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Dimensional, Categorical, or Dimensional-Categories: Testing the Latent Structure of Anxiety Sensitivity Among Adults Using Factor-Mixture Modeling

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Abstract

The present study tested multiple, competing latent structural models of anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007). Data were collected from 3 sites in North America (N=634). Participants were predominantly university students (M=21.3 years, SD=5.4). ASI-3 data were evaluated using an integration of mixture modeling and confirmatory factor analysis-factor mixture modeling (FMM; Muthén, 2008). Results supported a 2-class 3-factor partially invariant model of AS. Specifically, the FMM analyses indicated that AS is a taxonic (two-class) variable, and that each categorical class has a unique multidimensional factor structure. Consistent with the specific point-prediction regarding the hypothesized parameters of the putative latent class variable, FMM indicated that the putatively "high-risk" subgroup of cases or latent form of AS composed approximately 12% of the studied sample whereas the putatively "normative" subgroup of cases or latent form of AS composed 88% of the sample. In addition, the AS Physical and Psychological Concerns subscales, but not the Social Concerns subscale, most strongly discriminated between the two latent classes. Finally, comparison of continuous levels of AS Physical and Psychological Concerns between FMM-derived AS latent classes and independent clinical samples of patients with anxiety disorders provided empirical support for the theorized taxonic-dimensional model of AS and anxiety psychopathology vulnerability. Findings are discussed in regard to the implications of this and related research into the nature of AS and anxiety psychopathology vulnerability.

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... Recently, Bernstein and coauthors (Bernstein et al., 2010(Bernstein et al., , 2013Zvielli, Bernstein, & Berenz, 2012) have suggested that the AS latent structure can be placed somewhere between the two "traditional" models demonstrating the properties of both dimensions and categories (Bernstein et al., 2010). For example, there seem to be qualitative differences between the latent AS classes but also quantitative differences between the cases within each latent AS class (Bernstein et al., 2010). ...
... Recently, Bernstein and coauthors (Bernstein et al., 2010(Bernstein et al., , 2013Zvielli, Bernstein, & Berenz, 2012) have suggested that the AS latent structure can be placed somewhere between the two "traditional" models demonstrating the properties of both dimensions and categories (Bernstein et al., 2010). For example, there seem to be qualitative differences between the latent AS classes but also quantitative differences between the cases within each latent AS class (Bernstein et al., 2010). ...
... Recently, Bernstein and coauthors (Bernstein et al., 2010(Bernstein et al., , 2013Zvielli, Bernstein, & Berenz, 2012) have suggested that the AS latent structure can be placed somewhere between the two "traditional" models demonstrating the properties of both dimensions and categories (Bernstein et al., 2010). For example, there seem to be qualitative differences between the latent AS classes but also quantitative differences between the cases within each latent AS class (Bernstein et al., 2010). The development of factor mixture modeling (FMM; Muthén, 2006) has allowed for testing this hypothesis. ...
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Anxiety sensitivity (AS) is an established transdiagnostic risk factor for emotional disorders. It is defined as the fear of anxiety sensations that arises from beliefs that those sensations can have harmful consequences on cognitive, physical, and social functioning. Thus, AS is usually considered a multidimensional construct comprised of the following dimensions: Cognitive, Physical, and Social concerns. Some studies have questioned its continuous latent structure providing taxometric evidence for its categorical nature. However, more advanced factor mixture modeling (FMM) has offered support for a hybrid, dimensional-categorial latent structure of AS. In other words, 3 qualitatively different classes were identified, with a 3-factor model within each class. In the current study, FMM was used in 2 independent Serbian samples: an adult convenient community (Facebook) sample (N = 359) and a young treatment-seeking sample (N = 342). The obtained results are fairly in line with the most recent work targeting the nature of the AS construct, using the Anxiety Sensitivity Index-3 (ASI-3). By model fit, especially comparing the 2- and 3-class solution in Sample 1, and testing external validity in Sample 2, the empirical evidence supports the 3-class solution, with classes labeled as Normative AS, Moderate AS, and High AS. Important theoretical and practical questions were raised and discussed in the article. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... However, Bernstein and colleagues did not elaborate how they expect the two classes or forms to differ, for example, to which cues group members should be differentially sensitive. In sum, according to this account (Bernstein et al., 2007(Bernstein et al., , 2010, the AS construct consists of two distinct latent classes of persons that differ qualitatively from each other in trait AS. Within the proposed classes, a dimensional structure in which persons differ quantitatively from each other is assumed. ...
... Bernstein and colleagues conducted several studies applying taxometric and factor mixture models to support their claim of two distinct latent classes of AS (Bernstein et al., 2007(Bernstein et al., , 2010. However, challenging the dimensional concept of AS corroborated in three decades of AS research (Armstrong, Khawaja, & Oei, 2006;Kemper et al., 2009;Taylor & Cox, 1998;Zinbarg, Barlow, & Brown, 1997) based on these results could be premature. ...
... The aims of the research presented here were twofold. In order to enable researchers to draw valid conclusions concerning the construct validity of the ASI-3, we strived (1) to replicate the findings of latent discontinuity previously observed in AS data (Bernstein et al., 2007(Bernstein et al., , 2010) -we hypothesized (at least) two distinct latent classes -and (2) to explore possible interpretations for the qualitative differences not considered by Bernstein et al. One main assumption of the THAS was postulated but never explicitly tested -that persons in the putative maladaptive (AS taxon) class are not sensitive to the same cues as persons in the adaptive (normative AS) class (Bernstein et al., 2007). ...
Article
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Anxiety Sensitivity (AS) denotes the tendency to fear anxiety-related sensations. Trait AS is an established risk factor for anxiety pathology. The Anxiety Sensitivity Index-3 (ASI-3) is a widely used measure of AS and its three most robust dimensions with well-established construct validity. At present, the dimensional conceptualization of AS, and thus, the construct validity of the ASI-3 is challenged. A latent class structure with two distinct and qualitatively different forms, an adaptive form (normative AS) and a maladaptive form (AS taxon, predisposing for anxiety pathology) was postulated. Item Response Theory (IRT) models were applied to item-level data of the ASI-3 in an attempt to replicate previous findings in a large nonclinical sample (N = 2,603) and to examine possible interpretations for the latent discontinuity observed. Two latent classes with a pattern of distinct responses to ASI-3 items were found. However, classes were indicative of participant's differential use of the response scale (midpoint and extreme response style) rather than differing in AS content (adaptive and maladaptive AS forms). A dimensional structure of AS and the construct validity of the ASI-3 was supported.
... There are relatively few studies that have examined the structure of AS using FMM (e.g., Allan, Korte, Capron, Raines, & Schmidt, 2013;Allan, MacPherson, Young, Lejuez, & Schmidt, in press;Bernstein et al., 2010;Bernstein et al., 2013). Studies by Allan et al. (2013) and Bernstein et al. (2010) were both conducted using the ASI-3 in adult samples. ...
... There are relatively few studies that have examined the structure of AS using FMM (e.g., Allan, Korte, Capron, Raines, & Schmidt, 2013;Allan, MacPherson, Young, Lejuez, & Schmidt, in press;Bernstein et al., 2010;Bernstein et al., 2013). Studies by Allan et al. (2013) and Bernstein et al. (2010) were both conducted using the ASI-3 in adult samples. Bernstein et al. (2010) examined the structure of AS in a sample of 634 undergraduate students. ...
... Studies by Allan et al. (2013) and Bernstein et al. (2010) were both conducted using the ASI-3 in adult samples. Bernstein et al. (2010) examined the structure of AS in a sample of 634 undergraduate students. They reported that a two-class three-factor model in which factor loadings, intercepts, and factor covariances were allowed to vary across classes was the best-fitting model. ...
Article
Anxiety sensitivity (AS), a multidimensional construct, has been implicated in the development and maintenance of anxiety and related disorders. Recent evidence suggests that AS is a dimensional-categorical construct within individuals. Factor mixture modeling was conducted in a sample of 579 adult smokers (M age = 36.87 years, SD = 13.47) to examine the underlying structure. Participants completed the Anxiety Sensitivity Index-3 and were also given a Structured Clinical Interview for DSM-IV-TR. Three classes of individuals emerged, a high AS (5.2% of the sample), a moderate AS (19.0%), and a normative AS class (75.8%). A cut-score of 23 to identify high AS individuals, and a cut-score of 17 to identify moderate-to-high AS individuals were supported in this study. In addition, the odds of having a concurrent anxiety disorder (controlling for other Axis I disorders) were the highest in the high AS class and the lowest in the normative AS class.
... Notably, other taxometric studies have not found evidence for AS taxonicity (Broman-Fulks et al. 2008Taylor et al. 1999). It is possible that these mixed findings may be due to a number of methodological factors (e.g., sample selection, cognitive bias of raters, indicator selection); as well as the possibility that AS may demonstrate both taxonicity and within-class dimensionality which violates the assumption of local independence central to CCK taxometrics (see Bauer and Curran 2004;Bernstein et al. 2010 for a review; Ruscio et al. 2006). ...
... FMM has the capacity to uniquely integrate mixture modeling and factor analysis for the purpose of concurrently modeling the fit of various competing, latent structural models composed of categorical and continuous forms of variability, and does not assume local independence (Lubke and Neale 2006). In a recent FMM study of the ASI-3 among a large adult sample from North America, Bernstein et al. (2010) found support for a taxonic-dimensional model of ASspecifically, that AS is a taxonic, dichotomous two-class variable, and that each categorical class demonstrates a unique within-class, multi-dimensional factor structure. The observed FMM results were consistent with previous taxometric studies 1 FMM has a number of advantages relative to CCK taxometric methods and other latent mixture modeling techniques (Bauer and Curran 2004;Muthén 2008). ...
... First, research has not yet directly tested whether base-or point-prevalence rates of AS taxonicity based on the FMMderived taxonic-dimensional model of AS are indeed greater, as theorized (Bernstein et al. 2007), among clinical samples of patients with anxiety and related disorders. Preliminary criterion-related validity findings though, as reviewed above (Bernstein, Stickle et al. 2010), strongly suggest that such theorized effects are likely. Such knowledge may offer a particularly important form of criterion-related validity that has yet to be directly tested in the AS latent structural research literature to-date (Olatunji and Wolitzky-Taylor 2009), and therefore, represents an important gap in our clinical knowledge. ...
