Anxiety sensitivity and panic disorder

Individual Variables Involved in Perceived Pressure for Adolescent Drinking

Adolescence is a stage when individuals are especially vulnerable to the influence of their peer group, which could lead to the development of problematic behavior, such as drinking alcohol, due to perceived pressure. The objective of this study was to analyze the role of self-esteem, impulsivity, anxiety sensitivity and expectations for use under perceived pressure to drink alcohol among young people.

METHODS

The sample was made up of 1287 high school students aged 14 to 18, with a mean age of 15.11. The Bayes factor and mediation models were estimated to evaluate the data.

RESULTS

The results showed the existence of a positive relationship of impulsivity, anxiety sensitivity and expectations for use with perceived pressure. However, this relationship was negative with self-esteem and perception of pressure to drink alcohol. Furthermore, the model results showed that self-esteem mediates the relationship between physical, cognitive and social anxiety sensitivity and positive expectations with perceived pressure to drink alcohol in adolescence.

CONCLUSIONS

Given the strong need for affiliation during youth, it is hard to control grouping and peer influence on drinking behavior. However, knowledge of the role of individual variables, such as those described here, in perceived pressure could improve the prevention and intervention of such behaviors.

Anxiety sensitivity in relation to cigarette smoking and other substance use in African American smokers

Anxiety sensitivity (AS)-fearfulness of anxiety symptoms-has been implicated in the etiology of emotional disorders (e.g., depressive and anxiety disorders) and linked to cigarette smoking and other substance use (SU). However, studies examining AS in relation to SU primarily have been conducted with racially/ethnically heterogeneous or mostly European American samples. Hence, this cross-sectional study involving secondary analysis of baseline data focused on investigating associations of AS with cigarette smoking and other SU in a sample of 630 non-treatment-seeking African American smokers (37.3% female; M age = 49.6 years; M cigarettes smoked per day = 15.4). After screening out individuals with non-nicotine substance dependence, participants reported their demographics, AS, dysphoria symptoms (i.e., depression and anxiety symptoms), and SU. In regression analyses controlling for dysphoria symptoms, age, education level, income level, and years of regular smoking, AS was positively associated with tobacco withdrawal severity (β = .12, p = .007), overall smoking motives (β = .17, p < .001), alcohol use problems (β = .12, p = .005), and other (non-nicotine, nonalcohol) SU problems (β = .16, p < .001). Though lacking the passage of time between assessments needed to provide strong evidence of mediation, unplanned analyses further revealed indirect associations of AS with several SU variables through dysphoria symptoms. Current findings are consistent with those found in prior samples and suggest that AS is similarly related to SU in African Americans, who may benefit from interventions that have been helpful in improving AS, dysphoria symptoms, and SU in other groups. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Acculturative Stress, Anxiety Sensitivity, and Smoking among Spanish-Speaking Latinx Adult Smokers

Objectives: Although acculturative stress is a known individual difference factor related to poor health, little is understood about its relationship to smoking among Latinx adults. One transdiagnostic factor that may serve a mediational role in the relation between acculturative stress and smoking is anxiety sensitivity. The current study evaluated whether anxiety sensitivity mediated the relations between acculturative stress and smoking among a large sample of adult Spanish-speaking Latinx smokers. Method: Participants were 359 Spanish-speaking Latinx daily smokers (58.8% female, Mage= 33.2 years, SD = 9.7) who provided self-report data on acculturative stress, anxiety sensitivity, and smoking outcomes of cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Independent mediation models were conducted for each smoking outcome, with acculturative stress entered as the predictor and anxiety sensitivity entered as the proposed explanatory factor. Results: There were statistically significant indirect effects of acculturative stress via anxiety sensitivity in relation to cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Conclusions: The present findings provide novel evidence that anxiety sensitivity serves a mediational role in relations between acculturative stress and smoking outcomes among Latinx adult smokers.

Enhancing panic and smoking reduction treatment with D-Cycloserine: A pilot randomized clinical trial

In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.

