Unexpected arousal, anxiety sensitivity, and their interaction on CO2-induced panic: Further evidence for the context-sensitivity vulnerability model

Laboratory for the Study of Anxiety Disorders, The University of Texas at Austin, USA.
Journal of anxiety disorders (Impact Factor: 2.68). 06/2011; 25(5):645-53. DOI: 10.1016/j.janxdis.2011.02.005
Source: PubMed


The present experiment tested several predictions derived from the context-sensitivity vulnerability model of panic. Participants (N=79) scoring either high or low in anxiety sensitivity (AS) and with no history of unexpected panic were randomly assigned to one of two instructional sets: expected arousal (EA) or expected relaxation (ER). All participants were administered inhalation of room air and 35% CO(2) in a counterbalanced order. Consistent with theoretical predictions, High-AS participants who received ER instructions showed greater emotional responding compared to High-AS participants who received EA instructions, while instructional set did not affect responding among Low-AS participants. Panic attacks were observed in 52% of the High-AS-ER group compared to 17%, 5%, and 5% in the High-AS-EA, Low-AS-ER, and Low-AS-EA groups respectively. These findings are consistent with the theory's assertion that dispositional tendencies, such as anxiety sensitivity potentiate the panicogenic effects of threat-relevant context variables.

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Available from: Michael J Telch, Sep 29, 2014
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    • "These findings broaden previous evidence in regular caffeine consumers (Flaten and Blumenthal 1999; Mikalsen et al. 2001), in demonstrating that anxiety sensitivity affects this arousal response. This finding is additionally substantiated by the contextsensitivity vulnerability model that emphasizes the interplay of person and contextual factors such as the dispositional sensitivity to fear arousal sensations and an expected arousal induction (Telch et al. 2011). Thus, high AS potentiated the effect of the instructional set (arousal induction) by increasing the perceived threat of the expected arousal induction based on beliefs that arousal sensations signify potential dangerous consequences (McNally 2002; Telch et al. 2010). "
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    ABSTRACT: The way in which the tendency to fear somatic arousal sensations (anxiety sensitivity), in interaction with the created expectations regarding arousal induction, might affect defensive responding to a symptom provocation challenge is not yet understood. The present study investigated the effect of anxiety sensitivity on autonomic arousal, startle eyeblink responses, and reported arousal and alertness to expected vs. unexpected caffeine consumption. To create a match/mismatch of expected and experienced arousal, high and low anxiety sensitive participants received caffeine vs. no drug either mixed in coffee (expectation of arousal induction) or in bitter lemon soda (no expectation of arousal induction) on four separate occasions. Autonomic arousal (heart rate, skin conductance level), respiration (end-tidal CO2, minute ventilation), defensive reflex responses (startle eyeblink), and reported arousal and alertness were recorded prior to, immediately and 30 min after beverage ingestion. Caffeine increased ventilation, autonomic arousal, and startle response magnitudes. Both groups showed comparable levels of autonomic and respiratory responses. The startle eyeblink responses were decreased when caffeine-induced arousal occurred unexpectedly, e.g., after administering caffeine in bitter lemon. This effect was more accentuated in high anxiety sensitive persons. Moreover, in high anxiety sensitive persons, the expectation of arousal (coffee consumption) led to higher subjective alertness when administering caffeine and increased arousal even if no drug was consumed. Unexpected symptom provocation leads to increased attention allocation toward feared arousal sensations in high anxiety sensitive persons. This finding broadens our understanding of modulatory mechanisms in defensive responding to bodily symptoms.
    Full-text · Article · Jul 2015 · Psychopharmacology
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    • "In fact, preliminary evidence suggests that aerobic fitness may be reduced in this clinical condition [13], [14], [15]. Additionally, performance of maximal CPX could be particularly hampered by phobic anxiety, with autonomic manifestations naturally triggered by exercise, similar to those present in a PA [16]. Thus, due to the anticipatory anxiety related to a PA while performing a CPX, it is quite common that the patient will be unwilling to achieve the exhaustion that characterizes a maximal CPX [13], [17]. "
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    ABSTRACT: Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO2 - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO2 max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO2 max ( (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "However, the absence of low AS control groups and of autonomic and respiratory measures limits conclusions about mechanisms common to AS and PD. Telch et al. (2011) manipulated cognitive expectancies about the consequences of a single CO 2 inhalation in high-and low-AS individuals and showed that negative expectancies interacted with AS in triggering panic. The role of emotional avoidance and context conditioning was emphasized by Forsyth and coworkers (Finlay and Forsyth, 2009; Kelly and Forsyth, 2009). "
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    ABSTRACT: Psychometric studies indicate that anxiety sensitivity (AS) is a risk factor for anxiety disorders such as panic disorder (PD). To better understand the psychophysiological basis of AS and its relation to clinical anxiety, we examined whether high-AS individuals show similarly elevated reactivity to inhalations of carbon dioxide (CO2) as previously reported for PD and social phobia in this task. Healthy individuals with high and low AS were exposed to eight standardized inhalations of 20% CO2-enriched air, preceded and followed by inhalations of room air. Anxiety and dyspnea, in addition to autonomic and respiratory responses were measured every 15s. Throughout the task, high AS participants showed a respiratory pattern of faster, shallower breathing and reduced inhalation of CO2 indicative of anticipatory or contextual anxiety. In addition, they showed elevated dyspnea responses to the second set of air inhalations accompanied by elevated heart rate, which could be due to sensitization or conditioning. Respiratory abnormalities seem to be common to high AS individuals and PD patients when considering previous findings with this task. Similarly, sensitization or conditioning of anxious and dyspneic symptoms might be common to high AS and clinical anxiety. Respiratory conditionability deserves greater attention in anxiety disorder research.
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