Article
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The aim of the present study was to evaluate a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) (Bernstein et al. Behavior Therapy 41:515-521, 2010), as measured by the ASI-3 (Taylor et al. Psychological Assessment 19:176-188, 2007), in regard to panic attacks, anxiety symptoms, and behavioral impairment among a university sample (N = 150, n females = 107, M age = 21.3 years, SD = 4.3) and a clinical sample (N = 150, n females = 102, M age = 39.0 years, SD = 12.0) from Mexico City, Mexico. Findings demonstrated cross-national support for the conceptual and operational utility of the AS taxonic-dimensional hypothesis (Bernstein et al. Journal of Anxiety Disorders 20:1-22, 2007b). Specifically, (1) the FMM-based AS taxon class base rate was significantly greater among the clinical relative to the university sample; (2) risk for panic attacks was significantly greater among the AS taxon class relative to the AS normative class; and (3) continuous individual differences in AS physical and psychological concerns, within the AS taxon class, were associated with level of risk for panic attacks, as well as panic attack severity and anxiety symptom levels. Similar AS taxonic-dimensional effects were observed in relation to degree of behavioral impairment across domains of functioning. The study results are discussed with respect to their implications for better understanding the nature of AS-related cognitive vulnerability for panic and related anxiety psychopathology.
... All participants were matriculated into the study. Participants were included in the study on the basis of meeting the following inclusion criteria: (a) being between 18 and 45 years of age; (b) reporting exposure to at least three traumatic events, according to the definition delineated in DSM-IV-TR PTSD Criteria A1 and A2 (American Psychiatric Association, 2000 ), to allow for multiple trauma exposure; and (c) reporting clinically elevated and high-risk levels of AS (i.e., score ≥ 24 total score N 12 on the combined physical and cognitive fears subscales; Bernstein et al., 2010; Taylor et al., 2007). Participants were excluded from the study based on evidence of (a) current (i.e., past month) diagnosis of PTSD or PD; (b) current (i.e., past month) suicidal ideation or intent; (c) history of psychotic-spectrum psychopathology; (d) cognitivebehavioral treatment for PTSD or PD since the trauma exposure; (e) limited mental competency and the inability to give informed, voluntary, written consent to participate; and (f) insufficient a n x i e t y s e n s i t i v i t y a n d t r a u m a command of the English language (i.e., inability to converse with an interviewer in the English language or read text). ...
... Clinically robust therapeutic change in AS levels was observed 3-months postintervention. For example, as noted inTable 2, four participants demonstrated AS levels in the normative range, and only Participant 1 demonstrated AS levels in the clinically maladaptive AS range (Bernstein et al., 2010; Taylor et al., 2007) at the follow-up session; more specifically, Participant 1 demonstrated elevated levels of AS at follow-up relative to her baseline levels. posttraumatic stress at baseline and follow-up Relative to their baseline levels, all participants demonstrated decreased levels of posttraumatic stress symptom severity or maintained low and normative levels of posttraumatic stress at followup . ...
... Although all participants demonstrated markedly elevated levels of 488 v u j a n o v i c e t a l . AS at baseline (Bernstein et al., 2010; Taylor et al., 2007), therapeutic change in AS levels was observed 3-months postintervention (see Tables 1 and 2). These findings are consistent with past work on brief AS reduction programs (e.g., Schmidt, Richey, Buckner, & Timpano, 2009; Wald & Taylor, 2008), and extend that work to multiple trauma-related sequelae (i.e., panic symptoms, negative affect, functional impairment), including posttraumatic stress, among multiply trauma-exposed adults without current psychopathology. ...
Article
The present case series examined a single-session, cognitive-behavioral anxiety sensitivity (AS) reduction program among five trauma-exposed adults. Participants (age range=19-37 years) reported significantly elevated levels of AS at baseline, a history of posttraumatic stress disorder Criterion A trauma exposure, and no current Axis I psychopathology. The outcomes of the preventive intervention were examined with regard to 3-month postintervention changes in AS, posttraumatic stress, panic attack frequency and severity, negative affect levels, and behavioral functioning and impairment. Results demonstrated decreases in each of the studied outcomes over the examined time period. This preliminary yet uncontrolled data provides empirical evidence of the feasibility and support for the utilization of a brief AS reduction intervention program to target anxiety-related vulnerability among trauma-exposed adults.
... To evaluate the degree of change in AS from baseline (T1) to 1 month posttreatment (T5), we (a) calculated the mean change in the combined AS physical and psychological concerns score from baseline to 1 month posttreatment (T5) and (b) evaluated the number of participants who, at 1 month posttreatment (T5), demonstrated reduced-tonormative levels of AS (reduced-normative AS group) or maintained clinically elevated levels of AS (maintained-maladaptive AS group) ( Bernstein et al., 2010) (Table 1). Thus, we identified two subgroups of smokers. ...
... Thus, we identified two subgroups of smokers. Based on FMM data, the first subgroup demonstrated elevated levels of AS at preintervention (baseline) and markedly reduced, normative levels of AS at 1 month posttreatment ( Bernstein et al., 2010); this subgroup is referred as the reduced-normative AS group throughout this paper. The second subgroup also demonstrated elevated levels of AS at preintervention but maintained elevated levels of AS posttreatment ( Bernstein et al., 2010); this subgroup is referred as the maintainedmaladaptive AS group throughout this paper. ...
... Based on FMM data, the first subgroup demonstrated elevated levels of AS at preintervention (baseline) and markedly reduced, normative levels of AS at 1 month posttreatment ( Bernstein et al., 2010); this subgroup is referred as the reduced-normative AS group throughout this paper. The second subgroup also demonstrated elevated levels of AS at preintervention but maintained elevated levels of AS posttreatment ( Bernstein et al., 2010); this subgroup is referred as the maintainedmaladaptive AS group throughout this paper. ...
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This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.
... Future longitudinal research should assess the impact of attention style on a broad range of information processing biases (e.g., attention, interpretation, memory) that vary in reliance on strategic/explicit and automatic/implicit processes given that such biases have been shown to uniquely predict panic symptoms (Teachman et al. 2007 ). Additionally , there is a need to examine attention style subgroup differences using AS groups categorized based on new empirically derived and clinically meaningful cut-points (Bernstein et al. 2010). Recent research suggests that using a dimensional approach to AS classification based on the newer ASI-3 might be able to meaningfully identify ''high'' or ''at risk'' AS individuals (Bernstein et al. 2010). ...
... Additionally , there is a need to examine attention style subgroup differences using AS groups categorized based on new empirically derived and clinically meaningful cut-points (Bernstein et al. 2010). Recent research suggests that using a dimensional approach to AS classification based on the newer ASI-3 might be able to meaningfully identify ''high'' or ''at risk'' AS individuals (Bernstein et al. 2010). Future longitudinal research should investigate attentional subgroup differences among individuals using this classification approach to determine whether cognitive biases are stable within individuals across situations and time. ...
Article
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Results of research investigating the link between anxiety sensitivity (AS) and memory biases toward threat have been inconsistent. There may be subgroups of high AS individuals who differ in their preferred mode of attending to threat-related information, thereby impacting memory. The impact of individual attention style on intentional forgetting of words varying in emotional valence was examined among individuals with varying levels of AS. By incorporating an inhibition of return (IOR) task (to yield a proxy of attentional allocation) within the study phase of the item-method directed forgetting paradigm, we categorized high, moderate, and low AS individuals according to their attention style in response to threat stimuli: 'threat attenders' (small IOR effect) and 'threat avoiders' (large IOR effect). Among high AS individuals only, 'threat avoiders' showed greater intentional forgetting of threat-related words than 'threat attenders'. High AS 'threat avoiders' also had higher levels of anxiety-related psychopathology (AS and health anxiety) than high AS 'threat attenders'.
... This work illustrates the need to be cognizant of the heterogeneity that still exists among people with a shared vulnerability. In one such study, we used ASI-3 data and showed that approximately 12% of people fall into the high AS taxon (Bernstein et al., 2010) which is slightly fewer than the cutoff we are currently using. If there truly is a qualitative difference between those with "high AS" and those in the normative class as suggested by our work on AS taxonicity, interventions might be most beneficial for those in the high AS taxon. ...
Article
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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.
... The ASI-3 contains three subscales; only the ASSC subscale was used in the current study to capture trait ASSC. The three-factor structure of the ASI-3 has been confirmed across several studies [3,[20][21][22][23]. The ASI-3 was developed using an English-speaking university sample and has demonstrated strong reliability and validity metrics among university students [3]. ...
Article
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Anxiety sensitivity social concerns (ASSC), or the fear of observable anxiety symptoms, is a risk factor for social anxiety. ASSC predicts anxiety following the niacin biological challenge, a paradigm in which niacin is used to manipulate facial flushing during a speech task. However, it remains unclear if ASSC predicts physiological arousal during this task. The current study was designed to examine the effects of ASSC on self-reported distress and electrodermal activity (EDA) during the niacin biological challenge in a sample of undergraduates (N = 36; M age = 18.9, SD = 0.84; 69.4% female). Participants were randomly assigned to one of four conditions in a 2 (100 mg niacin vs. 100 mg sugar) × 2 (instructional set) design. Participants completed a speech task in a virtual reality environment. Participants rated their distress halfway through the speech and EDA was averaged over four intervals. There was a main effect for ASSC on subjective distress. There was a significant ASSC by condition interaction predicting EDA, in that ASSC was related to EDA only in the niacin condition. ASSC also was more strongly related to EDA anticipating the speech. These findings highlight the role of ASSC in predicting anxiety and physiological arousal.
... Wie zuvor bereits erwähnt, wird die Vergleichbarkeit von Interventionen durch die Verwendung uneinheitlicher Cut-Off-Werte für die Einteilung von hoher und niedriger AS erschwert und beeinflusst möglicherweise auch die gefundenen Effekte. Um AS als intermediären Risikofaktor für klinische und präventive Fragestellungen optimal nutzen zu können, ist daher ein besseres Verständnis der zugrundeliegenden latenten Struktur des Konstrukt AS und die Ableitung reliabler klinischer Cut-Off-Werte für die Identifikation von Risikogruppen wichtig(Allan, Korte, et al., 2014).Während einige Studien Belege für eine taxonomische Struktur im Sinne einer kleinen hoch angstsensitiven und einer zweiten großen Klasse mit normativen AS-Werten(Bernstein et al., 2010;Bernstein et al., 2006;Bernstein et al., 2007) oder gar einer dreiteiligen Struktur mit einer zusätzlichen moderat hohen Klasse(Allan, Korte, et al., 2014; darlegen, weisen andere darauf hin, dass intraindividuelle Unterschiede lediglich dimensionaler, also quantitativer Natur sind (Asmundson, Weeks, Carleton, Thibodeau & Fetzner, 2011; Broman-Fulks et al., 2010). Hier ist noch weitere Forschung notwendig, um die divergenten Befunde erklären zu können und fundierte Richtlinien für die Übertragung in die klinische Praxis zu formulieren. ...
