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Abstract

A brief cognitive-behavioral treatment intervention that included an interoceptive exposure (IE) component was previously demonstrated effective in decreasing fear of anxiety-related sensations in high anxiety-sensitive (AS) women (see Watt, Stewart, Birch, & Bernier, 2006). The present process-based study explored the specific role of the IE component, consisting of 10 minutes of physical exercise (i.e., running) completed on 10 separate occasions, in explaining intervention efficacy. Affective and cognitive reactions and objective physiological reactivity to the running, recorded after each IE trial, were initially higher in the 20 high-AS participants relative to the 28 low-AS participants and decreased over IE trials in high-AS but not in low-AS participants. In contrast, self-reported somatic reactions, which were initially greater in the high-AS participants, decreased equally in both AS groups over IE trials. Findings were consistent with the theorized cognitive and/or habituation pathways to decreased AS.

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... The intervention was successful in decreasing AS levels , as well as cognitive and affective reactions to the running (Sabourin et al., 2008) in high AS, but not low AS women. On the other hand, somatic reactions decreased for both the high and low AS women. ...
... Participants A total of 154 female undergraduate students from three eastern Canadian universities participated in the larger outcome study (Sabourin et al., under review). Only women were recruited for participation to control for sex effects, for replication purposes (Sabourin et al., 2008), and because women have been found to have higher AS levels than men (Stewart, Taylor, & Baker, 1997). Participants were recruited based on scoring one standard deviation (SD) above or below the mean score for university women (i.e., 18 þ/2 7; see Watt et al., 2008) on the Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992), a widely used measure of AS. ...
... A visual inspection of the HVQ-B revealed that minimal decreases in scores occurred after the first 20 trials. Because nearly all of the benefits from IE occurred during the first 20 trials, few participants completed all 42 trials, and 20 trials represented twice the amount from the previous Sabourin et al. (2008) study, treatment completion for the current process study was defined as having completed at least 20 running trials. ...
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A brief, group cognitive behavioural therapy with running as the interoceptive exposure (IE; exposure to physiological sensations) component was effective in decreasing anxiety sensitivity (AS; fear of arousal sensations) levels in female undergraduates (Watt et al., Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity, 201-219, 2008). Additionally, repeated exposure to running resulted in decreases in cognitive (i.e., catastrophic thoughts) and affective (i.e., feelings of anxiety) reactions to running over time for high AS, but not low AS, participants (Sabourin et al., "Physical exercise as interoceptive exposure within a brief cognitive-behavioral treatment for anxiety-sensitive women", Journal of Cognitive Psychotherapy, 22:302-320, 2008). A follow-up study including the above-mentioned intervention with an expanded IE component also resulted in decreases in AS levels (Sabourin et al., under review). The goals of the present process study were (1) to replicate the original process study, with the expanded IE component, and (2) to determine whether decreases in cognitive, affective, and/or somatic (physiological sensations) reactions to running would be related to decreases in AS. Eighteen high AS and 10 low AS participants completed 20 IE running trials following the 3-day group intervention. As predicted, high AS participants, but not low AS participants, experienced decreases in cognitive, affective, and somatic reactions to running over time. Furthermore, decreases in cognitive and affective, but not in somatic, reactions to running were related to decreases in AS levels. These results suggest that the therapeutic effects of repeated exposure to running in decreasing sensitivity to anxiety-related sensations are not related to decreasing the experience of somatic sensations themselves. Rather, they are related to altering the cognitive and affective reactions to these sensations.
... Second, Sabourin et al. (2008) used the HVQ to assess female high and low AS participants' reactions to another type of arousal-inducing exercise-running. Running was used as the IE component of a brief cognitive behavioural intervention for AS. ...
... Running was used as the IE component of a brief cognitive behavioural intervention for AS. Participants (n ¼ 41) were recruited from undergraduate psychology subject pools at two universities, and categorized as high or low AS based on scoring 1 SD above or below the mean female ASI score (see Sabourin et al., 2008 for additional information on participants and design). Scores on the HVQ assessing participants' reactions during the initial running trial were used for the present study. ...
... The HVQ-B was administered in a recent follow-up study to Sabourin et al. (2008;Sabourin, Stewart, Watt, & Krigolson (2012). Whereas in Study 1, we used the long version of the scale to determine which items to retain for the HVQ-B, in Study 2 we assessed the psychometric properties of the HVQ-B when administered as a stand-alone 18-item measure. ...
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The fear of arousal sensations characterizes some anxiety disorders and is a core feature of an established risk factor for anxiety and related disorders (i.e. anxiety sensitivity; Taylor, 1999). Anxiety sensitivity (AS) refers to a fear of anxiety-related bodily sensations stemming from beliefs that these have catastrophic consequences. Interoceptive exposure (IE; repeated exposure to feared arousal sensations) has been shown to decrease AS. The 33-item Hyperventilation Questionnaire (HVQ; Rapee & Medoro, 1994) measures state levels of cognitive, affective, and somatic responses to IE and arousal induction exercises more generally. The aim of the present set of studies was to develop and evaluate a brief version of the HVQ, the HVQ-B, in order to facilitate its use in research and clinical settings. In Study 1, three existing data sets that used the long version of the HVQ were combined to select the items to be retained for the HVQ-B. In Study 2, the 18-item HVQ-B was administered and its psychometric properties were evaluated. In Study 3, a confirmatory factor analysis (CFA) was performed on the 18 items of the HVQ-B. The HVQ-B demonstrated excellent psychometric properties, and accounted for most of the variance of the questionnaire's longer version. CFA indicated a reasonably good fit of the three-factor measurement model. Finally, the HVQ-B was able to distinguish between responses to arousal induction exercises by high versus low AS participants. The HVQ-B is a useful tool to assess cognitive, affective, and somatic responsivity to arousal sensations in both research and practice.
