two conditions (contingent and noncontingent) were conducted each day. These conditions were distinguished by the presence or absence of a blue or green box on a computer screen. In the contingent condition, CO2 presentation were delivered every 3 s unless a subject pulled a plunger. Each plunger pull postponed CO2 presentations for 10 s. In the noncontingent condition, CO2 presentations occurred on the average of every 5 min independent of responding. Following stable responding in Phase 1, condition-correlated stimuli were reversed. In both conditions, plunger response rate was high during the contingent condition and low or zero during the noncontingent condition. Furthermore, subjects avoided most CO2 presentations. However, CO2 presentations did not increase verbal reports of fear. Overall, the results from the present study suggest that CO2 can be used effectively in basic studies of aversive control and in laboratory analogues of response patterns commonly referred to as anxiety.
This study examined the relation between the intensity of COP-induced psychophysiological responses and content-specific fear conditioning. Sex-balanced groups of undergraduates (N = 96) were assigned to 1 of 3 conditioned stimuli (CSs) differing in fear-relevance, and within each CS, to either 20% or 13% CO2-enriched air (unconditioned stimuli [UCS]). Several psychophysiological measures were assessed before, during, and following conditioning phases. Consistent with expectation, electrodermal and cardiac conditioned responses were larger and more resistant to extinction when associated with fear-relevant compared with fear-irrelevant stimuli, and this overall effect of fear-relevance was more robust to the more intense UCS. Severity and frequency of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) panic symptoms also varied reliably with UCS intensity, and women reported more distress and symptoms than men. Overall, the findings suggest that content-specific fear conditioning is mediated, in part, by the intensity of the bodily response. The authors discuss clinical and theoretical implications for understanding fear onset in the absence of obvious environmental pain or trauma.
Control over the offset of repeated administrations of 20% carbon-dioxide-enriched air was assessed in nonclinical participants (n = 30) reporting elevated levels of anxiety sensitivity-a population at an increased risk for experiencing panic attacks and possibly developing panic disorder. In Phase I, participants were randomly assigned to 1 of 2 conditions: one that permitted offset control over gas inhalation and one that did not. These conditions were reversed in Phase II. Across phases, a lack of offset control resulted in greater self-reported anxiety compared with having control, although no significant differences were observed for heart rate. Whereas all participants demonstrated a Stroop interference effect for general (e.g., coffin) compared with specific (e.g., dizzy) physical threat word types prior to the first experimental phase, this effect persisted only for participants who had offset control in Phase I. We discuss these results in relation to the differential effects of offset control, with implications for better understanding anxious responding during elevated bodily arousal.
In this study we tested the hypothesis that claustrophobia is composed of two elements: fear of suffocation and fear of restriction. A self-report claustrophobia questionnaire, interview questions, and behavioural exposure tests were administered to an unselected sample of 179 university students. Results from each method of assessment supported the hypothesis, and suffocation and restriction fears were found to be moderately correlated. The basis of the correlation is considered and a number of explanations are set out. It is also suggested that these fears may be necessary but probably not sufficient for claustrophobia to occur, and that other factors, such as anxiety sensitivity, may play an important role.
Biological challenge experiments constitute “closed systems” that enable causal inferences about the generative mechanisms of panic that are unattainable in the “open system” of the natural environment. Experimental research promises to yield a comprehensive theory of panic that comprises explanations at three levels of analysis: task description (i.e., what “purpose” does the panic system serve?), computational (i.e., how is information about bodily sensations processed?), and implementational (i.e., how are the information-processing functions instantiated in the brain?). The purpose of this article is to provide an analysis of conceptual issues in challenge research with special emphasis on testing cognitive hypotheses.
Psychological features and complaints of persons presenting to medical settings with heart-focused anxiety and noncardiac chest pain are poorly understood. Comparing 20 healthy heart-anxious patients to cardiac and surgical inpatients and nonpatient controls, we found that healthy heart-anxious patients (a) were as afraid of chest pain and heart palpitations as inpatients with heart disease, (b) were as incapacitated by symptoms and using medical services as much as both inpatient groups; and (c) reported higher levels of cardiac disease conviction, heart awareness, and behaviors designed to protect their heart than surgical patients and nonpatients. Compared to all other groups, healthy heart-anxious patients reported more panic and other anxiety disorders, hypochondriacal beliefs, physical symptoms, obsessive-compulsive concerns, and negative affect. Following a hyperventilation test, heart-anxious patients also indicated more distressing symptoms and thoughts, and felt less safe and in control than surgical patients and nonpatients. Results support efforts for a timely recognition, diagnosis, and behavioral treatment of persons with heart-focused anxiety.