Thesis
Angsterkrankungen stellen mit einer 12-Monats-Prävalenz von 14% die häufigsten psychischen Erkrankungen in der westlichen Gesellschaft dar. Angesichts der hohen querschnittlichen wie sequentiellen Komorbidität von Angsterkrankungen, der ausgeprägten individuellen Einschränkungen sowie der hohen ökonomischen Belastung für das Gesundheitssystem ist neben therapeutischen Behandlungsansätzen die Entwicklung von kurzzeitigen, kostengünstigen und leicht zugänglichen Präventionsmaßnahmen von großer Bedeutung und steht zunehmend im Fokus des gesundheitspolitischen Interesses, um die Inzidenz von Angsterkrankungen zu reduzieren. Voraussetzung für die Entwicklung von gezielten und damit den effektivsten Präventionsmaßnahmen sind valide Risikofaktoren, die die Entstehung von Angsterkrankungen begünstigen. Ein Konstrukt, das in der Literatur als subklinisches Symptom in Form einer kognitiven Vulnerabilität für Angsterkrankungen und damit als Risikofaktor angesehen wird, ist die sogenannte Angstsensitivität (AS). AS umfasst die individuelle Tendenz, angstbezogene körperliche Symptome generell als bedrohlich einzustufen und mit aversiven Konsequenzen zu assoziieren. Das Ziel der vorliegenden Arbeit war daher die Etablierung und Validierung eines Präventionsprogramms zur Reduktion der AS an einer nicht-klinischen Stichprobe von 100 Probanden (18-30 Jahre) mit einer erhöhten AS (Anxiety Sensitivity Index [ASI-3] ≥17) sowie die Rekrutierung von 100 alters- und geschlechtsangeglichenen Probanden mit niedriger Angstsensitivität (ASI-3 <17). In einem randomisiert-kontrollierten Studiendesign durchliefen die Probanden mit hoher AS entweder das über fünf Wochen angelegte „Kognitive Angstsensitivitätstraining“ (KAST) als erste deutschsprachige Übersetzung des Computer-basierten „Cognitive Anxiety Sensitivity Treatment“ (CAST) von Schmidt et al. (2014) oder wurden der Wartelisten-Kontrollgruppe zugeteilt. Das KAST Training bestand aus einer einmaligen Vermittlung kognitiv-behavioraler Psychoedukation zum Thema Stress und Anspannung sowie deren Auswirkungen auf den Körper und der Anleitung von zwei interozeptiven Expositionsübungen (‚Strohhalm-Atmung‘ und ‚Hyperventilation‘), die über den anschließenden Zeitraum von fünf Wochen in Form von Hausaufgaben wiederholt wurden. Es konnte gezeigt werden, dass die Teilnehmer des KAST-Programms nach Beendigung des Trainings (T1) eine signifikant niedrigere AS-Ausprägung im Vergleich zur Wartelisten-Kontrollgruppe aufwiesen und diese Reduktion auch über den Katamnese-Zeitraum von sechs Monaten (T2) stabil blieb. Ergänzend wurde auch die Targetierbarkeit weiterer intermediärer Risikomarker wie der Trennungsangst (TA), des Index der kardialen Sensitivität sowie der Herzratenvariabilität (HRV) untersucht, die jedoch nicht durch das KAST-Training direkt verändert werden konnten. Im Vergleich der Subgruppen von Probanden mit hoher AS und gleichzeitig hoher TA (Adult Separation Anxiety Questionnaire [ASA-27] ≥22) und Probanden mit hoher AS, aber niedriger TA (ASA-27 <22) zeigte sich, dass die AS-TA-Hochrisikogruppe ebenfalls gut von der KAST-Intervention profitieren und eine signifikante Reduktion der AS erzielen konnte, indem sie sich bei T1 dem Niveau der Gruppe mit niedriger TA anglich. Zudem korrelierte die prozentuale Veränderung der Einstiegswerte der inneren Anspannung während der Strohhalm-Atmungsübung positiv mit der prozentualen Veränderung der dimensionalen TA bei T1. Zusammenfassend weisen die Ergebnisse der vorliegenden Arbeit erstmalig auf die Wirksamkeit der deutschsprachigen Übersetzung des CAST-Programms (Schmidt et al., 2014), eines Computer-basierten, und damit leicht zu implementierenden sowie kostengünstigen Programms, in Bezug auf die Reduktion der AS sowie indirekt der TA hin und können damit zur indizierten und demnach besonders effektiven Prävention von Angsterkrankungen in Hochrisikogruppen beitragen.
... In an effort to continue advancing this important area of PCBH practice, we encourage BHCs to collect outcome data on their patients to whom they deliver ET and researchers to conduct clinical trials of brief transdiagnostic ET in PCBH. It would be particularly beneficial to examine exposure in subclinical anxiety as a potential strategy to prevent escalation to clinically significant anxiety symptoms, as it is very common in PC (e.g., Rucci et al., 2003) and research supports a dimensional rather than categorical conceptualization of anxiety (e.g., Bernstein et al., 2010;Broman-Fulks et al., 2010). A critical next step would be to conduct an efficacy trial within a transdiagnostic sample that may include subthreshold and mild symptoms such that outcomes may inform prevention efforts in addition to interventions. ...
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Introduction: Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. Methods: The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. Results: Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. Discussion: Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Psychometric properties for the ASI-3 indicate that it is a reliable and valid measure of AS with high internal consistency (Cronbach's α = .93), strong convergent, discriminant, structural, criterion validity (Taylor et al. 2007), and a taxonic latent structure (Bernstein et al. 2010). The ASI-3 has been validated in both clinical and community samples (Ghisi et al. 2016;Wheaton et al. 2012). ...
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Background Public safety personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, public safety communications officials) are regularly exposed to potentially traumatic events and considerable uncertainty as part of their employment. Canadian PSP screen positively for mental disorders at much higher rates than the general population. Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are empirically-supported vulnerability factors associated with the development and maintenance of mental disorders.Methods The present study was designed to assess IU and AS across PSP—a population regularly encountering uncertainty—with and without mental disorders (n = 4304; 33.3% women), and across normative clinical, community, and undergraduate samples. Further, the study examined the relationship between IU and AS and mental disorders among PSP.ResultsThere were significant differences across groups on IU and AS scores (ps < .001). All PSP, with and without a positive screen for a mental disorder, reported lower IU and AS than clinical samples; however, PSP without mental disorders reported lower IU and AS than all other groups (ps < .001).Conclusion Increased resilience or the development of coping skills to manage regular exposures to uncertain threat may help explain why PSP reported low levels of IU and AS despite higher prevalence of mental disorders. Implications for PSP training and treatment are discussed.
... Thus, anxiety sensitivity is an 'amplifying factor,' enhancing the aversiveness and need to escape/avoid negative affective or somatic experiences (Otto et al., 2016;Taylor, 2014). Most of the past work on anxiety sensitivity suggests its maintains a dimensional latent structure (Bernstein et al., 2010), although there are some reports that it may have a taxonic (class) structure with in-class dimensional variability (Bernstein et al., 2011). ...
Article
Anxiety sensitivity, defined as the fear of anxiety and arousal-related sensations, has been among the most influential cognitive-based transdiagnostic risk and maintenance factors in the study and treatment of emotional and related disorders. The currently available anxiety sensitivity measures are limited by their length. Specifically, the length of these instruments discourages the adoption of routine anxiety sensitivity assessment in clinical or medical settings (e.g., primary care). The goals of this study were to develop and assess the validity and reliability of a short version of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007), entitled the Short Scale Anxiety Sensitivity Index (SSASI), using three independent clinical samples. Results indicated that the abbreviated five-item version of the SSASI had good internal consistency and a robust association with the ASI-3. Further, across the samples, there was evidence of unidimensionality and excellent convergent and discriminant validity. There also was evidence of partial measurement invariance across sex and full measurement invariance across time. Overall, the five-item scale offers a single score that can be employed to measure anxiety sensitivity. Use of the SSASI may facilitate screening efforts and symptom tracking for anxiety sensitivity, particularly within clinical settings where practical demands necessitate the use of brief assessment instruments.
... LVMMs have been used for a number of purposes, including, for example, to identify groups of individuals who exhibit certain response behaviors (e.g., socially desirable responding [e.g., 34], test taking behaviors [e.g., 35]). They have also been used to identify groups of individuals with different symptom patterns and characteristics related to psychological conditions, such as anxiety sensitivity, panic disorder, and conduct disorder [e.g., [36][37][38][39], and have been proposed as a tool in the development of diagnostic classifications [e.g., 40]. In the context of test development, our interest lies in the use of LVMMs for the assessment of measurement invariance. ...
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Purpose: Patient-reported outcome measures (PROMs) are frequently used in heterogeneous patient populations. PROM scores may lead to biased inferences when sources of heterogeneity (e.g., gender, ethnicity, and social factors) are ignored. Latent variable mixture models (LVMMs) can be used to examine measurement invariance (MI) when sources of heterogeneity in the population are not known a priori. The goal of this article is to discuss the use of LVMMs to identify invariant items within the context of test construction. Methods: The Draper-Lindely-de Finetti (DLD) framework for the measurement of latent variables provides a theoretical context for the use of LVMMs to identify the most invariant items in test construction. In an expository analysis using 39 items measuring daily activities, LVMMs were conducted to compare 1- and 2-class item response theory models (IRT). If the 2-class model had better fit, item-level logistic regression differential item functioning (DIF) analyses were conducted to identify items that were not invariant. These items were removed and LVMMs and DIF testing repeated until all remaining items showed MI. Results: The 39 items had an essentially unidimensional measurement structure. However, a 1-class IRT model resulted in many statistically significant bivariate residuals, indicating suboptimal fit due to remaining local dependence. A 2-class LVMM had better fit. Through subsequent rounds of LVMMs and DIF testing, nine items were identified as being most invariant. Conclusions: The DLD framework and the use of LVMMs have significant potential for advancing theoretical developments and research on item selection and the development of PROMs for heterogeneous populations.