Not the exercise type? Personality traits and anxiety sensitivity as predictors of objectively measured physical activity and sedentary time

Personality traits have been investigated as predictors of sedentary behavior, while both personality traits and anxiety sensitivity have been investigated as predictors of physical activity; however, few studies employed objective measurement of these behaviors. The current study recruited 64 young adults who completed the Anxiety Sensitivity Index-3 and NEO-Personality Inventory-3, then wore accelerometers for 1 week. Results revealed that agreeableness and anxiety sensitivity were inversely associated with moderate intensity or greater physical activity; however, none of the investigated constructs predicted sedentary time. These results highlight the importance of objective measurement when studying these behaviors and clinical implications for the identification of individuals at risk for physical activity avoidance.

Anxiety symptoms and smoking among Latinx adult smokers: the importance of sensitivity to internal cues in terms of dependence, barriers for quitting, and quit problems

Anxiety symptoms are one of the most common forms of psychological distress among Latinx individuals and related to poorer cessation outcomes among non-Latinx Whites. Yet, little is known about the relationship between anxiety symptoms and smoking among Latinx smokers. The current study evaluated sensitivity to internal anxiety-related sensations (anxiety sensitivity) as an explanatory variable in the relation between anxiety symptoms and cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants included 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.8). Results revealed that anxiety symptoms were indirectly associated with cigarette dependence, perceived barriers for cessation, and problems experienced during past quit attempts through anxiety sensitivity. The findings suggest that anxiety sensitivity is a potential mechanism in anxiety symptom-smoking relations among Latinx adult smokers.

Indirect Associations of Anxiety Sensitivity with Tobacco, Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents

Theoretically, anxiety sensitivity-fear of anxiety symptoms-enhances perception of and emotional reactivity to autonomic arousal and mental distress, thereby increasing negative affect and motivation to use substances for negative reinforcement. Because no prior study of adolescents has tested if anxiety sensitivity is indirectly associated with substance use problems through symptoms of emotional disorders (i.e., disorders involving high levels of negative affect), the current cross-sectional study examined this theoretical pathway. Participants included ninth-grade students from 10 different high schools in the Los Angeles metropolitan area (N = 3005; 54.3% female). Self-report measures of anxiety sensitivity, emotional disorder symptoms, tobacco dependence, and alcohol and other drug problems were administered. Controlling for sex, race/ethnicity, parental education, school, and impulsiveness, we tested the associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems as well as the indirect effects of anxiety sensitivity on each domain of substance use problems through emotional disorder symptoms. Anxiety sensitivity was associated with more severe tobacco dependence and greater alcohol problems and other drug problems, and anxiety sensitivity further was indirectly associated with all three domains of substance use problems through emotional disorder symptoms. Current findings suggest that adolescents high in anxiety sensitivity tend to experience emotional disorder symptoms, which may increase risk for substance use problems. Interventions that target anxiety sensitivity and enhance negative-affect coping skills may assist in preventing and reducing adolescent substance use problems.

State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study

QUESTION

Do measures of state anxiety and trait anxiety in people with acute low back pain (ALBP) improve prediction of chronic low back pain (CLBP), defined as pain or pain-related disability at 12 weeks?

DESIGN

Observational multi-centre prospective cohort study in primary physiotherapy care with measurements at baseline and at 12 weeks of state and trait anxiety, as well as other established prognostic factors for CLBP.

PARTICIPANTS

People with nonspecific ALBP, aged 18 to 60 years, who had been pain free for ≥ 3 months before their current ALBP, and who were being treated according the Dutch clinical guidelines.

OUTCOME MEASURES AND ANALYSIS

CLBP was defined as a pain score ≥ 3/10 on the Numerical Pain Rating Scale (primary outcome), and as a pain-related disability score ≥ 19/70 on the Pain Disability Inventory. Univariate and multivariate logistic regression analyses estimated how the risk of CLBP differed with state and trait anxiety and other established prognostic factors.