Laboratory-based experimental research has led to important breakthroughs in our understanding and treatment of anxiety disorders as well as other types of psychopathology. Despite the importance of this work, the relevance of laboratory-based research using clinical and nonclinical populations has been understated—particularly given concerns about the ecological and external validity of this research. Although some of these issues have been addressed elsewhere, there continues to be less emphasis on laboratory-based investigations compared to other types of research (e.g., treatment outcome). There also is continued misunderstanding regarding what questions can be examined and answered by experimental studies. As an introduction to this special series on the relevance of laboratory examinations of anxiety, we suggest that advances in laboratory preparations can make significant contributions to current behavior therapy. We also suggest that observations in clinical practice can spur innovations in laboratory research. One theme echoed by the articles in this miniseries is the need for a renewed commitment to reestablishing a link between laboratory-based research and clinical application as a means to further advance the science and practice of behavior therapy over the long-term.
A cognitive model of panic is described. Within this model panic attacks are said to result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those involved in normal anxiety responses (e.g. palpitations, breathlessness, dizziness etc.) but also include some other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are (e.g. perceiving palpitations as evidence of an impending heart attack). A review of the literature indicates that the proposed model is consistent with the major features of panic. In particular, it is consistent with the nature of the cognitive disturbance in panic patients, the perceived sequence of events in an attack, the occurrence of ‘spontaneous’ attacks, the role of hyperventilation in attacks, the effects of sodium lactate and the literature on psychological and pharmacological treatments. Finally, a series of direct tests of the model are proposed.
The increasing recognition that panic attacks are heterogeneous phenomena necessitates better and more objective criteria to define and examine what constitutes a panic attack. The central aim of the present study was to classify subtypes of panic attacks (i.e. prototypic, cognitive, and non-fearful) in a nonclinical sample (N=96) based on the concordance/discordance between subjective and physiological responding to multiple inhalations of 20 and 13% CO2-enriched air. Results show that a substantial proportion of this nonclinical sample (55.2%) responded to the CO2 challenge in a manner consistent with clinical and research definitions of different subtypes of panic attacks. The implications of this dimensional approach for discriminating subtypes of panic in the laboratory are discussed as a means to better understand the phenomenology and nature of panic attacks.
For many years, researchers have noted that certain individuals report an exaggerated response to so-called biological challenge procedures (such as sodium lactate infusions, hyperventilation, carbon dioxide inhalations). To date, much interest has focused on the role of various biochemical variables in the response to such procedures. However, there is growing evidence that the affective response to biological challenge procedures can also be markedly influenced by certain psychological constructs. There is currently evidence to suggest that greater distress will be reported in response to these procedures by patients who associate particular physical symptoms with danger and have low perception of control over symptoms.
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.
Cardiophobia is defined as an anxiety disorder of persons characterized by repeated complaints of chest pain, heart palpitations, and other somatic sensations accompanied by fears of having a heart attack and of dying. Persons with cardiophobia focus attention on their heart when experiencing stress and arousal, perceive its function in a phobic manner, and continue to believe that they suffer from an organic heart problem despite repeated negative medical tests. In order to reduce anxiety, they seek continuous reassurance, make excessive use of medical facilities, and avoid activities believed to elicit symptoms. The relationship of cardiophobia to illness phobia, health anxiety, and panic disorder is discussed. An integrative psychobiological model of cardiophobia is presented which includes previous learning conditions relating to experiences of separation and cardiac disease; deficient and inappropriate behavioural repertoires which constitute a psychological vulnerability for cardiophobic problems; negative life events, Stressors, and conflicts in the person's present situation that trigger and contribute to the symptoms; current affective, cognitive, and behavioural symptoms and their stimulus properties; and genetic and acquired biological vulnerability factors. Finally, recommendations for the treatment of cardiophobia are derived from the model and areas of future research are outlined.