... Anxiety Sensitivity Index -3 (ASI -3; Taylor et al., 2007) It is an 18-item scale measuring fear of anxious arousal. Past work has documented that fear of cognitive or psychological dyscontrol due to anxious arousal (e.g., "It scares me when I am unable to keep my mind on a task") specifically is most predictive of anxiety-related psychopathology (Olthuis et al., 2014); and taxometric and factor mixture modeling research documented that anxiety sensitivity has a latent taxonic structuresuch that lower vs. higher values on measures of anxiety sensitivity reflect qualitatively distinct forms or kinds of anxiety sensitivity (adaptive versus maladaptive) rather than a dimensional latent construct (Bernstein et al., 2006(Bernstein et al., , 2010(Bernstein et al., , 2013Bernstein and Zvolensky, 2007;Leen-Feldner et al., 2005). In the present study we used ASI-3 sub-scale measuring the cognitive fear of dyscontrol due to anxious arousal (α = .85 in the present study). ...
Article
Re-examining decades of the social construal of Oxytocin, the General Approach-Avoidance Hypothesis of Oxytocin (GAAO) predicts that Oxytocin will modulate responding to emotionally-evocative and personally-relevant social and non-social stimuli due to its action on the neural substrate of approach and avoidance motivation. We report the first critical experimental test of GAAO predictions by means of a double-blind intra-nasal administration of Oxytocin vs. placebo in 90 healthy adults (N = 90, 50% women). As predicted, we found that among men and women for whom negative emotion (anxious arousal) is motivationally-relevant, intra-nasal administration of Oxytocin reduced behavioral avoidance of emotionally-evocative negatively-valenced social and non-social stimuli, but not closely matched emotionally-neutral stimuli. Findings cannot be explained by extant social theories of Oxytocin. We discuss the implications of the present findings for basic and translational clinical Oxytocin research.
... In the only study to date looking at the latent structure of IU, Carleton, Weeks et al. (2012) found IU to be a continuous construct when using taxometric methods. However, a myriad of studies have investigated the structure of AS, a vulnerability factor for anxiety disorders closely related to IU, and found evidence for a categorical latent structure using FMM (Allan, Korte, Capron, Raines, & Schmidt, 2014;Bernstein, Stickle, & Schmidt, 2013;Bernstein et al., 2010). Further, studies using FMM to examine the latent structure of GAD and OCD have also found evidence for a categorical latent structure (e.g., Korte, Allan, & Schmidt, 2015;Schooler, Revell, Timpano, Wheaton, & Murphy, 2008). ...
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Intolerance of uncertainty (IU) is a multidimensional construct that has been proposed as an important transdiagnostic risk factor across various anxiety and mood disorders. Recent work found support for IU having a continuous latent structure when utilizing taxometric methods. However, taxometrics may not be ideally suited to examine the latent structure of constructs such as IU given the methodological shortcomings associated with this technique. The current study applied factor mixture modeling, a statistical technique that overcomes shortcomings of prior work, to examine the latent structure of IU in a sample of 371 individuals presenting at an outpatient clinic. Findings indicated that the best fitting solution was a 3-class model with 1 class consisting of individuals with high levels of IU (High IU; n = 55) and 1 containing individuals with low levels of IU (Low IU; n = 206). Our third class, labeled Moderate IU, consisted of 110 individuals with levels of IU between those of the High IU and Low IU groups. There were also significant differences across the 3 IU classes, including the relations between IU classes and anxiety-related and depressive disorders. The current investigation was the first to find evidence of IU having a categorical latent structure. Implications for research and clinical utility are discussed.
... Factor mixture modeling (FMM) evaluations of anxiety sensitivity have proposed two major models. Bernstein, Stickle, & Schmidt, (2013) and Bernstein et al. (2010) originally identified a 2 class 3 factor model for anxiety sensitivity. In this model, individuals can be divided in two classes (anxiety sensitivity taxon and anxiety sensitivity normative) with three factors within each class (physical concerns, cognitive concerns and social concerns). ...
... Participants are instructed to rate the degree to which they believe the 18 statements apply to them (e.g., "It scares me when my heart beats rapidly") on a Likert-type scale from 0 ("very little") to 4 ("very much"). Recent research has noted that when utilizing a continuous measurement of AS, it is optimally derived from the combined scores on the physical and cognitive subscales, while omitting the items related to the social subscale (Bernstein et al., 2010). Thus, the present investigation utilized a composite score derived from these two subscales (α = .93). ...
Article
Anxiety sensitivity (AS; fear of anxiety and internal sensations) has been implicated in a variety of aspects of smoking, including difficulties achieving and maintaining abstinence during tobacco cessation. However, research has yet to evaluate whether AS impacts premature termination of initiating a quit attempt. Therefore, the aim of the present investigation was to explore the extent to which AS was associated with tobacco cessation dropout, as indexed by attendance on the scheduled quit day visit. Participants included 84 adult daily cigarette smokers (61.7% male; Mage = 34.6 years, SD = 13.9), who were recruited to participate in a self-guided quit attempt (an attempt to quit smoking without professional or pharmacological aid). Results indicated that after controlling for the effects of participant sex, race, current (past month) psychological disorder, cigarettes smoked per day, number of years as a regular smoker, and pre-quit levels of motivation to quit, AS significantly predicted increased odds of study dropout prior to attending the scheduled quit day. These findings suggest that AS may be a mechanism involved with challenges in the initiation of quitting.
... 39 Research has noted that when utilizing a continuous measurement of AS, it is optimally derived from the combined scores on the physical and cognitive subscales, while omitting the items related to the social subscale. 40 Thus, the present investigation utilized a composite score derived from these two subscales (physical and cognitive). Internal consistency of ASI-3 (combined score of the physical and cognitive subscales) in the current sample was α = 0.91. ...
Article
Introduction: Anxiety sensitivity, defined as the extent to which individuals believe anxiety and internal sensations have harmful consequences, is associated with the maintenance and relapse of smoking. Yet, little is known about how anxiety sensitivity interplays with negative affect during the quit process in terms of smoking behavior. To address this gap, the current study examined the dynamic interplay between anxiety sensitivity, negative affect, and smoking lapse behavior during the course of a self-guided (unaided) quit attempt. Methods: Fifty-four participants (33.3% female; Mage = 34.6, SD = 13.8) completed ecological momentary assessment procedures, reporting on negative affect and smoking status via a handheld computer device, three times per day for the initial 14 days of the self-guided cessation attempt. Results: As expected, a significant interaction was observed, such that participants characterized by high levels of anxiety sensitivity were at a higher risk of smoking on days when negative affect was high (relative to low). Results also revealed a significant interaction between anxiety sensitivity and daily smoking lapse behavior in terms of daily change in negative affect. Participants characterized by high levels of anxiety sensitivity reported significant increases in same-day negative affect on days when they endorsed smoking relative to days they endorsed abstinence. Conclusions: This study provides novel information about the nature of anxiety sensitivity, negative affect, and smoking behavior during a quit attempt. Results suggests there is a need for specialized intervention strategies to enhance smoking outcome among this high-risk group that will meet their unique 'affective needs.'
... EXPLICIT AND IMPLICIT SOCIAL REJECTION CONCERNS Self-focused attention and social rejection concerns or the fear that scrutiny and negative evaluation from others will cause feelings of embarrassment, humiliation, and shame are core characteristics of conceptual models of social anxiety (Bernstein et al., 2010;Hirsch & Clark, 2004;Kemper, Lutz, Bähr, Rüddel, & Hock, 2012;Leary, 1983a;Rapee & Heimberg, 1997;Tanay, Lotan, & Bernstein, 2012;Taylor et al., 2007;Watson & Friend, 1969;Wheaton, Deacon, Mc-Grath, Berman, & Abramowitz, 2012). Social rejection concerns are associated with fear of criticism, low self-esteem, and shyness, and socially anxious people often avoid social situations and thereby strengthen their dysfunctional fears (Croizier & Alden, 2001). ...
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a Single Target Implicit association Test (ST-IaT) was used in three internet studies in order to assess the malleability of automatic rejection associations in socially anxious participants. Study 1 and Study 2 explored whether automatic rejection associations could be reduced by an evaluative conditioning task that combined social situations with acceptance. results showed that the conditioning task reduced rejection associations in the group that completed the ST-IaT shortly after the conditioning task. In contrast, rejection associations were not signifiantly different from a control group when the ST-IaT was assessed with a one week interval after the conditioning task. explicit social rejection measures were not, or only marginally, affected by the conditioning task. Study 3 used an attentional training task that fosters sensitivity to positive social feedback (dandeneau, baldwin, baccus, Sakellaropoulo, & Pruessner, 2007). after one week of daily training, implicit but not explicit social rejection associations were reduced by the attentional training task even if they were assessed after an additional one-week interval without any training. The results show that cognitive trainings can affect implicit social rejection associations and that the effects are visible even after a period without training.
... Hence, faking can be disentangled into those aspects that are due to a qualitatively distinct response pattern and those aspects that are due to interindividual differences. FMMs have, for example, been used in clinical psychology to determine the existence of qualitatively distinct anxiety sensitivity populations (Bernstein et al., 2010), in sports psychology to explore the existence of different classes of physically fit adolescents (Lämmle, Ziegler, Seidel, Worth, & Bös, 2012), in cognitive psychology to shed light on Spearman's law of diminishing returns (Reynolds, Keith, & Beretvas, 2010), and in several studies dealing with response styles (e.g., Leite, 2010;McIntyre, 2011). ...
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Research trying to uncover the true nature of faking is currently dominated by two competing modeling approaches. One approach views faking as the manifestation of distinct and qualitatively different response patterns. Typically, mixed Rasch models are used within this approach. The alternative approach views faking as a continuous and quantitative variable resulting from the interaction between test taker personality and situational demands. Modeling techniques for this approach range from regression analyses to structural equation modeling. So far, there has been no study in which both modeling approaches have been applied within one data set. More importantly, so far there has been no methodological model in which both views of faking could have been modeled simultaneously. Within the present article such a modeling approach is introduced and applied to a data set of N = 497 applicants. By combining factor mixture modeling with a latent change score model, it was possible to test both views of faking within the same model. Findings support the view of faking mainly as a continuous and quantitative variable. Theoretical implications are discussed.