... Findings were consistent with a cognitive mediation pathway where running trials provided opportunities to practice challenging catastrophic interpretations of arousal-related sensations, allowing for reduction of fear to the sensations. Alternatively, by countering their tendency to avoid arousal-related sensations through exercise avoidance, running trials may have allowed for habituation of the fear response to arousal-related sensations like rapid heart rate (Sabourin et al., 2008). ...
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Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
... This was as expected, as our participants were not selected for elevated anxiety levels and the protocol did not have a specific anxiogenic component. However, results may have differed had participants been selected for high anxiety sensitivity, for which physical exercise often elicits fear and catastrophic thinking (Sabourin et al., 2008;Sabourin, Stewart, Watt, & Krigolson, 2015). ...
Article
Introduction: It is well established that some individuals self-medicate their anxiety with alcohol. Though much evidence exists that alcohol consumption can be negatively reinforcing, there remains uncertainty regarding what mediates the relationship between alcohol and anxiety. An unexplored possibility is that, for some, alcohol impairs interoceptive sensitivity (the ability to accurately perceive one's physiological state), thereby decreasing state anxiety. Consistent with this, highly accurate heartbeat perception is a risk factor both for elevated trait anxiety and anxiety disorders. However, the direct impact of alcohol on cardioceptive accuracy has not to our knowledge been previously examined. Methods: Sixty-one social drinkers came to the lab in groups of 4-6 on two days spaced a week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants engaged in a Schandry heartbeat perception task on three occasions: at baseline, after an alcohol absorption period, and after physiological arousal was raised via exercise. Results: For men only, alcohol significantly impaired cardioceptive accuracy relative to a placebo at both low and high levels of arousal, with medium to large effect sizes. Conclusions: Though preliminary, this finding is consistent with the proposed hypothesis linking alcohol consumption and anxiety, at least for men. Future studies should directly examine whether, among individuals with anxiety disorders, cardioceptive sensitivity mediates the relationship between alcohol consumption and state anxiety.
... For example, people with high (vs. low) AS have been found to engage in physical activity for briefer durations of time (Smits, Tart, Presnell, Rosenfield, & Otto, 2010), at a reduced level of intensity (Boyle, Watt, & Gallagher, 2014), or to avoid physical activity altogether (Sabourin et al., 2008;Smits et al., 2010). Broman-Fulks, McCloskey, and Berman (2007) found that AS levels were inversely correlated with physical aggression, even in the face of provocation. ...
Article
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High anxiety sensitivity (AS; fear of arousal-related bodily sensations) is a known risk factor for psychopathology and medical pathology. High AS individuals tend to avoid activities that induce feared arousal-related sensations; yet, few studies have examined AS and sexual activity, those that did have produced mixed results, and no study to date has examined AS and sexual avoidance. In Study 1, 296 young adult women completed the Anxiety Sensitivity Index-3 (ASI-3) and the Female Sexual Distress Scale-Revised, which were positively correlated, r = 0.34, p < .001. Women scoring in the highest and lowest quartiles on the ASI-3 were recruited for Study 2. As predicted, high (vs. low) AS women reported significantly more sexual distress, impairments in sexual functioning (including sexual pain), and avoidance of sexual activity, and less sexual satisfaction. Results suggest that high AS can limit the frequency and quality of sexual functioning in young adult women, or lead to avoidance of sexual activity altogether. Reducing AS via empirically validated cognitive-behavioural approaches could improve women's sexual and relationship well-being.
... Elucidating therapeutic mechanisms of aerobic exercise is relevant to strengthening its legitimacy as a treatment option for PTSD and related disorders. Some (Sabourin et al., 2008;Watt, Stewart, Lefaivre, &amp; Ulman, 2006) suggest that aerobic exercise constitutes a form of interoceptive exposure, an evidencebased treatment for anxiety disorders (Arntz, 2002) and PTSD (Wald &amp; Taylor, 2008) that reduces AS via exposure to feared somatic sensations (Craske, Rowe, Lewin, &amp; NoriegaDimitri, 1997). Others (Morgan, 1987;Salmon, 2001;Strohle, 2009) suggest that aerobic exercise provides distraction from anxious and fearful thoughts, thereby providing escape from distressing symptoms. ...
Article
Evidence suggests aerobic exercise has anxiolytic effects; yet, the treatment potential for posttraumatic stress disorder (PTSD) and responsible anxiolytic mechanisms have received little attention. Emerging evidence indicates that attentional focus during exercise may dictate the extent of therapeutic benefit. Whether benefits are a function of attentional focus toward or away from somatic arousal during exercise remains untested. Thirty-three PTSD-affected participants completed two weeks of stationary biking aerobic exercise (six sessions). To assess the effect of attentional focus, participants were randomized into three exercise groups: group 1 (attention to somatic arousal) received prompts directing their attention to the interoceptive effects of exercise, group 2 (distraction from somatic arousal) watched a nature documentary, and group 3 exercised with no distractions or interoceptive prompts. Hierarchal linear modeling showed all groups reported reduced PTSD and anxiety sensitivity (AS; i.e., fear of arousal-related somatic sensations) during treatment. Interaction effects between group and time were found for PTSD hyperarousal and AS physical and social scores, wherein group 1, receiving interoceptive prompts, experienced significantly less symptom reduction than other groups. Most participants (89%) reported clinically significant reductions in PTSD severity after the two-week intervention. Findings suggest, regardless of attentional focus, aerobic exercise reduces PTSD symptoms.
