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Journal
of
Abnormal Psychology
1997,
Vol. 106,
No. 3.
355-364
In
the
public domain
The
Role
of
Anxiety Sensitivity
in the
Pathogenesis
of
Panic:
Prospective Evaluation
of
Spontaneous Panic Attacks
During Acute Stress
Norman
B.
Schmidt
and
Darin
R.
Lerew
Uniformed
Services University
of the
Health
Sciences
Robert
J.
Jackson
United States
Air
Force Academy
Expectancy theory posits that anxiety sensitivity
may
serve
as a
premorbid risk factor
for the
development
of
anxiety pathology
(S.
Reiss,
1991).
The
principal
aim of the
present study
was to
determine whether anxiety sensitivity acts
as a
specific vulnerability factor
in the
pathogenesis
of
anxiety
pathology.
A
large, nonclinical sample
of
young adults
(N =
1,401)
was
prospectively
followed
over
a
5-week highly stressful period
of
time (i.e., military basic
training).
Anxiety sensitiv-
ity
was
found
to
predict
the
development
of
spontaneous panic attacks
after
controlling
for a
history
of
panic attacks
and
trait anxiety. Approximately
20% of
those scoring
in the
upper decile
on the
Anxiety
Sensitivity Index
(R. A.
Peterson
& S.
Reiss,
1987)
experienced
a
panic attack during
the
5-week
follow-up period compared
with
only
6% for the
remainder
of the
sample. Anxiety sensitivity
also
predicted anxiety symptomatology, functional impairment created
by
anxiety,
and
disability.
These data provide strong evidence
for
anxiety sensitivity
as a
risk factor
in the
development
of
panic
attacks
and
other anxiety symptoms.
Panic attacks
are
discrete
and
intense
periods
of
autonomic
arousal accompanied
by
fear.
Spontaneous panic,
as
opposed
to
situationally bound
or
situationally
disposed
panic,
is
unex-
pected
and not
readily associated with
a
triggering stimulus.
Panic attacks,
in
particular spontaneous panic,
are the
central
and
defining
feature
of
panic disorder,
but
panic
attacks
are not
limited
to
those experiencing panic disorder
or
agoraphobia.
Panic
is
common
to all the
anxiety disorders (Barlow
et
al.,
1985),
hence
its
separation
from
panic disorder
in the
fourth
edition
of the
Diagnostic
and
Statistical Manual
of
Mental
Dis-
orders
(DSM-IV;
American Psychiatric Association,
1994).
In
Norman
B.
Schmidt
and
Darin
R.
Lerew, Department
of
Medical
and
Clinical Psychology, Uniformed Services University
of the
Health
Sciences;
Robert
J.
Jackson, Department
of
Behavioral Sciences
and
Leadership, United States
Air
Force Academy.
This research
was
supported
by
Uniformed Services University
of the
Health
Sciences Grant RO72CF. Portions
of
this article were presented
at the
104th
Annual Convention
of the
American Psychological Associa-
tion, Toronto, Ontario, Canada,
August
1996,
and at the
30th Annual
Conference
of the
Association
for
Advancement
of
Behavior Therapy,
New
\brk,
New
"Vbrk,
November
1996.
The
opinions
or
assertions
con-
tained
herein
are the
private ones
of the
authors
and are not to be
construed
as
official
or
reflecting
the
views
of the
Department
of De-
fense,
the
United States
Air
Force Academy,
or the
Uniformed Services
University
of the
Health Sciences.
We
express
our
appreciation
to
David
S.
Krantz
for
helpful
comments
on
a
draft
of the
manuscript
and to
Annette
Waddelow
and
Carla
Pulliam
for
assistance with data collection.
We
also thank Donald
F.
Klein
for
his
helpful
comments.
Correspondence concerning this article should
be
addressed
to
Nor-
man
B.
Schmidt, Uniformed
Services
University
of the
Health Sciences,
Department
of
Medical
and
Clinical Psychology,
4301
Jones Bridge
Road,
Bethesda,
Maryland 20814-4799. Electronic mail
may be
sent
via
Internet
to
schmidt@usuhsb.usuhs.mil.
fact,
surveys
of
nonclinical samples suggest that
a
substantial
number
of
adults experience spontaneous panic attacks
(Norton,
Dorward,
&
Cox, 1986; Norton, Harrison, Hauch,
&
Rhodes,
1985).
One
study
of
over
2,000
college students indicated
a
lifetime
prevalence
of
approximately
12% for
spontaneous panic
(Telch,
Lucas,
&
Nelson,
1989).
'
'Fear
of
fear''
has
played
an
important role
in the
conceptual-
ization
of and
research
on
both panic attacks
and
panic disorder.
Goldstein
and
Chambless
(1978)
suggested that panic
disorder
patients learn
to
fear symptoms
of
anxiety through interoceptive
classical conditioning
of
internal physical sensations. Internal
bodily cues
become
a
conditioned stimulus
for the
conditioned
response
of
anxiety
and
panic. According
to
Goldstein
and
Chambless,
fear
of
fear
develops
as a
consequence
of
having
panic
attacks. Fear
of
fear
has
also been
described
within cogni-
tive
theories
of
panic
(Beck
&
Emery, 1985; Clark,
1986),
which
suggest that panic attacks arise
from
the
catastrophic
misinterpretation
of
benign bodily perturbations. Misinterpreta-
tion
of
bodily cues leads
to a
vicious cycle
in
which
faulty
interpretation
leads
to
more anxiety
as a
fearful
response
to
arousal increases
the
very symptoms that constitute
the
focus
of
apprehension. This process
may
ultimately spiral into
full-
blown
panic
as
fear
feeds upon itself
(see
McNally,
1990).
The
construct
of
anxiety sensitivity
is
closely linked
with
fear
of
fear (Reiss
&
McNally,
1985).
Anxiety sensitivity refers
to
the
extent
to
which
an
individual believes that autonomic arousal
can
have
harmful
consequences.
For
example, individuals with
high
anxiety sensitivity
may
believe that shortness
of
breath
signals
suffocation
or
that heart palpitations indicate
a
heart
attack, whereas those with
low
anxiety sensitivity experience
these sensations
as
unpleasant
but
nonthreatening.
Consistent
with
cognitive theories
of
anxiety,
the
anxiety sen-
sitivity
conceptualization
posits
that cognitive
misappraisal
is
critical
for the
generation
of
anxiety. However, anxiety sensitiv-
355
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