We present a conditioning methodology to examine the role of abrupt aversive systemic bodily responses (alarms) in human fear acquisition and extinction in a non-clinical student population (N = 64). Animated fear-relevant and fear-irrelevant video stimuli referring to either the body (internal) or environment (external) were paired with an unconditioned stimulus (UCS) of 20 sec inhalations of 20% carbon dioxide (CO2)-enriched air. Measurements of psychophysiological responses, such as electrodermal, electromyograph (EMG), heart rate, and Subjective Units of Distress Scale (SUDS) to fear-relevant stimuli were more easily acquired, were of higher magnitude, and showed greater resistance to extinction compared with measurements for fear-irrelevant stimuli. Conditioning was more pronounced to external (snake) than to internal (heart) phobic stimuli. Findings support the viability of using CO2-enriched air as an alternative to commonly used peripheral UCSs (e.g., shock) to mimic the role of alarms as conditioning events in human fear acquisition. We discuss the relevance of this methodology for understanding fears that develop without identifiable environmental trauma.
Twelve of 38 cardiology patients with chest pain and current panic disorder reported that during their last major panic attack they did not experience intense fear, nor did they experience fear of dying, fear of loss of control or fear of going crazy. Using the DSM-III(R) criteria, they were diagnosed as non-fearful panic disorder (NFPD), and contrasted with the other 26 Ss on several descriptive and self-report measures. The NFPD group reported significantly fewer phobias but was no different on reports of depression and several panic attack variables. The NFPD group scored lower on only three of 18 self-report scales. These results suggest that the DSM-III(R) defined NFPD Ss resemble those who report the subjective experience of anxiety during their attacks.
We tested the hypothesis that anxiety sensitivity enhances responses to biological challenge by exposing college students who scored either high or low on the Anxiety Sensitivity Index (ASI) to 5 min of voluntary hyperventilation. The ASI is a validated self-report instrument that measures the fear of anxiety symptoms. Following hyperventilation, high-anxiety-sensitivity (HAS) subjects reported more frequent and more intense hyperventilation sensations and a higher level of subjective anxiety than did low-anxiety-sensitivity (LAS) subjects. Analyses of covariance controlling for baseline differences indicated that the magnitude of increase (i.e., reactivity) in hyperventilation symptoms remained greater in the HAS than in the LAS group, whereas the magnitude of increase in anxiety did not. HAS subjects also exhibited a bias for reporting bodily sensations in general. These findings parallel those obtained when panic patients and normal controls are biologically challenged with hyperventilation, lactate infusion, and other anxiogenic agents. Taken together, these results suggest that anxiety sensitivity may also enhance the anxiety responses of panic patients during biological challenge tests. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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’.
Reciprocal inhibition is a process of relearning whereby in the presence of a stimulus a non-anxiety-producing response is
continually repeated until it extinguishes the old, undesirable response. A variety of the techniques based on reciprocal
inhibition, such as systematic desensitization, avoidance conditioning, and the use of assertion, are described in detail.
Behavior therapy techniques evaluated on the basis of their clinical efficacy are found to have striking success over traditional
psychoanalytic methods. Currently, more comparative studies are required which will validate the merit of behavior therapy
in the psychotherapeutic field while experimental research should continue to refine the techniques.
In a recent stimulating article, Dr Klein1(p306) boldly proposed that "many spontaneous panics occur when the brain's suffocation monitor erroneously signals a lack of useful air, thereby maladaptively triggering an evolved suffocation alarm system." Klein postulated that this is a physiological mechanism and that spontaneous panic attacks occur when the suffocation alarm threshold is pathologically lowered, or when psychosocial cues to suffocation are particularly salient. The theory spans a wide range of phenomena, although its primary focus is on spontaneous panic attacks.
We investigated the theory's main assumption that suffocation alarm hypersensitivity is a risk factor for panic disorder. Alarm hypersensitivity was operationalized by a recently developed measure of suffocation fear,2 which we administered to a sample of 179 university students. The sample's mean age was 20 years and two thirds were women. We reasoned that people with hypersensitive alarms are more likely to have their
The authors compared the maximal duration of voluntary breath-holding in patients with panic disorder (N = 23), patients with generalized social phobia (N = 10), and healthy subjects (N = 26). Patients with panic disorder had significantly shorter breath-holding durations than either comparison group. Groups did not otherwise differ in physiologic response to the breath-holding. Implications for a false suffocation alarm in panic disorder are discussed.
A carbon dioxide hypersensitivity theory of panic has been posited. We hypothesize more broadly that a physiologic misinterpretation by a suffocation monitor misfires an evolved suffocation alarm system. This produces sudden respiratory distress followed swiftly by a brief hyperventilation, panic, and the urge to flee. Carbon dioxide hypersensitivity is seen as due to the deranged suffocation alarm monitor. If other indicators of potential suffocation provoke panic this theoretical extension is supported. We broadly pursue this theory by examining Ondine's curse as the physiologic and pharmacologic converse of panic disorder, splitting panic in terms of symptomatology and challenge studies, reevaluating the role of hyperventilation, and reinterpreting the contagiousness of sighing and yawning, as well as mass hysteria. Further, the phenomena of panic during relaxation and sleep, late luteal phase dysphoric disorder, pregnancy, childbirth, pulmonary disease, separation anxiety, and treatment are used to test and illuminate the suffocation false alarm theory.