... Participants were screened using the Anxiety Sensitivity Index (ASI; Peterson and Reiss 1992) completed as part of a mass screening at three universities. This pre-treatment screening was conducted for a larger treatment outcome study of a cognitive-behavioural approach to the treatment of high AS for college women (see Sabourin et al. 2008 or Watt and Stewart 2008, for a detailed description of the approach). To qualify for both the larger study and the present study, individuals had to score at least one standard deviation above (high AS) or below (low AS) the mean ASI screening score for women as reported in past research with a similar population (i.e., 17.9±8.7; ...
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Anxiety sensitivity (AS) is a psychological risk factor for anxiety disorders. Negative interpretation biases are a maladaptive form of information-processing also associated with anxiety disorders. The present study explored whether AS and negative interpretation biases make independent contributions to variance in panic and generalized anxiety symptoms and whether particular interpretation bias domains (e.g., of ambiguous arousal sensations) have specific associations with panic and/or generalized anxiety symptoms. Eighty-nine female undergraduates (44 low AS; 45 high AS) completed measures of AS, interpretation biases, and panic and generalized anxiety symptoms. Findings showed that AS and negative interpretation biases both significantly added to the prediction of anxiety symptoms. Negative interpretations of ambiguous arousal sensations were uniquely associated with panic symptoms, while negative interpretations of ambiguous general and social events were uniquely associated with generalized anxiety symptoms. Findings support the conceptual validity of AS and negative interpretation biases and their unique and shared contributions to anxiety symptoms.
... More recently, running, which also produces arousal-related sensations, was used as the interoceptive exposure component of a brief cognitive behavioural therapy (CBT) for reducing AS in high-AS undergraduate women (Watt et al., 2006). The combination of the brief CBT and interoceptive exposure component of ten 10- min sessions of running led to decreases in AS (Watt et al., 2006) and in fearful responses to arousal sensations elicited by exercise (Sabourin et al., 2008). Thus, exposure strategies that incorporate physical exercise appear to be viable and effective for reducing AS levels. ...
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Anxiety sensitivity (AS; fear of arousal sensations) is a risk factor for mental and physical health problems, including physical inactivity. Because of the many mental and physical health benefits of exercise, it is important to better understand why high-AS individuals may be less likely to exercise. The present study's aim was to understand the role of barriers to exercise in explaining lower levels of physical exercise in high-AS individuals. Participants were undergraduate women who were selected as high (n = 82) or low (n = 72) AS. High-AS women participated in less physical exercise and perceived themselves as less fit than low-AS women. Mediation analyses revealed that barriers to exercise accounted for the inverse relationships between AS group and physical exercise/fitness levels. Findings suggest that efforts to increase physical exercise in at-risk populations, such as high-AS individuals, should not focus exclusively on benefits to exercise but should also target reasons why these individuals are exercising less.
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Anxiety sensitivity (AS; i.e. fear of arousal-related sensations) and impulsivity (i.e. tendency to act quickly without regard for longer-term consequences) represent risks for low physical activity participation. Theoretically, higher impulsivity may exacerbate the negative exercise behaviours of high AS individuals given the tendency of impulsive individuals to favour immediate (e.g. watching TV) over delayed rewards (e.g. the benefits of exercise). Our goal was to investigate the main and interactive effects of AS and impulsivity on physical activity levels at varying exercise intensities. Participants were 178 emerging adults (Mean age = 21.9; 68.8% women). Higher AS was associated with less engagement in vigorous intensity exercise. Moderator analyses revealed an AS x impulsivity interaction: high AS predicted significantly less engagement in moderate intensity exercise at low impulsivity levels and marginally more engagement in moderate intensity exercise at high impulsivity levels. Finally, higher impulsivity was associated with more time spent walking. Cognitive behavioural therapy for high AS, or teaching individuals with high AS to focus on immediate, external rewards of exercise, may help them engage in more physical activity. Given the wide-ranging physical and mental health benefits of exercise involvement, developing effective strategies to increase such involvement in high AS individuals is vital.