... The most recent published measure, the 18-item Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007), was designed, in part, based on previous measures of anxiety sensitivity (Reiss, Peterson, Gursky, & McNally, 1986;Taylor & Cox, 1998). Psychometric tests of the ASI-3 have consistently yielded a three-factor model of anxiety sensitivity, including physical, cognitive, and social concerns (Bernstein et al., 2010;Ebesutani, McLeish, Luberto, Young, & Maack, 2014;Stellman et al., 2008;Taylor et al., 2007). Although the ASI-3 has been validated among clinical (anxiety disordered) and nonclinical samples (Escocard, Fioravanti-Bastos, & Landeira-Fernandez, 2009;Kemper, Lutz, Bähr, Rüddel, & Hock, 2012;Osman et al., 2010;Wheaton, Deacon, McGrath, Berman, & Abramowitz, 2012), none of these past studies assessed for, or screened on the basis of, smoking behavior. ...
Article
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The Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) is a self-report assessment of anxiety sensitivity, reflecting an individual's tendency to misinterpret the meaning of anxiety-relevant sensations. Despite this construct being related to a wide array of clinically significant smoking maintenance and relapse processes, the psychometric properties of scores on the ASI-3 have not yet been investigated for use among smokers. Therefore, the current study aimed to test the psychometric properties of the scores on the ASI-3 in a sample of cigarette smokers. Participants were treatment-seeking daily smokers who completed the ASI-3 at a precessation visit (Time 1, N = 464) and 3 months postcessation attempt (Time 2, n = 137). Confirmatory factor analyses results of the scores on ASI-3 at Time 1 and Time 2 revealed the hypothesized 3-factor model, including physical, social, and cognitive concerns. In addition, the ASI-3 factor scores evidenced factor stability, test-retest reliability, internal consistency, and convergent, and discriminant, and predictive validity. The present study provides evidence in support of the validity and reliability of scores on the ASI-3 as a measure of anxiety sensitivity among treatment-seeking cigarette smokers. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
... Some research suggests that AS is dimensional (e.g., Broman-Fulks et al., 2008, 2010, whereas other research suggests that AS has a taxonic structure (i.e., is categorical) and that the base rate of the AS taxon differs by gender. More specifically, the AS taxon base for women is higher than for men (12% vs. 7%, respectively) (Bernstein et al., 2010;Bernstein, Zvolensky, Stewart, Comeau, & Leen-Felder, 2006). The reason for the difference in base rate is unclear, but may be related to differential levels of genetic heritability (Taylor, Jang, Stewart, & Stein, 2008) or differential exposure to relevant learning experiences (Watt, McWilliams, & Campbell, 2005;Watt, Stewart, & Cox, 1998). ...
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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.
... Although FMMs have been used in areas such as genetic heritability (Muthén, Asparouhov, & Rebollo, 2006), anxiety sensitivity (Bernstein et al., 2010), tobacco dependence , and social desirability (Leite & Cooper, 2010), they have had limited (if any) use in the area of family studies. In fact, a cursory search through several family-oriented journals (Journal of Marriage and Family, Family Relations, Family Psychology, and Family Process) yielded no articles in which this method had been used. ...
Article
The authors introduce factor mixture modeling (FMM) and its implications for assessing varying degrees of shared reality in families. FMM extends the typical factor analytic model that uses a set of observed indicators to identify an unobservable factor and its structure. FMM examines the possibility a sample is a mixture of “classes,” each with unique factor structures. To demonstrate, varying factor structures of father involvement are identified using father, mother, and child reports as observed indicators. Three classes were identified and relate to varying degrees of shared reality regarding the father. Predictors and outcomes of these classes are modeled. The class in which the child's view most overlapped with his or her parents' view was predicted by higher child agreeableness and higher levels of maternal depressive symptoms. As hypothesized, membership in this class predicted lower levels of parental conflict and fewer parental attempts to involve their children in their conflicts.
... More recently, two alternative statistical methods, model-based clustering and latent variable mixture modeling (LVMM), although primarily developed in other areas of science, have also been applied to psychiatric data to investigate this question (e.g. Lenzenweger et al. 2007;Lubke et al. 2007Lubke et al. , 2009Bernstein et al. 2010). ...
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Taxometric procedures, model-based clustering and latent variable mixture modeling (LVMM) are statistical methods that use the inter-relationships of observed symptoms or questionnaire items to investigate empirically whether the underlying psychiatric or psychological construct is dimensional or categorical. In this review we show why the results of such an investigation depend on the characteristics of the observed symptoms (e.g. symptom prevalence in the sample) and of the sample (e.g. clinical, population sample). Furthermore, the three methods differ with respect to their assumptions and therefore require different types of a priori knowledge about the observed symptoms and their inter-relationships. We argue that the choice of method should optimally match and make use of the existing knowledge about the data that are analyzed.
... One of the best ways to consider belief as a psychological construct is to examine counterfactual cases (Langdon and Connaughton, 2013). Persons who are anxious or depressed have beliefs that are dysfunctional and experienced as negative and invalidating (Bernstein et al., 2010(Bernstein et al., , 2013. Example: BEL("If I try to do this, I'm going to fail"). ...
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Belief revision is the key change mechanism underlying the psychological intervention known as cognitive behavioral therapy (CBT). It both motivates and reinforces new behavior. In this review we analyze and apply a novel approach to this process based on AGM theory of belief revision, named after its proponents, Carlos Alchourrón, Peter Gärdenfors and David Makinson. AGM is a set-theoretical model. We reconceptualize it as describing a non-linear, dynamical system that occurs within a semantic space, which can be represented as a phase plane comprising all of the brain's attentional, cognitive, affective and physiological resources. Triggering events, such as anxiety-producing or depressing situations in the real world, or their imaginal equivalents, mobilize these assets so they converge on an equilibrium point. A preference function then evaluates and integrates evidentiary data associated with individual beliefs, selecting some of them and comprising them into a belief set, which is a metastable state. Belief sets evolve in time from one metastable state to another. In the phase space, this evolution creates a heteroclinic channel. AGM regulates this process and characterizes the outcome at each equilibrium point. Its objective is to define the necessary and sufficient conditions for belief revision by simultaneously minimizing the set of new beliefs that have to be adopted, and the set of old beliefs that have to be discarded or reformulated. Using AGM, belief revision can be modeled using three (and only three) fundamental syntactical operations performed on belief sets, which are expansion; revision; and contraction. Expansion is like adding a new belief without changing any old ones. Revision is like adding a new belief and changing old, inconsistent ones. Contraction is like changing an old belief without adding any new ones. We provide operationalized examples of this process in action.
... The available evidence suggests both IU (Carleton et al., 2012b) and AS (Bernstein et al., 2010) are continuous rather than taxonic; as such, a positive and linear relationship between the two variables and panic disorder symptoms is consistent with prior research. Nevertheless, higher levels of both IU and AS could reasonably be expected to produce an interaction or moderation effect. ...
... A variety of statistical techniques including taxometrics (Meehl 1995, Ruscio et al. 2006) and factor mixture analysis (Muthen & Muthen 2010) have been developed to examine the dimensionality versus taxonicity of diagnostic constructs. Many taxometric studies find that dimensions tend to be favored for a variety of psychiatric disorders (Haslam et al. 2012), especially the PDs , Wright et al. 2013), but other studies find justification in the measurement characteristics for retaining groups (Bernstein et al. 2010, Lenzenweger et al. 2008, Picardi et al. 2012. ...
Article
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created in 1952 by the American Psychiatric Association so that mental health professionals in the United States would have a common language to use when diagnosing individuals with mental disorders. Since the initial publication of the DSM, there have been five subsequent editions of this manual published (including the DSM-III-R). This review discusses the structural changes in the six editions and the research that influenced those changes. Research is classified into three domains: (a) issues related to the DSMs as measurement systems, (b) studies of clinicians and how clinicians form diagnoses, and (c) taxonomic issues involving the philosophy of science and metatheoretical ideas about how classification systems function. The review ends with recommendations about future efforts to revise the DSMs.
... It recognizes that syndromes such as anxiety and depression are ataxonic and multidimensional. 101 Instead, funding will be directed toward projects using multiple data sources, ranging from behavioral symptoms to neuroimaging results. A transdiagnostic approach in turn implicates what might be characterized as a trans-treatment response, addressing all symptoms at once regardless of their provenance or origin. ...
Article
Anxiety or depression may be a risk factor for the development of diabetes. This relationship may occur through a combination of genetic predispositions; epigenetic contingencies; exacerbating conditions such as metabolic syndrome (a precursor to diabetes); and other serious medical conditions. Medications used to treat anxiety and depression have significant side effects, such as weight gain, further increasing the possibility of developing diabetes. These components combine, interact, and reassemble to create a precarious system for persons with, or predisposed to, diabetes. Clinicians must be aware of these interrelationships to adequately treat the disease.
... Reliable change and clinical significance calculations [58] were conducted on the DASS subscales, the QLES, and disorder specific measures. Normative data were used to calculate the cutoff criteria [3,4344454647596061626364. Tables 4-6 display the proportion of clients in each condition that met the respective criteria for the three DASS subscales and the QLES respectively. ...
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Background Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. MethodsA total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction. ResultsRetention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P
... A higher score demonstrates a higher rating of AS. Although three dimensions of AS are assessed (i.e., physical, cognitive, and social), recent research suggests the physical and cognitive dimensions are the best representation of the construct (Bernstein et al., 2010). Therefore, a scale comprised of these two dimensions was used in the current study (M women = 5.74, SD women = 7.29; M men = 6.82, ...
Article
Recent evidence suggests that an interaction of personality dimensions and self-regulatory mechanisms partially explains the development of anxiety-related psychopathology. We examined the associations between behavioral inhibition system (BIS) sensitivity, negative emotionality (NE), anxiety sensitivity (AS), and experiential avoidance (EA) to understand the role of personality dimensions and self-regulatory mechanisms in relation to anxiety disorder risk. In a sample of 675 undergraduates, we used path analysis models to examine the associations between the study variables. The results suggest a positive relationship between BIS sensitivity and EA, and between EA and AS. Therefore, there is an indirect path between BIS sensitivity and AS through EA. Further, the relationship between EA and AS was stronger for men than for women. The examination of an alternative model indicated poor fit and provides evidence for a model of AS that includes personality dimensions and EA.