We investigated predictors of response to carbon dioxide challenge (i.e. breathing deeply and rapidly into a paper bag for 5 min) in college students. Zero-order correlations indicated that scores on both the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986) and the Suffocation Fear Scale (SFS: Rachman & Taylor, 1994), predicted anxious response to challenge, whereas a behavioral measure of carbon dioxide sensitivity (i.e. maximum breath-holding duration) and scores on the State-Trait Anxiety Inventory--Trait form (STAI-T: Spielberger, Gorsuch, Lushene, Vagg & Jacobs, 1983) did not. Multiple regression revealed that all four variables remained in the model, entering in the following order: ASI, breath-holding duration, SFS, and STAI-T. These data suggest that psychological variables reflecting fears of bodily sensations are better predictors of response to challenge than either behavioral sensitivity to carbon dioxide or general trait anxiety.
This essay describes the current status of our conceptualization and assessment of catastrophic thoughts in panic disorder, an area that is more heterogeneous than may first appear. It is suggested that a heuristic approach would involve assessing both 'state' catastrophic cognitions (automatic thoughts) and the underlying 'trait' cognitive factors (beliefs). The cognitive symptoms listed in the DSM-IV and the self-report Anxiety Sensitivity Index serve as useful preliminary measures for assessing these respective domains. The trait cognitive domain is seen as multidimensional and congruence is required with internal or external stimuli in producing state catastrophic thoughts and accompanying panic attacks. Pressing challenges and controversies in this field are also highlighted and strategies for potentially resolving these issues are offered. Accordingly, several directions for future investigation are presented throughout the paper. Examples of innovative assessment techniques are briefly described.
Individualized treatment based on a functional analysis of problem behavior used to be considered a hallmark of behavior therapy. Yet the relative success of recently developed treatment manuals for DSM-defined disorders has cast doubts as to whether treatment individualization is really necessary. This article evaluates some of the relative merits of assessments and manualized treatments based on DSM categories and discusses data that indicate when a protocol treatment approach is sufficient and when it is not. Finally, a theory-driven approach to conducting behavior therapy is proposed as a way to complement individualized and manualized treatments. This approach is illustrated by presenting a model-based assessment and treatment approach to overcome excessive heart-focused anxiety (cardiophobia).
Voluntary breath-holding duration was investigated in patients with panic disorder, patients with a mood disorder, and normal controls. There were no differences in mean breath-holding durations, but the pattern of scores was different among groups. Furthermore, the scores were influenced by motivational and cognitive factors. It is argued that voluntary breath-holding is not a suitable test to measure carbon dioxide sensitivity or suffocation alarm threshold in panic disorder.
Anxiety sensitivity (AS) is the fear of anxiety-related sensations, based on beliefs that these sensations have harmful consequences. AS is thought to play an important role as a diathesis for anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower-order factors, which load on a single higher-order factor. If each factor corresponds to a discrete mechanism, 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 (ASI), which may not contain enough items to reveal the type and number of lower-order factors. Accordingly, we developed the 60-item Anxiety Sensitivity Profile, which was administered to 349 university students. Factor analyses revealed four lower-order factors: (1) Fear of respiratory symptoms, (2) fear of cognitive dyscontrol, (3) fear of gastrointestinal symptoms, and (4) fear of cardiac symptoms. These loaded on a single higher-order factor. The lower-order factors shared variance with the higher-order factor, but also contained unique variance. Thus, the results suggest that AS is the product of a general factor, with independent contributions from four specific factors.
Anxiety and its Disorders
- D H Barlow
Barlow, D. H. (1988). Anxiety and its Disorders. New York: Guilford Press.
The use of nonclinical panickers to test a prediction
- G R Norton
- S R Pidlubny
- P J Norton
Norton, G. R., Pidlubny, S. R., & Norton, P. J. (1999). The use of nonclinical panickers to test a prediction. Behavior Therapy, 30, 321-332.
Panic disorder: A critical analysis
- R J Mcnally
McNally, R. J. (1994). Panic disorder: A critical analysis. New York: Guilford Press.