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Anxiety sensitivity (AS)—the tendency to interpret anxiety as an aversive state—is associated with low rates of physical activity. Previous interventions targeting AS via exercise-based interoceptive exposure have not assessed physical activity as an outcome and are limited by brief follow-up periods. This study replicated and extended previous work by including a 6-week follow-up and assessing physical activity. Participants were 44 sedentary young adults with elevated AS randomized to intervention (six 20-minute sessions of moderate-intensity walking) or assessment-only control. Assessments of AS and physical activity were conducted at baseline and weeks 2 (post-treatment), 4, and 8. Between-group change in AS and physical activity over time was assessed using hierarchical linear modeling. The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4, which eroded by week 8. There were no significant between-group differences for change in physical activity. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS or related exercise avoidance without additional treatment. Intervention effects were weaker than previous reports, which may be due to the greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in response.ClinicalTrials.gov identifier: NCT03128437
Article
A brief group-based cognitive behavioral therapy (CBT), with running as an interoceptive exposure (IE) component, was effective in reducing anxiety sensitivity (AS) levels in undergraduate women (Watt, Stewart, Lefaivre, & Uman, 2006). This study investigated whether the CBT/IE intervention would result in decreases in AS and emotional distress that would be maintained over 14 weeks. Female undergraduates, high (n = 81) or low (n = 73) in AS, were randomized to 3-day CBT plus forty-two 10-min running IE trials (n = 83) or 3-day health education control (HEC) with interactive discussions and problem solving on exercise, nutrition, and sleep (n = 71). The CBT/IE intervention led to decreases in AS, depression, and stress symptoms for high AS participants, which were maintained at 14 weeks. Unexpectedly, HEC participants experienced similar and lasting decreases in AS, depression, and anxiety symptoms. Furthermore, there were no post-intervention differences between CBT/IE and HEC participants in any of the outcomes. Low AS participants experienced few sustained changes. Clinical implications and the possible role of aerobic exercise in explaining outcomes of both interventions are discussed.
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Co-morbidity is defined as the presence of any co-occurring condition in a patient with an index disease (Kranzler & Rosenthal, 2003). Epidemiologic surveys of psychopathology in the United States have found that while approximately half of the general population will experience a major psychiatric illness at some point over their lifetime, the majority of affected individuals will simultaneously meet diagnostic criteria for two or more disorders (Kessler et al., 1994). Co-morbidity has important clinical implications including: more severe symptoms, more functional disability, longer illness duration, and higher treatment service utilization (see de Graaf, Bijl, ten Have, Beekman, & Vollebergh, 2004). One of the most common co-morbid conditions is anxiety disorder cooccurring with substance use disorder. Studies that have examined rates of alcohol dependence in anxiety disorder outpatient samples suggest ranges from 15% to 30% depending on the particular anxiety disorders (see Barlow, 1997). Other epidemiologic studies cite lifetime prevalence rates of clinically significant anxiety disorders in patients with alcohol dependence as ranging from 25% to 45% (Kushner et al., 2005). These rates of alcohol dependence in anxiety disorder patients, and of anxiety disorders in alcoholism patients, are markedly elevated relative to base-rates in the general population. Nonetheless, co-morbidity studies with patient populations can lead to overestimates of co-morbidity due to the issue of ‘‘Berkson’s bias’’ – the fact that individuals with more than one disorder may be more likely to seek treatment than those with only one disorder (Galbaud du Fort, Newman, & Bland, 1993). Thus, population-based studies are important to examine ‘‘true’’ rates of co-morbidity of anxiety and substance use disorders. In the Epidemiological Catchment Area Survey (ECA), which included more than 20,000 respondents from five communities in the United States, alcoholics were significantly more apt to have a co-morbid anxiety disorder than non-alcoholics (19.4% vs. 13.1%) (Regier et al., 1990). Moreover, the ECA survey found that individuals with any anxiety disorder had a 50% increase in the odds of being diagnosed with a lifetime alcohol use disorder (alcohol abuse or dependence). Co-morbid psychiatric symptoms, such as anxiety, can make accurate assessment of substance use more difficult and is associated with a poorer substance use outcome following treatment (Kranzler & Rosenthal, 2003). Indeed, anxiety disorders may especially complicate the treatment of substance use disorders in that they have been found to take significantly longer to remit as compared to mood disorders (Wagner, Krampe, & Stawicki, 2004). Another issue relates to whether the anxiety disorder is seen as being ‘‘independent’’ of the substance use disorder or ‘‘substance-induced’’. The former views onset of an anxiety disorder occurring before that of an alcohol disorder and/or persisting after the substance abuse is resolved and in need of specific treatment. The latter views onset of an anxiety disorder occurring after that of an alcohol disorder due to substance intoxication and/or withdrawal and not in need of specific treatment; rather, substance-induced anxiety disorders will resolve as the substance abuse is brought under control. Using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) in a large epidemiologic survey, Grant et al. (2004) concluded that the vast majority of the anxiety disorders found in the general population and in alcoholism treatment settings are independent of substance abuse (see chapter 1).
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Increasingly, mobile technologies are used to gather diary data in basic research and clinical studies. This article considers issues relevant to the integration of electronic diary (ED) methods in clinical assessment. EDs can be used to gather rich information regarding clients' day-to-day experiences, aiding diagnosis, treatment planning, treatment implementation, and treatment evaluation. The authors review the benefits of using diary methods in addition to retrospective assessments, and they review studies assessing whether EDs yield higher quality data than conventional, less expensive paper-pencil diaries. Practical considerations--including what platforms can be used to implement EDs, what features they should have, and considerations in designing diary protocols for sampling different types of clinical phenomena--are described. The authors briefly illustrate with examples some ways in which ED data could be summarized for clinical use. Finally, the authors consider barriers to clinical adoption of EDs. EDs are likely to become increasingly popular tools in routine clinical assessment as clinicians become more familiar with the logic of diary designs; as software packages evolve to meet the needs of clinicians; and as mobile technologies become ubiquitous, robust, and inexpensive.
