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Anxiety Sensitivity as a Transdiagnostic Factor in Emotional Disorders, Addictive Disorders, and Their Comorbidities: How Basic Research Informs Intervention Research

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Sherry H Stewart at Dalhousie University
Sherry H Stewart
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Abstract

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.
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CPA Donald O. Hebb Award for Distinguished Contributions to Psychology as a Science / Prix Donald O. Hebb pour
contributions remarquables àla psychologie en tant que science
Anxiety Sensitivity as a Transdiagnostic Factor in Emotional
Disorders, Addictive Disorders, and Their Comorbidities:
How Basic Research Informs Intervention Research
Public Significance Statement
Emotional disorders (anxiety, depressive, and stress/trauma disorders) and addictive disorders (substance use
and gambling disorders) are highly comorbid conditions. This review covers basic and intervention research
on anxiety sensitivity (AS) as a transdiagnostic factor which may help explain this comorbidity and which can
be targeted to effectively treat or prevent both emotional and addictive disorders. The article also illustrates
how basic, mechanistic research is essential for informing effective intervention content.
SHERRY H. STEWART
Department of Psychiatry, Dalhousie
University
Abstract
The present article summarises our research
program on anxiety sensitivity (AS)—a
cognitive–affective dispositional factor
involving fears of anxiety-related sensations
due to beliefs that these sensations have catastrophic consequences.
AS and its lower order dimensions are established as transdiagnostic
risk or maintenance factors for emotional disorders and addictive
disorders. Understanding mechanisms by which AS exerts its effects
can reveal key intervention targets for AS-focused preventative and
treatment programs. In the present article, I review basic research we
have conducted to understand the mechanisms linking AS to these
disorders and their symptoms. I also describe AS-targeted
transdiagnostic interventions and illustrate how basic research
informed the content of these interventions. Finally, I review current
projects underway in my lab and highlight important future directions
for this field. While substantial progress has been made over the past 3
decades, and research has considerably advanced our understanding
of AS as a transdiagnostic factor, there are many remaining questions.
Answers should help us further refine interventions to maximally
benefit people with a high level of fear of fear.
Keywords: anxiety sensitivity, transdiagnostic factor, emotional disorder,
addictive disorder, cognitive behaviour therapy
The present article is an invited article to accompany my receipt of
the 2023 Donald O. Hebb Award for Distinguished Contributions to
Psychology as a Science from the Canadian Psychological Association.
In this article, I will focus on my interests in and discoveries relevant to
the nature, causes and consequences, and intervention of anxiety
sensitivity (AS)—a trait which I have been studying for over 3 decades.
I began this work as a clinical psychology graduate student at McGill
University and continued to expand and refine it as a faculty member at
Dalhousie University. I am truly honoured to receive an award that
celebrates the legacy of D. O. Hebb given overlaps in our institutional
histories, research epistemologies, and student mentorship philoso-
phies. When I was an undergraduate honours psychology student at
Dalhousie in the mid-1980s, Hebb was a professor emeritus there, as he
had returned to his home province of Nova Scotia in his retirement; his
influence was pervasive in the top-notch experimental methodology,
cognitive psychology, and neuroscience training I received as an
undergraduate. Hebb’s legacy continued to shape my doctoral training
at McGill where Hebb spent most of his academic career; his
philosophy that mechanistic research is needed to inform effective
interventions can be seen in my PhD dissertation research—asetof
basic, mechanistic studies designed to understand the role of AS in the
comorbidity of anxiety and alcohol use disorders. Hebb’sinfluence
persisted as I returned home to Nova Scotia to begin as a faculty
The author thanks Gordon Flett whose helpful comments on an earlier
version of this article helped to substantially improve the final product. The
author also acknowledges the contributions of my many students and
colleagues over the years who have contributed immensely to the ideas and
work presented herein. Finally, the author acknowledges grants received
from Health Canada, Canadian Institutes of Health Research, Social Sciences
and Humanities Research Council, the Natural Sciences and Humanities
Research Council, Canadian Research Initiative in Substance Matters, the
Alcoholic Beverage Medical Research Foundation, the Canadian Foundation
for Innovation, and the Canada Research Chairs program for providing the
funding for the work described in this review.
Correspondence concerning this article should be addressed to Sherry
H. Stewart, Department of Psychiatry, Dalhousie University, 5909
Veterans’Memorial Lane, 8th Floor, Abbie J. Lane Building, Halifax,
NS B3H 2E2, Canada. Email: sstewart@dal.ca
Canadian Psychology / Psychologie canadienne
ISSN: 0708-5591 2024, Vol. 65, No. 2, 75–92
© 2024 Canadian Psychological Association https://doi.org/10.1037/cap0000393
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