RESULTS

Most (204 of 225) participants completed both assessments. State anxiety was an independent predictor of CLBP, whether defined as pain or pain-related disability at 12 weeks, in contrast to trait anxiety. State anxiety improved the predictive performance of the model, with area under the curve (AUC) increasing from 0.64 (95% CI 0.56 to 0.71) to 0.75 (95% CI 0.68 to 0.82) and Nagelkerke's R² increasing from 0.08 to 0.24 for the primary outcome measure, pain. For the secondary outcome measure, pain-related disability: AUC 0.63 (95% CI 0.54 to 0.72) improved to 0.73 (95% CI 0.65 to 0.82) and Nagelkerke's R² increased from 0.05 to 0.16. Adding trait anxiety to the prognostic model for pain improved the AUC from 0.64 (95% CI 0.56 to 0.71) to 0.70 (95% CI 0.62 to 0.77) and Nagelkerke's R² from 0.08 to 0.15.

CONCLUSION

State anxiety in patients with ALBP improved prediction of CLBP, defined as pain and pain-related disability at 12 weeks.

Comorbidity of opioid-related and anxiety-related symptoms and disorders

Opioid use disorder and anxiety disorders co-occur at strikingly high rates, and this comorbidity is marked by a more severe clinical presentation and poorer prognosis for treatment. Given the substantial morbidity and mortality associated with these two disorders, it is imperative to understand factors related to the high rates of co-occurrence in order to inform the development of specialized treatments for this population. Several lines of study suggest that simultaneously addressing opioid-related and anxiety-related symptoms and processes, particularly intolerance of distress and pain-related anxiety, may yield improved outcomes for this high risk, vulnerable population. Future work is needed to identify other novel mechanisms as well as develop specialized treatments to augment standard medication-assisted treatment.

Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3)

INTRODUCTION

Anxiety sensitivity plays a prominent role in the etiology of anxiety disorders. This construct has attracted widespread interest from experts and researchers. The Anxiety Sensitivity Index (ASI-3) is the most common scale for measuring anxiety sensitivity.

OBJECTIVE

To analyze the psychometric properties and factor structure of the ASI-3 in Iranian student samples.

METHODS

220 students (135 women, 85 men) from Kermanshah University of Medical Sciences were selected by the convenience sampling method to evaluate the psychometric properties and analyze the factor structure of the ASI-3. The subjects were also asked to complete the Acceptance and Action Questionnaire-II (AAQ-II), Whiteley Index, Intolerance of Uncertainty, and Neuroticism scales. LISREL and SPSS were used to analyze the data. Cronbach's alpha and correlation coefficients were calculated and confirmatory factor analysis was conducted.

RESULTS

The results of the confirmatory factor analysis revealed a three-factor structure with physical, cognitive, and social components (comparative fit index = 0.94; normed fit index = 0.91; root mean square error of approximation = 0.09). The ASI-3 had positive and significant correlations with health anxiety (0.59), intolerance of uncertainty (0.29), and neuroticism (0.51). Furthermore, the ASI-3 had a negative and significant correlation with the AAQII (-0.58). Cronbach's alpha coefficients for the whole scale and for the physical, cognitive, and social concerns factors were 0.90, 0.74, 0.79, and 0.78, respectively. The invariance of the index was significant compared to the original English version.

CONCLUSION

In general, the results support the adequacy of the psychometric properties of the Persian version of the ASI-3. Theoretical and applied implications will be discussed.

Differences in anxiety sensitivity factors between anxiety and depressive disorders

BACKGROUND

Anxiety sensitivity (AS) refers to the tendency to fear physical sensations associated with anxiety due to concerns about potential physical, social, or cognitive consequences. Many previous studies were limited by the use of the anxiety sensitivity index (ASI) or the ASI-revised (ASI-R), which are both measurements with unitary or unstable structures. No recent study that has utilized the ASI-3 examined the relations between AS dimensions and depression. Thus, we examined multiple relationships between AS and anxiety disorders and depression using the ASI-3.

METHODS

The total sample consisted of 667 outpatients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth text revision as assessed by a structured clinical interview. There were eight patient groups: multiple anxiety disorder, major depressive disorder (MDD), panic disorder (PD), social phobia (SP), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and anxiety disorder not otherwise specified (AD NOS). We conducted one-way analysis of variances and post hoc tests to compare the ASI-3 total and subscale scores across the groups.

RESULTS

The physical concern score was higher in patients with PD than patients with MDD, SP, OCD, or GAD. The social concern score was higher in the SP group than those with MDD, PD, GAD, and AD NOS. Patients with GAD and PTSD showed higher cognitive concern scores than the patients with PD.