Article
Panic disorder is characterized by unexpected panic attacks, anxiety about experiencing future attacks, and avoidance or dread of situations where attacks might occur. Panic attacks are defined as discrete periods of fear that develop abruptly and are accompanied by physical symptoms, cognitive symptoms, or both. Panic attack symptoms include sweating, shortness of breath, heart palpitations, trembling or shaking, chest pain or discomfort, feeling of choking, nausea, fear of dying or going crazy, derealization or depersonalization, chills or hot flushes, numbness, and feeling dizzy, unsteady, or faint. The first criterion of panic disorder is the presence of recurrent, unexpected panic attacks. It is required that “unexpected” panic attacks occur, meaning that from the patient's perspective, such attacks seem to occur “out of the blue” or without any obvious causes. This is an important feature when conducting a differential diagnosis, as panic attacks that occur due to other anxiety disorders are situationally bound or situationally predisposed (e.g., panic attacks cued by social situations in social phobia). Although panic disorder patients may experience such situationally bound or situationally predisposed panic, in order to meet diagnostic criteria for panic disorder, they must experience recurrent, “unexpected” panic attacks. Also, the panic attacks must not be caused by the direct physiological effects of a substance or general medical condition. Experiencing unexpected panic attacks is necessary, but not sufficient, for a diagnosis of panic disorder.
Article
Simple slopes, regions of significance, and confidence bands are commonly used to evaluate interactions in multiple linear regression (MLR) models, and the use of these techniques has recently been extended to multilevel or hierarchical linear modeling (HLM) and latent curve analysis (LCA). However, conducting these tests and plotting the conditional relations is often a tedious and error-prone task. This article provides an overview of methods used to probe interaction effects and describes a unified collection of freely available online resources that researchers can use to obtain significance tests for simple slopes, compute regions of significance, and obtain confidence bands for simple slopes across the range of the moderator in the MLR, HLM, and LCA contexts. Plotting capabilities are also provided.
Article
The present study tested if the global anxiety sensitivity construct and its constituent factors (i.e., physical, mental incapacitation, and social concerns) moderate the relation between traumatic event exposure frequency and posttraumatic stress symptomatology. Participants were 61 rural young adults who reported experiencing at least 1 lifetime traumatic event. Consistent with prediction, anxiety sensitivity total and subfactor levels moderated the relation between trauma exposure frequency and posttraumatic stress symptomatology. These moderating effects were above and beyond variance accounted for by the respective anxiety sensitivity and stress main effects as well as other theoretically relevant factors (e.g., negative affectivity). Findings are discussed in relation to better understanding cognitive-based individual difference factors associated with posttraumatic stress symptomatology.
Article
[This book] presents the latest research of leading psychology, psychiatry, cardiology, internal medicine, and methodology experts working in [the field of panic disorder]. The authors address such issues as: What is panic disorder? How is it diagnosed? What are the current treatments? What are the effects of these treatments? What are the directions for future research? (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Evaluated a scale for measuring anxiety sensitivity (i.e., the belief that anxiety symptoms have negative consequences), the Child Anxiety Sensitivity Index (CASI), in 76 7th–9th graders and 33 emotionally disturbed children (aged 8–15 yrs). The CASI had sound psychometric properties for both samples. The view that anxiety sensitivity is a separate concept from that of anxiety frequency and that it is a concept applicable with children was supported. The CASI correlated with measures of fear and anxiety and accounted for variance on the Fear Survey Schedule for Children—Revised and the State-Trait Anxiety Inventory for Children (Trait form) that could not be explained by a measure of anxiety frequency. The possible role of anxiety sensitivity as a predisposing factor in the development of anxiety disorder in children is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The relative efficacy of cognitive restructuring and interoceptive exposure procedures for the treatment of panic disorder, as well as the differential effects of the order of these interventions, was studied. Eighteen clients with panic disorder were seen for four sessions of exposure therapy and four sessions of cognitive therapy in a crossover design study. Half of the participants received exposure therapy followed by cognitive therapy and for half the order was reversed. There was a 1-month follow-up period between the two interventions and after the second intervention. Questionnaire measures and independent clinician ratings were used to assess outcome. Participants expected greater benefit from cognitive therapy, but tended to improve to a similar degree with either intervention. The order in which treatments were presented did not influence outcome. Participants tended to improve with the first intervention and maintain improvement across the follow-up periods and subsequent intervention. Several methodological limitations qualify the conclusions that can be drawn from this study. These limitations, as well as some conceptual and methodological challenges of conducting this type of research, are discussed.