... However, the BAI has been widely used in the extant AS research as a covariate to control for anxiety. Third, some recent work has found that AS may maintain continuous, categorical, and hierarchical properties but the present examination only focused on AS as a continuous construct (Bernstein et al., 2006(Bernstein et al., , 2010Zinbarg et al., 1997). Although future work on AS as a categorical and hierarchical construct is needed, the focus in the current paper on AS as a continuous construct is most consistent with Reiss' (1991) original prediction. ...
Article
Despite the high impact of anxiety sensitivity (AS; a fear of anxiety related sensations) research, almost no research attention has been paid to its parent theory, Reiss' expectancy theory (ET). ET has gone largely unexamined to this point, including the prediction that AS is a better predictor of number of fears than current anxiety. To test Reiss' prediction, we used a large (N=317) clinical sample of anxiety outpatients. Specifically, we examined whether elevated AS predicted number of comorbid anxiety and non-anxiety disorder diagnoses in this sample. Consistent with ET, findings indicated that AS predicted number of comorbid anxiety disorder diagnoses above and beyond current anxiety symptoms. Also, AS did not predict the number of comorbid non-anxiety diagnoses when current anxiety symptoms were accounted for. These findings represent an important examination of a prediction of Reiss' ET and are consistent with the idea that AS may be a useful transdiagnostic treatment target.
... In comparison with the original ASI, the ASI-3 accounts for significantly more of the total variance in general and lower-order factors (76% vs. 66%) and has been show to have convergent, discriminant, and criterion validity . Cut-off scores for AS taxon group membership were defined on the basis of the results of a recent multisite investigation conducted using the ASI-3 among a young adult sample (Bernstein et al., 2010). The results of this investigation demonstrated that a cut-off score of greater than or equal to 13 (high-risk taxon group membership) and less than 13 (normative taxon group membership) on the combined ASI-3 cognitive and physiological concerns subscales resulted in approximately 80% accurate assignment to each class. ...
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There is a well-established and clinically meaningful relation between the cognitive-affective-based construct of anxiety sensitivity (AS) and risk for the development and maintenance of anxiety psychopathology (B. J. Cox, Fuentes, Borger, & Taylor, 2001). Research findings within this area have revealed mixed results; however, there is evidence to suggest that some individuals with anxiety disorder diagnoses may demonstrate enhanced subcortical arousal (e.g., exaggerated startle response to unexpected, aversive stimuli [A. M. Waters et al., 2008], and deficient prepulse inhibition [PPI; S. Ludewig, Ludewig, Geyer, Hell, & Vollenweider, 2002]), it is presently unclear whether these differences are found within the general population. To address this gap in the extant literature, the current investigation examined the impact of AS on acoustic startle response magnitude and PPI. Results indicated that individuals high and low in AS differ with regard to subcortical measures of arousal, with individuals expressing high levels of AS demonstrating enhanced startle response and deficient PPI. Results are discussed in terms of the role of the cognitive-affective-based factor of AS in the context of physiologic markers for vulnerability for anxiety psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Factor mixture modeling (FMM) incorporates both continuous latent variables and categorical latent variables in a single analytic model clustering items and observations simultaneously. After two decades since the introduction of FMM to psychological and behavioral science research, it is an opportune time to review FMM applications to understand how these applications are utilized in real-world research. We conducted a systematic review of 76 FMM applications. We developed a comprehensive coding scheme based on the current methodological literature of FMM and evaluated common usages and practices of FMM. Based on the review, we identify challenges and issues that applied researchers encounter in the practice of FMM and provide practical suggestions to promote well-informed decision making. Lastly, we discuss future methodological directions and suggest how FMM can be expanded beyond its typical use in applied studies.
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Background: Black adults experience high rates of overweight/obesity, which is linked to chronic diseases and is exacerbated by fast-food consumption. Anxiety sensitivity, a relative stable fear of anxiety-related sensations, has been linked to high caloric intake. Here, we examine whether anxiety sensitivity is associated with fast-food ordering habits within a convenience sample of Black adults. Methods: Of 124 adults (79.4% women; Mage=49.3±11.6; 84.8% overweight/obese), 107 (86.3%) reported eating from a fast-food restaurant in the last month. Participants completed the Anxiety Sensitivity-Index 3, which has a total score and physical, cognitive, and social concerns subscales. Investigator-generated items queried frequency of ordering "supersized" quantities of fast-food (e.g., cheeseburgers, fries), and healthy items (e.g., salads, oatmeal, yogurt), respectively, from "never" to "always." Covariate-adjusted ordinal logistic regression models were used to assess relations between measures of interest. Results: Anxiety sensitivity (total and physical concerns) was associated with greater odds of more frequently ordering supersized unhealthy fast-food; and anxiety sensitivity (total and cognitive concerns) was associated with lower odds of more frequently ordering healthy items from fast-food restaurants. Conclusions: Results suggest that adults with greater anxiety sensitivity may engage in fast-food ordering habits that can contribute to the overweight/obesity epidemic. Future studies should replicate results and determine the potential for anxiety sensitivity-reduction interventions to affect dietary choices that contribute to overweight/obesity.
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Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17–20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.
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Introduction Treatment completion is associated with abstinence outcomes in smoking cessation interventions. Previous research has stated that anxiety sensitivity (AS) is associated with smoking-related variables and smoking-cessation outcomes. To date, research has not examined the interaction between AS and treatment completion on smoking-cessation outcomes over time. This study aims to examine the main and the interactive effects of treatment completion and AS (total score and specific dimensions) on smoking-cessation outcomes at 3-, 6-, and 12-month follow-ups. Method The sample consisted of 210 smokers enrolled in an eight-session smoking-cessation cognitive-behavioral treatment (62.1% women; Mage = 45.2, SD = 11.0). Participants were classified as completers (attended the eight treatment sessions) and non-completers (attended ≤ 7 sessions). Abstinence was biochemically confirmed. Results Main effects indicated that completers had a higher likelihood of being abstinent over time when compared to non-completers. Regarding AS, those with greater AS-Physical Concerns had lower abstinence rates. Besides, a significant interaction between treatment completion, time and AS-Physical Concerns was found. Particularly, completers with greater AS-Physical Concerns had a higher likelihood of being abstainers than non-completers over time, while no significant differences were found for those with lower AS-Physical Concerns. Conclusion These data highlight the relevance of AS-Physical levels and smoking-cessation treatment completion on abstinence outcomes over time among treatment-seeking smokers.
Article
Person-centered methods are useful for studying individual differences in terms of (dis)similarities between response profiles on multivariate outcomes. Multivariate distance matrix regression (MDMR) tests the significance of associations of response profile (dis)similarities and a set of predictors using permutation tests. This paper extends MDMR by deriving and empirically validating the asymptotic null distribution of its test statistic, and by proposing an effect size for individual outcome variables, which is shown to recover true associations. These extensions alleviate the computational burden of permutation tests currently used in MDMR and render more informative results, thus making MDMR accessible to new research domains.
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Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.
Article
Anxiety sensitivity (AS), the belief that anxious arousal is harmful, is a malleable risk factor that has been implicated in anxiety and depression symptoms in adolescents. Although there is some evidence that adolescents possess distinct developmental trajectories, few studies have explored this topic. This study examined the developmental trajectory of AS in 248 adolescents ( M age = 11.0 years, SD = 0.82; 56% male) across 6 years, beginning when children were age 11. This study also examined the influence of AS trajectories on anxiety and depression at age 16. Finally, this study examined the utility of AS classes in identifying anxiety and depression growth. Three AS classes were found, described by normative-stable, high-stable, and high-unstable trajectories. Adolescents in the high-stable and the high-unstable AS classes had higher levels of anxiety and depression at age 16 than did adolescents in the normative-stable AS class. In addition, the anxiety and depression trajectories fit by AS class mirrored the AS class trajectories. These findings suggest three AS trajectories can be identified in adolescents. These trajectories are discussed in relation to a developmental perspective of AS.
Article
The purpose of the current study was to investigate the fit of a bifactor model of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al. Psychological Assessment, 19, 176-188, 2007) as well as to examine measurement invariance of the ASI-3 across gender. Participants were undergraduate students from the University of Cincinnati (n = 954; 63 % female). Results indicated that the bifactor model was the best fit to the data, and that this model of AS is fully invariant in terms of gender. The current findings suggest that anxiety sensitivity consists of a general factor and three independent group factors (rather than a higher-order factor with three correlated lower-order factors). The ASI-3 subscales from the bifactor model however did not provide incremental predictive utility above and beyond the general AS factor with respect to an external anxiety criterion. Related research and clinical implications are discussed.
Article
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Anxiety sensitivity (AS) is a multidimensional construct composed of several lower order factors and has been implicated in the development and maintenance of anxiety and depression symptoms and disorders. Recently, it has been suggested that AS is a dimensional-categorical construct, reflecting classes of individuals with different levels of and relations between AS factors. Factor mixture modeling was applied to examine the latent structure of AS in a sample of 1,151 college students (M age = 18.88, SD = 1.91). Results indicated that the best fitting model comprised three classes consisting of individuals with normative AS (n = 953), moderate AS (n = 124), and high AS (n = 74). Relations among the factors appeared to be different across groups, with the highest relations found in the normative AS class and the lowest relations found in the high AS class. There were significant differences in mean levels of anxiety and depression symptoms across classes, with the exception of social anxiety disorder symptoms. This study was the first to find and provide support for a third AS class. Implications for research and clinical utility are discussed, including the benefit of developing cut scores for AS classes based on this and similar studies. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Article
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Anxiety sensitivity has been implicated as an important risk factor, generalizable to most anxiety disorders. In adults, factor mixture modeling has been used to demonstrate that anxiety sensitivity is best conceptualized as categorical between individuals. That is, whereas most adults appear to possess normative levels of anxiety sensitivity, a small subset of the population appears to possess abnormally high levels of anxiety sensitivity. Further, those in the high anxiety sensitivity group are at increased risk of having high levels of anxiety and of having an anxiety disorder. This study was designed to determine whether these findings extend to adolescents. Factor mixture modeling was used to examine the best fitting model of anxiety sensitivity in a sample of 277 adolescents (M age = 11.0 years, SD = 0.81). Consistent with research in adults, the best fitting model consisted of 2 classes, 1 containing adolescents with high levels of anxiety sensitivity (n = 25) and another containing adolescents with normative levels of anxiety sensitivity (n = 252). Examination of anxiety sensitivity subscales revealed that the social concerns subscale was not important for classification of individuals. Convergent and discriminant validity of anxiety sensitivity classes were found in that membership in the high anxiety sensitivity class was associated with higher mean levels of anxiety symptoms, controlling for depression and externalizing problems, and was not associated with higher mean levels of depression or externalizing symptoms controlling for anxiety problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Article
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This study used factor mixture modeling to investigate individual differences in how life satisfaction is construed. Referring to the cognitive regulation of well-being we aimed to identify individuals for whom work and nonwork life domains contribute differently to overall life satisfaction. In a sample of 1,704 working adults two subgroups with different response patterns were identified. In the first subgroup work and nonwork life domains contributed equally to overall life satisfaction. In the second subgroup satisfaction with nonwork rather than work-related life domains were important sources of life satisfaction. Furthermore, participants in the second group processed negative affect from the work domain in ways that enabled them to maintain high levels of life satisfaction. We examined the external validity of class assignment and replicated our findings in a second sample. How factor mixture modeling can be used to uncover cognitive mechanisms that operate in evaluations of life satisfaction is discussed.