CONCLUSION

Results partially replicated the relationship between PD and physical concern, between SP and social concern, and between GAD and cognitive concern examining the relationships between AS dimensions and anxiety disorders.

Are non-pregnant women afraid of childbirth? Prevalence and predictors of fear of childbirth in students

Introduction: Fear of childbirth (FOC) has been mostly studied in peripartum women; however, it can be present in non-pregnant young women, and the question is whether it occurs even before pregnancy planning. Objective: (1) to determine the prevalence of clinically significant FOC in non-pregnant female students, and (2) to investigate the role of anxiety sensitivity (AS), trait anxiety, childbirth pain expectancy, and sources of birth knowledge for FOC. Methods: Non-pregnant female students (N = 374) from different study programmes (health studies, social sciences and humanities, and biotechnical studies) participated in the study. They completed Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), The State-Trait Anxiety Inventory (STAI-T), Anxiety Sensitivity Index (ASI), the average expected labor pain, and sources of information about childbirth. Results: The results showed that 25.9% of students reported clinically significant FOC. FOC could be predicted by postponing pregnancy planning, the high expectancy of labor pain, high trait anxiety, and high physical dimension of AS. Students from health sciences reported a lower level of FOC, as opposed to social science and humanities' students. Students reported receiving the most information about childbirth from family and the least from the professional books. Conclusions: Fear of childbirth is highly prevalent in the sample of young nulliparous women with one in four women reporting clinically significant fear. The higher levels of the FOC could be predicted, by AS, trait anxiety, expected labor pain, and sources of knowledge about the childbirth. Implications of the findings are discussed.

Incidence of panic disorder in patients with non-cardiac chest pain and panic attacks

This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.

Reduced Sensitivity to Non-Fear-Related Stimulus Changes in Panic Disorder

Panic disorder (PD) is associated with increased body vigilance and reduced cognitive resources directed at non-fear-related stimuli, particularly in the absence of stimulus-rich environments. To date, only few studies have investigated whether this deficit in PD is reflected in reduced mismatch negativity (MMN), an event-related potential indexing preattentive sensitivity to unexpected stimulus changes. We tested 35 patients affected by PD and 42 matched healthy controls in an oddball paradigm, using frequency and duration deviant stimuli to measure auditory MMN. PD patients displayed reduced duration MMN amplitudes in comparison to healthy controls. No group differences were detected for duration MMN latency, as well as frequency MMN indices. Results support the notion of reduced processing of non-fear-related stimuli in PD patients, particularly with regard to the preattentive processing of sound duration deviants. Additionally, our findings are in line with clinical studies reporting divergent deficits in preattentive processing of frequency and duration deviants.

Anxiety Sensitivity as a Risk Indicator for Anxiety, Depression, and Headache Severity in Women With Migraine

OBJECTIVE

The primary aim of this exploratory study was to assess the relationship between anxiety sensitivity and emotional disorders, migraine characteristics, and migraine-related fear and avoidance behaviors in women with probable migraine.

BACKGROUND

Anxiety and depressive disorders are the most frequent comorbid psychiatric conditions in migraine, particularly in women; however, the underlying reasons for these comorbidities are uncertain. Anxiety sensitivity, the tendency to catastrophically appraise anxiety and bodily sensations in terms of their physical, social, or cognitive consequences, is a psychological factor that may contribute to the comorbidity of anxiety and depressive disorders and migraine. It was hypothesized that anxiety sensitivity would be associated with greater migraine severity and psychiatric symptoms.

METHOD

Participants were women (n = 100) who screened positive for migraine on the validated IDMigraine Screener participated in an anonymous single-session online survey-based study on migraine. The Anxiety Sensitivity Index-3 total and subscales scores were used to assess anxiety sensitivity. Anxiety and depression symptoms were assessed with the brief Patient Health Questionnaire.