Article
Previous research suggests that high anxiety sensitivity (AS) young adults are particularly sensitive to alcohol's dampening effects on their responses to arousal-induction challenge [Alcohol.: Clin. Exp. Res. 24 (2000) 1656.]. This sensitivity to alcohol reward may place high AS individuals at increased risk for alcohol abuse. Over-and-above alcohol's pharmacological effects, tension-reduction expectancies might contribute to alcohol's reactivity-dampening effects in high-AS individuals. The present study examined the role of alcohol and alcohol expectancy factors by activating expectancies experimentally. Forty-eight high-AS young adults were randomly assigned to one of three beverage conditions: alcohol (pharmacology plus expectancy), placebo (expectancy only), and control (no pharmacology and no expectancy). Following beverage consumption and absorption, participants underwent a 3-min voluntary hyperventilation challenge. Replicating and extending previous findings, participants in the alcohol condition showed dampened affective and somatic responses to the challenge, and marginally dampened cognitive responses to the challenge, compared to both placebo and control participants. However, placebo participants did not display dampened responses to the challenge relative to control beverage condition participants. Additional analyses suggested that activation of tension-reduction expectancies might have contributed to an “inverse placebo” effect among high-AS participants administered placebo. Implications of the results for future research and for the prevention and treatment of alcohol problems among high-AS individuals are discussed.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related sensations arising from beliefs that these sensations have harmful physical, psychological, or social consequences. AS is measured using the Anxiety Sensitivity Index (ASI), a 16-item self-report questionnaire. Little is known about the origins of AS, although social learning experiences (including sex-role socialization experiences) may be important. The present study examined whether there were gender differences in: (a) the lower- or higher-order factor structure of the ASI; and/or (b) pattern of ASI factor scores. The ASI was completed by 818 university students (290 males; 528 females). Separate principal components analyses on the ASI items of the total sample, males, and females revealed nearly identical lower-order three-factor structures for all groups, with factors pertaining to fears about the anticipated (a) physical, (b) psychological, and (c) social consequences of anxiety. Separate principal components analyses on the lower-order factor scores of the three samples revealed similar unidimensional higher-order solutions for all groups. Gender × AS dimension analyses on ASI lower-order factor scores showed that: females scored higher than males only on the physical concerns factor; females scored higher on the physical concerns factor relative to their scores on the social and psychological concerns factors; and males scored higher on the social and psychological concerns factors relative to their scores on the physical concerns factor. Finally, females scored higher than males on the higher-order factor representing the global AS construct. The present study provides further support for the empirical distinction of the three lower-order dimensions of AS, and additional evidence for the theoretical hierarchical structure of the ASI. Results also suggest that males and females differ on these various AS dimensions in ways consistent with sex role socialization practices.
Article
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Article
The link between exercise intensity and affect has been a popular topic of investigation for many years but has drawn few universally accepted conclusions. Recently, Ekkekakis [(2003). Pleasure and displeasure from the body: Perspectives from exercise. Cognition and Emotion, 7, 213–239] proposed a ‘dual-mode model’ to explain the nature of this relationship by employing individual metabolic markers (such as the ventilatory threshold) as demarcators of exercise intensity. The overall purpose of the study was to test this model with an inactive female sample as current evidence is based largely on research with healthy, active participants.
Article
Exercise interventions repeatedly have been shown to be efficacious for the treatment of depression, and initial studies indicate similar efficacy for the treatment of anxiety conditions. To further study the potential beneficial role of prescriptive exercise for anxiety-related conditions, we examined the role of exercise in reducing fears of anxiety-related sensations (anxiety sensitivity). We randomly assigned 60 participants with elevated levels of anxiety sensitivity to a 2-week exercise intervention, a 2-week exercise plus cognitive restructuring intervention, or a waitlist control condition. Assessment of outcome was completed at pretreatment, midtreatment, 1-week posttreatment, and 3-week follow-up. We found that both exercise conditions led to clinically significant changes in anxiety sensitivity that were superior to the waitlist condition, representing a large controlled effect size (d=2.15). Adding a cognitive component did not facilitate the effects of the exercise intervention. Consistent with hypotheses, changes in anxiety sensitivity mediated the beneficial effects of exercise on anxious and depressed mood. We discuss these findings in terms of the potential role of exercise as an additional psychosocial intervention for conditions such as panic disorder, where anxiety sensitivity is a prominent component of pathology.
Article
The aim of this study was to assess the rate of change on clinical, behavioral and cognitive variables during exposure therapy and cognitive restructuring in the treatment of panic disorder with agoraphobia. A total of 28 Ss who received a diagnosis of panic disorder with agoraphobia were randomly assigned to either of two treatment conditions: exposure therapy or cognitive restructuring. Treatment conditions were kept as distinct as possible from each other. Subjects were assessed on five occasions: pretreatment, after 5, 10, and 15 (posttreatment) sessions of treatment and at a 6-month follow-up. Analyses of outcome data revealed strong and significant time effects on all measures. However, no group x time interaction reached statistical significance, suggesting that both strategies operate at the same pace. Furthermore, power analyses suggest that any difference that might exist in the rate of improvement between exposure and cognitive restructuring in the treatment of panic disorder with agoraphobia is marginal.
Article
In order to explore the mechanism of action of interoceptive exposure, 12 Panic Disorder (PD) patients were presented with two sessions of repeated CO2 inhalation. Two distinct patterns of responding were noted. The first pattern was described as habituation of fear (n = 6). These patients showed decrements in pre- and post-inhalation anxiety during both sessions (with more rapid decline during session 2), as well as spontaneous recovery of fear at the onset of session 2. The second pattern indicated fear sensitization. These patients showed relatively low levels of anticipatory anxiety preceding CO2 inhalation during both sessions but reported robust increases in fear following gas inhalation. The extent of this increase was slightly less during session 2 relative to session I and did not appear to be mediated by cardiovascular arousal, as both groups showed rapid HR habituation during both sessions. Results are discussed in light of current theories of PD and its treatment.