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A Single Target Implicit Association Test (ST-IAT) was used in three internet studies in order to assess the malleability of automatic rejection associations in socially anxious participants. Study 1 and Study 2 explored whether automatic rejection associations could be reduced by an evaluative conditioning task that combined social situations with acceptance. Results showed that the conditioning task reduced rejection associations in the group that completed the ST-IAT shortly after the conditioning task. In contrast, rejection associations were not significantly different from a control group when the ST-IAT was assessed with a one week interval after the conditioning task. Explicit social rejection measures were not, or only marginally, affected by the conditioning task. Study 3 used an attentional training task that fosters sensitivity to positive social feedback (Dandeneau, Baldwin, Baccus, Sakellaropoulo, & Pruessner, 2007). After one week of daily training, implicit but not explicit social rejection associations were reduced by the attentional training task even if they were assessed after an additional one-week interval without any training. The results show that cognitive trainings can affect implicit social rejection associations and that the effects are visible even after a period without training.
Article
BACKGROUND: The purpose of the present study was to shed light on the latent structure and nature of individual differences in anxiety sensitivity (AS) and related risk for psychopathology. METHODS: The present study evaluated the latent structure of AS using factor mixture modeling (FMM; Lubke and Muthén, 2005) and tested the relations between the observed FMM-based model of AS and psychopathology in a large, diverse adult clinical research sample (N=481; 57.6% women; M(SD)(age)=36.6(15.0) years). RESULTS: Findings showed that a two-class three-factor partially invariant model of AS demonstrated significantly better fit than a one-class dimensional model and more complex multi-class models. As predicted, risk conferred by AS taxonicity was specific to anxiety psychopathology, and not to other forms of psychopathology. LIMITATIONS: The sample was not epidemiologic, self-report and psychiatric interview data were used to index AS and psychopathology, and a cross-sectional design limited inference regarding the directionality of observed relations between AS and anxiety psychopathology. CONCLUSIONS: Findings are discussed with respect to the nature of AS and related anxiety psychopathology vulnerability specifically, as well as the implications of factor mixture modeling for advancing taxonomy of vulnerability and psychopathology more broadly.
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Abstract The present investigation evaluated the moderating role of distress tolerance (DT) in the relation between the physical concerns (PC) dimension of anxiety sensitivity (AS-PC) and panic and posttraumatic stress disorder (PTSD)-related re-experiencing symptoms in a nonclinical, undergraduate sample (n = 416; 300 females; M (age)=20.3 years, SD = 4.8). Consistent with prediction, there was a significant interactive effect between AS-PC and DT in regard to panic symptoms, such that greater AS-PC and low DT was associated with greater panic symptoms after controlling for the variance accounted for by negative affectivity and the respective main effects. However, contrary to prediction, AS-PC and DT did not significantly interact to predict PTSD-related re-experiencing symptoms. Also consistent with prediction, there was no interactive effect apparent for symptoms of depression or general anxiety, suggesting that the interaction between AS-PC and DT is specific to panic psychopathology.
Article
The aim of this study was to evaluate the associations between a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) and posttraumatic stress, panic, generalized anxiety, depression, psychiatric multimorbidity, and quality of life among a young adult sample exposed to traumatic stress (N = 103, n (females) = 66, M (age) = 23.68 years, SD (age) = 9.55). Findings showed support for the conceptual and operational utility of the AS taxonic-dimensional model with respect to concurrent transdiagnostic vulnerability among trauma-exposed adults. Specifically, relative to the low-AS group, the high-AS group demonstrated elevated levels of panic, depressive, and posttraumatic stress symptom severity as well as greater psychiatric multimorbidity and poorer quality of life. Furthermore, past-month MDD, GAD, PTSD, and panic attacks occurred nearly exclusively among the high-AS group. Continuous AS physical and psychological concerns scores were found to be significantly related to levels of panic and posttraumatic stress symptom severity, psychiatric multimorbidity as well as panic attack status only among the high-AS group and not among the low-AS group. Findings are discussed with respect to their implications for the conceptual and operational utility of the FMM-based taxonic-dimensional model of AS, related vulnerability for psychopathology in the context of trauma, and the clinical implications of these findings for assessment and intervention.
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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 sensitivity 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.
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Latent variable models exist with continuous, categorical, or both types of latent variables. The role of latent variables is to account for systematic patterns in the observed responses. This article has two goals: (a) to establish whether, based on observed responses, it can be decided that an underlying latent variable is continu- ous or categorical, and (b) to quantify the effect of sample size and class propor- tions on making this distinction. Latent variable models with categorical, continu- ous, or both types of latent variables are fitted to simulated data generated under different types of latent variable models. If an analysis is restricted to fitting con- tinuous latent variable models assuming a homogeneous population and data stem from a heterogeneous population, overextraction of factors may occur. Similarly, if an analysis is restricted to fitting latent class models, overextraction of classes may occur if covariation between observed variables is due to continuous factors. For the data-generating models used in this study, comparing the fit of different explor- atory factor mixture models usually allows one to distinguish correctly between categorical and/or continuous latent variables. Correct model choice depends on class separation and within-class sample size. Starting with the introduction of factor analysis by Spearman (1904), different types of latent variable models have been developed in various areas of the social sciences. Apart from proposed estimation methods, the most obvious differences between these early latent variable models concern the assumed distribution of the
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The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. O. Lilienfeld, S. M. Turner, and R. G. Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures. In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
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Cross-lagged panel analysis of interview data collected from survivors of traumatic physical injury (N = 677) was used to examine the temporal relationship between anxiety sensitivity and posttraumatic stress disorder (PTSD) symptom severity. The 2 constructs were assessed at 3 time points: within days of physical injury, at 6-month follow-up, and at 12-month follow-up. Results indicated that anxiety sensitivity and PTSD symptom severity were reciprocally related such that anxiety sensitivity predicted subsequent PTSD symptom severity, and symptom severity predicted later anxiety sensitivity. Findings have both theoretical and clinical implications.
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We empirically test existing theories on the provision of public goods, in particular air quality, using data on sulfur dioxide (SO2) concentrations from the Global Environment Monitoring Projects for 107 cities in 42 countries from 1971 to 1996. The results are as follows: First, we provide additional support for the claim that the degree of democracy has an independent positive effect on air quality. Second, we find that among democracies, presidential systems are more conducive to air quality than parliamentary ones. Third, in testing competing claims about the effect of interest groups on public goods provision in democracies we establish that labor union strength contributes to lower environmental quality, whereas the strength of green parties has the opposite effect.
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Anxiety sensitivity is the fear of anxiety-related bodily sensations, which arises from beliefs that the sensations have harmful somatic, psychological, or social consequences. Elevated anxiety sensitivity, as assessed by the Anxiety Sensitivity Index (ASI), is associated with panic disorder. The present study investigated the relationship between anxiety sensitivity and depression. Participants were people with panic disorder (n = 52), major depression (n = 46), or both (n = 37). Mean ASI scores of each group were elevated, compared to published norms. Principal components analysis revealed 3 factors of anxiety sensitivity: (a) fear of publicly observable symptoms, (b) fear of loss of cognitive control, and (c) fear of bodily sensations. Factors 1 and 3 were correlated with anxiety-related measures but not with depression-related measures. Conversely, factor 2 was correlated with depression-related measures but not with anxiety-related measures.
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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 sensitivity 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.
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Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.
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A new approach is presented for the interpretation of differences among means and proportions. Post hoc techniques, such as Tukey's honestly significant difference procedure, have interpretive problems related to intransitive decisions and technical issues arising from unequal sample sizes or heterogeneity of variance. These concerns can be avoided by considering ordered subsets of means and by using information criterion to select among competing models. This paired-comparisons information-criterion (PCIC) approach is wholistic in nature and does not depend on interpreting a series of statistical tests. Simulation results suggest that a protected version of the PCIC procedure is desirable to minimize failures to detect the null case. This technique is illustrated for independent means, proportions, and means from repeated measures.
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Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents.
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Structural equation mixture modeling (SEMM) integrates continuous and discrete latent variable models. Drawing on prior research on the relationships between continuous and discrete latent variable models, the authors identify 3 conditions that may lead to the estimation of spurious latent classes in SEMM: misspecification of the structural model, nonnormal continuous measures, and nonlinear relationships among observed and/or latent variables. When the objective of a SEMM analysis is the identification of latent classes, these conditions should be considered as alternative hypotheses and results should be interpreted cautiously. However, armed with greater knowledge about the estimation of SEMMs in practice, researchers can exploit the flexibility of the model to gain a fuller understanding of the phenomenon under study.
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Sources of population heterogeneity may or may not be observed. If the sources of heterogeneity are observed (e.g., gender), the sample can be split into groups and the data analyzed with methods for multiple groups. If the sources of population heterogeneity are unobserved, the data can be analyzed with latent class models. Factor mixture models are a combination of latent class and common factor models and can be used to explore unobserved population heterogeneity. Observed sources of heterogeneity can be included as covariates. The different ways to incorporate covariates correspond to different conceptual interpretations. These are discussed in detail. Characteristics of factor mixture modeling are described in comparison to other methods designed for data stemming from heterogeneous populations. A step-by-step analysis of a subset of data from the Longitudinal Survey of American Youth illustrates how factor mixture models can be applied in an exploratory fashion to data collected at a single time point.