RESULTS

On average, anxiety sensitivity was clinically elevated (mean ± SD: 24.0 ± 15.2). Anxiety sensitivity cognitive and social concerns were most strongly correlated with severity of anxiety (r's = .38-.46) and depressive symptoms (r = .35-.39, P's < .001), and all anxiety sensitivity facets were related to fear of head pain (r's = .35-.38, P's < .001). Anxiety sensitivity cognitive concern facet was uniquely related to headache patterns, including longer migraine attack duration (r = .22, P = .029) and pain intensity (r = .24, P = .029), pain-related avoidance, including avoiding movement and more frequent misuse of prescribed or non-prescribed pain medication (r's = .20-.21, P's < .01).

CONCLUSIONS

These novel findings indicate that anxiety sensitivity, specifically fearful appraisal of bodily sensations, are linked to both psychiatric symptoms and migraine severity in women. In this cross-sectional study, causal sequence cannot be determined. If anxiety sensitivity leads to more severe pain and psychiatric distress, targeting anxiety sensitivity could lead to better headache outcomes.

Anxiety Sensitivity is Associated with Lower Enjoyment and an Anxiogenic Response to Physical Activity in Smokers

Background

The subjective affective response to, and enjoyment of, physical activity are strong predictors of engagement in physical activity. Anxiety sensitivity, the fear of bodily sensations, is a cognitive factor that may inhibit the pleasurable affective experience of physical activity, possibly contributing to low levels of physical activity. The current study evaluated anxiety sensitivity in relation to PA enjoyment and affective experience before and after exercise in smokers.

Method

Participants were low-active treatment-seeking smokers (n = 201) enrolled in a smoking cessation intervention. At baseline, participants completed self -report assessments of anxiety sensitivity, cigarette dependence, and physical activity enjoyment. State affect was also reported before and after a submaximal exercise test to index pre-exercise activity affect and affective response to exercise.

Results

Anxiety sensitivity was significantly negatively correlated with physical activity enjoyment, specifically lower enjoyable physical feelings of physical activity. Anxiety sensitivity was significantly correlated with lower state mood and higher state anxiety prior to the submaximal exercise test, and higher anxiety immediately after the exercise test. Additionally, anxiety sensitivity predicted increased anxiety, but not lower mood, in response to the submaximal exercise test.

Conclusions

This is the first study to document an association of anxiety sensitivity with affective determinants of physical activity behavior in smokers. Anxiety sensitivity was associated with lower physical activity enjoyment, higher negative affect prior to after exercise testing, and an anxiogenic response to exercise. Future work is needed to understand how the current findings generalize beyond smokers.

Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic Disorder

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.

Relations of anxiety sensitivity dimensions to nonsuicidal self-injury frequency and versatility among patients with substance use disorders

OBJECTIVE

Despite the theoretical and empirical relevance of anxiety sensitivity (AS) to nonsuicidal self-injury (NSSI), few studies have investigated this association. This study examined the incremental validity of AS dimensions in NSSI frequency and versatility, above and beyond emotion dysregulation and relevant covariates (racial/ethnic background, negative affectivity). AS dimensions were expected to account for additional unique variance in NSSI outcomes.

METHOD

Participants included 204 patients (50.5% female) with substance use disorders in residential treatment.

RESULTS

In this sample, 37.2% reported a history of NSSI. The hierarchical regression models revealed a unique positive association between AS social concerns and NSSI outcomes when adjusting for model variables. In contrast, AS physical concerns were uniquely negatively associated with NSSI outcomes.

CONCLUSION

Findings provide support for AS social concerns as a vulnerability for engagement in NSSI behaviors and highlight this particular AS dimension as a potential treatment target for NSSI prevention and intervention programs.

Predicting the consequences of physical activity: An investigation into the relationship between anxiety sensitivity, interoceptive accuracy and action

The ability to predict the consequences of our actions is imperative for the everyday success of our interactions. From negotiating an uneven surface, to mounting an immune response, we continually infer the limits of our body. The current investigation considered the impact that the inferred consequences of action has on the placement of limits. We hypothesised that the performance of individuals in a novel, sprint task would reflect both their ability to accurately detect changes in bodily arousal (Interoceptive Accuracy) and the inferred consequences associated with heightened arousal signals (Anxiety Sensitivity). We found that individuals who demonstrated accuracy associated with physiological arousal changes, and who showed a heightened fear of the consequences of arousal symptoms, modified their actions by decreasing their power output (mean Watts•kg^-1) in a sprint task (ΔR² = 0.19; F(1,34) = 19.87); p<0.001). These findings provide a basis for understanding the varying actions taken as we encounter bodily perturbation.