Article
Exercise habits and indices of aerobic fitness as measured by spiroergometric testing were examined in 38 patients with panic disorder and/or agoraphobia and 24 untrained healthy controls. Maximal oxygen consumption, maximal power output and the power output at a lactate concentration of 4 mmol/l were significantly reduced in the patient group when compared to untrained controls. Other parameters like physical work capacity at a heart rate of 150/min, maximal lactate concentration, vital capacity, subjective exertion at maximal work load, and maximal heart rate did not differ between patients and controls. Patient interviews revealed that aerobic exercise is avoided by the vast majority of patients. Reduced aerobic fitness might contribute to the pathophysiology of panic disorder and/or agoraphobia.
Article
The purpose of this study was to compare the therapeutic effect of exercise for patients with panic disorder to a drug treatment of proven efficacy and to placebo. Forty-six outpatients suffering from moderate to severe panic disorder with or without agoraphobia (DSM-III-R criteria) were randomly assigned to a 10-week treatment protocol of regular aerobic exercise (running), clomipramine (112.5 mg/day), or placebo pills. The dropout rate was 31% for the exercise group, 27% for the placebo group, and 0% for the clomipramine group. In comparison with placebo, both exercise and clomipramine led to a significant decrease in symptoms according to all main efficacy measures (analysis of variance, last-observation-carried-forward method and completer analysis). A direct comparison of exercise and clomipramine revealed that the drug treatment improved anxiety symptoms significantly earlier and more effectively. Depressive symptoms were also significantly improved by exercise and clomipramine treatment. These results suggest that regular aerobic exercise alone, in comparison with placebo, is associated with significant clinical improvement in patients suffering from panic disorder, but that it is less effective than treatment with clomipramine.
Article
This study examined the rate of symptom improvement in patients receiving cognitive-behavioral group treatment for panic disorder in an outpatient clinic setting. Treatment was a standard program of 12 sessions that emphasized information, interoceptive and situational exposure, and cognitive restructuring, but also included diaphragmatic breathing and relaxation training as elements of treatment. Subjects were 37 patients selected from sequential admissions into an outpatient treatment program; all data were derived from ongoing quality assurance measures that are a standard part of clinical monitoring. Consequently, this study provides data not on the relative efficacy of cognitive-behavioral therapy (CBT), but on rate of improvement and effectiveness of CBT for panic disorder in actual clinical practice. Patients achieved significant treatment gains on all panic disorder dimensions assessed, and the largest reduction in symptoms was during the first third of the treatment program, thereby challenging the notion that CBT delivers its gains slowly over time. Information on rats of symptom improvement is valuable for providing patients with accurate expectations about potential treatment benefits and for helping to maintain motivation during initial treatment sessions.
Article
While there is mounting evidence that the concept of anxiety sensitivity (AS) is linked to the expression of anxiety (specifically, panic), there has been little research comparing the efficacy of interoceptive exposure alone with interoceptive exposure coupled with cognitive restructuring among high AS participants. The present investigation addressed this issue in a sample of high anxiety-sensitive college students (scores above 29 on the Anxiety Sensitivity Index). Participants were randomly assigned to receive either five consecutive trials of voluntary hyperventilation or five consecutive trials of hyperventilation with cognitive restructuring instructions. It was expected that while repeated hyperventilation would be associated with a significant reduction in self-reported anxiety, catastrophic cognitions, and somatic sensations across trials, the greatest reduction in symptoms would occur with the addition of cognitive restructuring. These predictions were partially supported. As expected, high AS participants evidenced significant decreases in anxiety symptoms when habituation was accompanied by cognitive restructuring. Contrary to predictions, however, interoceptive exposure alone was not effective in reducing anxious symptoms. These results suggest that brief habituation alone may not be an effective strategy for high AS participants and are discussed as providing further support for a cognitive model of anxiety.
Article
the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.
Article
Previous research suggests that high levels of anxiety sensitivity (AS; fear of anxiety symptoms) may constitute a risk factor for alcohol abuse. The present study evaluated the hypothesis that high AS levels may increase risk for alcohol abuse by promoting a heightened sober reactivity to theoretically relevant stressors and heightened sensitivity to alcohol's emotional reactivity dampening effects, which would negatively reinforce drinking in this population. One hundred and two undergraduate participants (51 high AS, 51 low AS) with no history of panic disorder were assigned to either a placebo, low-dose alcohol, or high-dose alcohol beverage condition (17 high AS, 17 low AS per beverage condition). After beverage consumption and absorption, participants underwent a 3 min voluntary hyperventilation challenge. High-AS/placebo participants displayed greater affective and cognitive reactivity to the challenge than low-AS/placebo participants, which indicated increased fear and negative thoughts (e.g., "losing control") during hyperventilation among sober high AS individuals. Dose-dependent alcohol dampening of affective and cognitive reactivity to hyperventilation was observed only among high-AS participants, which suggested that high-AS individuals may be particularly sensitive to alcohol-induced reductions in their degree of fear and negative thinking in response to the experience of physical arousal sensations. In contrast, dose-dependent alcohol dampening of self-reported somatic reactivity was observed among both high- and low-AS participants. We discuss implications of these results for understanding risk for alcohol abuse in high-AS individuals, as well as directions for future research.