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The question of whether mental disorders are discrete clinical conditions or arbitrary distinctions along dimensions of functioning is a long-standing issue, but its importance is escalating with the growing recognition of the frustrations and limitations engendered by the categorical model. The authors provide an overview of some of the dilemmas of the categorical model, followed by a discussion of research that addresses whether mental disorders are accurately or optimally classified categorically or dimensionally. The authors' intention is to document the importance of this issue and to suggest that future editions of the Diagnostic and Statistical Manual of Mental Disorders give more recognition to dimensional models of classification. They conclude with a dimensional mental disorder classification that they suggest provides a useful model.
Book
Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions.© 1999 by Lawrence Erlbaum Associates, Inc. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions. © 1999 by Lawrence Erlbaum Associates, Inc. All rights reserved.
Article
The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. O. Lilienfeld, S. M. Turner, and R. G. Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures. In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
We demonstrate that, under a theorem proposed by Q.H. Vuong [Econometrica 57, No. 2, 307-333 (1989; Zbl 0701.62106)], the likelihood ratio statistic based on the Kullback-Leibler information criterion or the null hypothesis that a random sample is drawn from a k 0 -component normal mixture distribution against the alternative hypothesis that the sample is drawn from a k 1 -component normal mixture distribution is asymptotically distributed as a weighted sum of independent chi-squared random variables with one degree of freedom, under general regularity conditions. We report simulation studies of two cases where we are testing a single normal versus a two-component normal mixture and a two-component normal mixture versus a three-component normal mixture. An empirical adjustment to the likelihood ratio statistic is proposed that appears to improve the rate of convergence to the limiting distribution.
Article
The present investigation evaluated the Anxiety Sensitivity (AS) taxon using the 16-item Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986) and its relation with two theoretically relevant cognitive processes associated with panic vulnerability: bodily vigilance and perceived uncontrollability over anxiety-related events. Taxometric analyses of 589 young adults indicated that the latent structure of AS was taxonic with an estimated base rate ranging between 13% and 14%. As predicted, an 8-item ASI Taxon Scale accounted for significant variance above and beyond that accounted for by the full-scale ASI total score in terms of bodily vigilance and perceived controllability of anxiety-related events. Moreover, after accounting for the variance explained by the full-scale ASI total score, the total score for the 8 ASI items not included in the ASI Taxon Scale was associated with significant variance in these same dependent measures, but it was in the opposite direction from that predicted by contemporary panic disorder theory. Dichotomous taxon membership accounted for significant variance above total ASI scores for bodily vigilance but not perceptions of control for anxiety-related events. These findings are discussed in terms of their theoretical implications for the study of AS and panic vulnerability.
Article
The purpose of this book is to begin the ambitious task of "true diagnostics," standing on the shoulders of taxometric theory, by reviewing taxometric studies, analyzing several large new data sets, and trusting in the future cooperation and enterprise of psychologists and others who read this book. The book begins with a review of the nature of classification procedures by highlighting some of its main problems and controversies. In chapter 2, the evolution of our current diagnostic system--the DSM--is discussed and the central argument is advanced. The authors suggest that for the DSM to continue to advance, we must begin to scientifically determine the underlying nature of these diagnostic entities through the use of procedures such as taxometrics. Chapter 3 offers a detailed analytic primer on the nature of taxometrics. The primer is written in a user-friendly manner so clinicians and others not familiar with the underlying mathematics associated with taxometrics can gain a full understanding of the importance and utility of these procedures. Chapter 4 is specifically focused on outlining a method by which taxometric procedures can be applied to diagnostic entities within the DSM. The final two chapters provide a review of the current taxometrics literature and the degree to which it has been applied to specific psychopathological entities (e.g., schizophrenia spectrum, anxiety, eating disorders). In summary, this book represents a "call to action" to revolutionize the diagnostic system. The point of this book is not that a diagnostic revolution has occurred; it is that it can and should occur and that, to a degree, it is occurring. Through this book, the authors hope to stimulate this enterprise by describing it, summarizing its initial progress, and contributing toward it. The enterprise, although difficult, is clearly feasible (within years not decades), if a core of psychological scientists join the fray. One of the main purposes of the book is to invite them to contribute to this cause. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Diathesis-stress models have long been cited in conceptualizations of the etiology of clinical disorders (Meehl, 1962; Rosenthal, 1970). These models suggest that specific types of psychopathology arise from a combination of vulnerability factors (diatheses) and life stress (Fowles, 1992). Despite an accumulating body of evidence demonstrating that specific diatheses, in the context of life stress, predict depressive symptomatology (Metalsky, Joiner, Hardin, and Abramson, 1993; Satterfield, Folkman, and Acree, 2002), few attempts have been made to directly test diathesis-stress models of anxiety disorders. Recent research, however, has indicated anxiety sensitivity (AS), defined as the fear of bodily sensations, interacts with life stress to predict panic-related problems (Zvolensky, Kotov, Antipova, and Schmidt, in press; Zvolensky and Schmidt, 2003). Although promising, extant panic-relevant diathesis-stress research has not addressed recently emerging taxometric research indicating that AS may be characterized by an underlying qualitative discontinuity between normal and pathological groups rather than an evenly graded dimension. Such neglect is unfortunate, as failure to accurately conceptualize the latent structure of the diathetic component of the panic-relevant diathesis-stress model may (1) limit the model's construct valid representation of the panic-relevant diathesis-stress phenomenon; and (2) preclude psychopathologists from further elucidating the specific processes underlying panic vulnerability. To begin to address this gap in the literature, the present study sought to test a panic-relevant diathesis-stress model using a taxometrically-derived categorical index of AS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
151 college students to whom the Anxiety Sensitivity Index (ASI) was administered in 1984 were retested in 1987 for anxiety sensitivity and tested for panic attacks, state-trait anxiety, and anxiety disorder history. ASI scores in 1984 predicted the frequency and intensity of panic attacks in 1987. Compared to Ss with low 1984 ASI scores, Ss with high 1984 ASI scores were 5 times more likely to have an anxiety disorder during the period 1984 to 1987. Test-retest reliability for the ASI across 3 yrs was .71. Data provide evidence for the stability of anxiety sensitivity over time and that the concept of anxiety sensitivity should be considered a personality variable. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This book discusses the MAXCOV-HITMAX procedure to reveal the underlying rationale of MAXCOV in simple terms and show how this technique can be used in a variety of disciplines by researchers in their taxonomic work. The misconceptions concerning the psychometric and philosophical status of taxonic constructs are discussed, and several meanings of the term "taxon" and the philosophy of science that has guided the authors' work in this area are reviewed. The authors describe MAXCOV-HITMAX and demonstrate how MAXCOV uses the General Covariance Mixture Theorem to test taxonic hypotheses (using utility programs written in S-Plus to do the taxometric procedures). Two new taxometric procedures are introduced, MAXEIG-HITMAX and L-Mode, for the simultaneous analysis of multiple taxon indicators. These techniques are contrasted with other data clustering and classification methods, such as latent profile analysis and Q-technique factor analysis. Guidelines are provided for corroborating taxonic models and the role of taxometrics in scientific methodology is described. The book is intended for professionals and practitioners in statistics, evaluation, survey research, sociology, psychology, education and communication research, policy studies, management, public health, and nursing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Taxometrics is a statistical tool that can be used to discern psychopathological categories from continua. In this study, taxometric analyses were conducted to determine whether a psychopathological category (or taxon) underlies a cognitive vulnerability to panic (i.e., fear of anxiety symptoms and body vigilance). The construct was operationalized with 3 variables: the Anxiety Sensitivity Index, the Body Sensations Questionnaire, and the Body Vigilance Scale. The test was performed in a large nonclinical sample (N = 1,224). Analyses and consistency tests support the taxonic conjecture for the existence of a latent cognitive vulnerability taxon with a base rate of about 18% in this population. Moreover, tests of the taxon’s utility indicated that taxon membership has incremental validity in predicting future panic attacks.
Article
The present investigation applied Item Response Theory (IRT) methodology to the 16-item Anxiety Sensitivity Index (ASI) [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] for a sample of 475 daily adult smokers (52% women; Mage = 26.9, S.D. = 11.1, range = 18–65). Using non-parametric item response analysis, all 16 ASI items were evaluated. Evaluation of the option characteristic curves for each item revealed 4 poorly discriminating ASI items (1: “It is important not to appear nervous;” 5: “It is important to me to stay in control of my emotions;” 7: “It embarrasses me when my stomach growls;” 9: “When I notice my heart beating rapidly, I worry that I might be having a heart attack”), which were dropped from analysis. Upon repeat analysis, the remaining items appeared to make adequate separations within levels of anxiety sensitivity in this sample. Graded response modeling data indicated important differences in ASI items’ capacity to discriminate between, and provide information about, latent levels of anxiety sensitivity. Specifically, three items best discriminated and provided the most information regarding latent levels of AS—items 3, 15, and 16. Items 1, 5, 7, and 9 were omitted due to their limited capacity to discriminate between latent levels of anxiety sensitivity; items 8, 12, and 13 also performed poorly. Overall, current findings suggest that evaluation of anxiety sensitivity among adult smokers using the 16-item ASI may usefully choose to focus on items that performed well in these IRT analyses (items: 2, 3, 4, 6, 10, 11, 14, 15, and 16).
Article
Anxiety sensitivity, or the fear of anxiety sensations, has been implicated in the etiology of anxiety disorders, particularly panic disorder. Recently, inconsistent findings have been reported regarding the latent structure of anxiety sensitivity. Whereas some taxometric studies of anxiety sensitivity have reported evidence of categorical latent structure, others have found evidence of a latent dimension. The purpose of the present research was to further examine the latent structure of anxiety sensitivity using taxometric procedures and commonly utilized measures of anxiety sensitivity. To this end, three mathematically independent taxometric procedures (MAXEIG, MAMBAC, and L-Mode) were applied to data collected from two large nonclinical samples (n's=1,171 and 2,173) that completed the Anxiety Sensitivity Index and the Anxiety Sensitivity Index-Revised. Results from both studies converged in support of a dimensional conceptualization of anxiety sensitivity. A third study was conducted using indicators derived from the newly revised Anxiety Sensitivity Index-3 in a separate sample of 1,462 nonclinical participants. Results of these analyses provided further support for a dimensional anxiety sensitivity solution. The implications of these results for anxiety sensitivity research are discussed, and several potential directions for future research are considered.