Anxiety sensitivity, its stability and longitudinal association with severity of anxiety symptoms

Anxiety sensitivity is associated with the onset of panic attacks, anxiety, and other common mental disorders. Anxiety sensitivity is usually seen as a relative stable trait. However, previous studies were inconclusive regarding the longitudinal stability of anxiety sensitivity and differed in study designs and outcomes. The current study examines the stability of anxiety sensitivity over time and its longitudinal associations with severity of anxiety symptoms. Participants from the Netherlands Study of Depression and Anxiety with and without an anxiety, depressive, or comorbid anxiety-depressive disorder diagnosis were included (N = 2052). Stability in anxiety sensitivity over two year follow-up and the longitudinal association between the change in anxiety sensitivity and change in severity of anxiety symptoms were tested. Results indicated that two-year stability of anxiety sensitivity was high (r = 0.72), yet this test-retest estimate leaves room for changes in anxiety sensitivity in some individuals as well. Change in anxiety sensitivity was positively associated with change in severity of anxiety symptoms (B = 0.64 in univariable analysis and B = 0.52 in multivariable analysis). The longitudinal association of anxiety sensitivity with severity of anxiety symptoms indicates that targeting anxiety sensitivity may be of additional benefit in clinical practice.

Type D personality, anxiety sensitivity, social anxiety, and disability in patients with acne: a cross-sectional controlled study

Introduction

Acne has long been associated with many psychiatric comorbidities.

Aim

To determine anxiety and depression levels, social phobia frequency, social anxiety level, subjective stress perception, anxiety sensitivity, disability, and the frequency of type D personality in patients with acne.

Material and methods

In total, 61 patients with acne aged > 16 years and 61 age, gender, and educationally matched healthy volunteers were included in the study. The patients and healthy controls were evaluated using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for social anxiety disorder and completed the Liebowitz Social Anxiety Scale, Sheehan Disability Scale, Anxiety Sensitivity Index, Hospital Anxiety and Depression Scale, Perceived Stress Scale (PSS), and Type D Scale-14.

Results

Depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability levels were significantly higher in patients with acne than in healthy controls (p < 0.05). Type D personality was more prevalent in patients with acne than in healthy controls (49% vs. 18%, p < 0.001).

Conclusions

To our knowledge, this study is the first reported in which type D personality and anxiety sensitivity, as well as social anxiety disorder according to the DSM-5 criteria, was evaluated in patients with acne compared with healthy controls. This study shows that patients with acne have higher levels of depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability, and a greater prevalence of type D personality, than healthy controls. Psychiatric evaluation of patients with acne may aid the detection of mental disorders.

Discomfort Intolerance in Relation to Asthma Outcomes

Anxiety symptoms and disorders are common among those with asthma and contribute to poorer health outcomes. Building on work examining anxiety-related cognitive-affective risk factors in asthma, the current study sought to explore associations between discomfort intolerance (i.e., the inability to withstand or tolerate unpleasant bodily sensations) in relation to lung function, asthma control, and quality of life. Participants were 61 adults with asthma (61.9% female; 54.8% African American; M age = 34.72, SD = 13.58) who were administered a self-report assessment battery and a lung function assessment. We found that, above and beyond the effects of anxiety sensitivity-physical concerns, greater discomfort intolerance was significantly associated with poorer lung function (9.5% variance), asthma control (9.9% variance), and overall asthma-related quality of life (11.7% variance) as well as the specific quality of life domains of activity limitations (12.6% variance) and asthma symptoms (6.8% variance). Thus, individuals with asthma who are unable to tolerate physical discomfort may be at risk for poor asthma outcomes and interventions to reduce discomfort intolerance could potentially be useful in this population.

Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity

The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, Mage = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

BACKGROUND AND OBJECTIVES

Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

METHODS

Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit.

RESULTS

Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

CONCLUSIONS

These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.