Article
Little research has addressed McNally's hypothesis [(1996). Anxiety sensitivity is distinguishable from trait anxiety. In: R. M. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 214-227). New York: The Guilford Press.] that anxiety sensitivity (AS) should be negatively associated with the use of arousal-increasing substances. In the present study, we examined the relationship between AS and the self-reported use of two widely available stimulants--nicotine and caffeine--and exercise frequency in a sample of 256 university students. A measure of trait anxiety was also incorporated within the design. The associations between use of both substances and levels of AS and trait anxiety were weak and nonsignificant. Although inconsistent with McNally's hypothesis, some significant findings were found when the lower-order components of AS (i.e., fears of physical, psychological, and publicly observable symptoms of anxiety) were examined. The associations between exercise frequency and the anxiety measures, indicating a negative relationship, were generally consistent with McNally's hypothesis. Implications of these findings are discussed with reference to future investigation.
Article
Cognitive therapy (CT) and interoceptive exposure (IE) as treatments of panic disorder without agoraphobia were compared in a sample of 69 patients, randomly allocated to condition. There were no significant differences between treatments as to reductions in panic frequency, daily anxiety levels and a composite questionnaire score, at posttest after the 12-session treatment, and at both follow-ups (4 weeks, 6 months). In both conditions, high percentages of patients were panic free at post and follow-up tests (range 75-92%). Although the reduction in idiosyncratic beliefs about the catastrophic nature of bodily sensations was equally strong in both conditions, post-treatment beliefs correlated strongly with symptoms at post and follow-up tests in the CT condition, but not in the IE condition. Reduction of beliefs may be essential in CT, but not in IE. This suggests that the two treatments utilize different change mechanisms.
Article
There is now ample evidence that extinction, the loss of learned performance that occurs when a Pavlovian signal or an instrumental action is repeatedly presented without its reinforcer, does not reflect a destruction of the original learning. This article summarizes the evidence and extends and updates earlier reviews. The main alternative to "unlearning" is the idea that extinction (as well as other retroactive interference processes, including counterconditioning) involves new learning that is stored along with the old. One consequence is that the Pavlovian signal or instrumental action has two available "meanings" and thus has the properties of an ambiguous word: its current meaning (and the resulting behavioral output) depends on what the current context retrieves. Contexts can be provided by a variety of background stimuli, including the physical environment, internal drug state, and time. The second thing learned (e.g., extinction, counterconditioning) seems especially dependent on the context for retrieval. A variety of evidence is consistent with this analysis, which highlights several important sources of relapse after extinction. The article concludes with several issues for future research, among them the question of how we can optimize extinction and other putative "unlearning" treatments so as to prevent the various forms of relapse discussed here.
Article
Affective valence responses to exercise may influence adherence. According to a newly proposed dual-mode model, affective responses have been proposed to vary depending on whether exercise is undertaken above or below the anaerobic threshold. With the model in mind, the study objectives were to explore the impact of an above-lactate, below-lactate, and self-selected exercise condition on acute affective responses in sedentary individuals. Using a repeated measures design, 12 volunteers participated in two prescribed intensity exercise conditions (above and below-lactate threshold) and one self-selected intensity exercise condition. The three conditions were randomized. An incremental walking protocol was used to identify exercise intensities that would elicit above- and below-lactate threshold work rates for each participant. The exercise conditions were completed on different days and each lasted for 20 minutes. Physiological and affective responses were recorded pre-exercise, during exercise, and post-exercise. Affective responses were more negative in the above-lactate condition during exercise compared with the below-lactate and self-selected conditions. There were no differences between the conditions post-exercise. Participants exercised around the lactate threshold and at a significantly higher intensity in the self-selected compared with the below-lactate condition. Inter-individual variability in responses was greatest below the lactate threshold, with similar levels of variability in the self-selected and above-lactate conditions. Data are consistent with the proposals of the dual-mode model and support the use of self-selected intensity with sedentary individuals to promote positive affective responses.
Article
Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N=404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy 1986; 24: 1-8.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.
Article
The aim of this study is to assess if changes in dysfunctional beliefs and self-efficacy precede changes in panic apprehension in the treatment of panic disorder with agoraphobia. Subjects participated in a larger study comparing the effectiveness of cognitive restructuring and exposure. Four variables were measured: (a) the strength of each subject's main belief toward the consequence of a panic attack; (b) perceived self-efficacy to control a panic attack in the presence of panicogenic body sensations; (c) perceived self-efficacy to control a panic attack in the presence of panicogenic thoughts; and (d) the level of panic apprehension of a panic attack. Variables were recorded daily on a "0" to "100" scale using category partitioning. Multivariate time series analysis and "causality testing" showed that, for all participants, cognitive changes preceded changes in the level of panic apprehension. Important individual differences were observed in the contribution of each variable to the prediction of change in panic apprehension. Changes in apprehension were preceded by changes in belief in three cases, by changes in self-efficacy in six cases, and by changes in both belief and self-efficacy in the remaining three cases. This pattern was observed in participants in the exposure condition as well as those in the cognitive restructuring condition. These results provide more empirical support to the hypothesis that cognitive changes precede improvement. They also underlie the importance of individual differences in the process of change. Finally, this study does not support the hypothesis that exposure and cognitive restructuring operate through different mechanisms, namely a behavioral one and a cognitive one.
Treatment of panic disorder: A consensus development conference
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An investigation of relations between anxiety sensitivity and physical activity in adolescence. Poster presented at the Child and Adolescent Anxiety Special Interest Group Poster Exposition at the 37th annual convention of the Association for Advancement of Behavior Therapy
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Alternative covariance structures for polynomial models of individual growth and change
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