Posttraumatic stress disorder and cigarette smoking: A systematic review

BACKGROUND

Previous reviews of the PTSD and cigarette smoking literature showed high PTSD-smoking comorbidity and problematic smoking outcomes (Feldner et al., 2007, Clinical Psychology Review, 27, 14-45; Fu et al., 2007, Nicotine & Tobacco Research, 9, 1071-1084). However, past reviews also noted several prominent gaps in the literature, including a lack of etiological work examining underlying mechanisms and research on specialized PTSD-smoking treatments. The present review summarizes an extensive body of research conducted since the previous reviews targeting these areas of need.

METHODS

Literature searches identified 66 empirical studies specific to smoking and PTSD.

RESULTS

Smokers were approximately twice more likely to have PTSD than nonsmokers in the general population, and individuals with PTSD were approximately twice as likely to be current smokers. Smokers with PTSD evidenced more negative affect, trauma history, and comorbid psychiatric history, as well as quit attempts and higher relapse rates. PTSD symptoms were associated with expectations that smoking would reduce negative affect, which, in turn, was associated with increased smoking rate and nicotine dependence. Male sex was associated with nicotine dependence and PTSD avoidance, while the relationship between PTSD and smoking relapse due to withdrawal was stronger in females. Specialized, integrated PTSD and smoking cessation treatments showed promise in increasing quit success relative to standard care in randomized trials.

CONCLUSIONS

Rates of PTSD-smoking co-occurrence remain high. Notable gains have been made in relevant epidemiological and etiological research, although more work is needed in trauma-specific subpopulations. Several promising specialized treatments for comorbid smoking-PTSD have been developed and empirically tested but require replication.

Refinement of anxiety sensitivity measurement: The Short Scale Anxiety Sensitivity Index (SSASI)

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.

Individual differences in emotion dysregulation and trajectory of withdrawal symptoms during a quit attempt among treatment-seeking smokers

OBJECTIVE

Cigarette smoking remains the leading preventable cause of death in the United States, and withdrawal symptoms are central to the maintenance of tobacco use. Previous research suggests that individual differences in the propensity to experience negative affect may be related to more severe withdrawal symptoms. However, little research has examined how individual differences in the ability to regulate affect (emotion dysregulation) may impact withdrawal symptoms over time.

METHOD

Therefore, the current study examined the effects of emotion dysregulation on change in tobacco withdrawal symptoms over 12 weeks following a cigarette quit attempt among 188 (M_age = 38.52, SD = 14.00, 46.8% male) treatment seeking smokers.

RESULTS

Results from the study indicated greater emotion dysregulation was associated with greater quit day withdrawal symptoms as well as with as slower decline in withdrawal symptoms over the 12-week period (B = -0.001, SE = 0.001, p = .046).

CONCLUSION

The current study offers novel evidence into the role of emotion dysregulation in relation to withdrawal symptoms during a quit attempt. Assessing and reducing heightened emotion dysregulation prior to a quit attempt may be a potentially important therapeutic tactic for helping smokers achieve greater success in managing tobacco withdrawal.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

This study emphasizes the ways in which emotional dysregulation may affect tobacco withdrawal symptoms. This study can be utilized to further target smoking cessation programs for those attempting to quit smoking.

Associations between distress tolerance and asthma symptoms and quality of life

Objective: Given the robust associations between anxiety and asthma, the purpose of the current study was to explore associations between asthma outcomes and tolerance for negative affective states (i.e. distress tolerance) as well as tolerance for the specific negative emotional states of anxiety and fear. Methods: Participants were 61 nonsmoking adults with asthma (61.9% female, 54.8% African-American, M_age = 34.72, SD = 13.58) who underwent spirometry and completed self-report measures. Results: After controlling for the effects of age, race and the physical concerns domain of anxiety sensitivity, poorer global distress tolerance and tolerance for fear and anxiety each significantly predicted poorer lung function (8.7-13.8% variance), asthma control (4.9-8.8% variance) and asthma-related quality of life (6.7-8.9%). Conclusions: These findings suggest that targeting distress tolerance, specifically tolerance of fear and anxiety, may be helpful in improving asthma outcomes.

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3

The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; M_age = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African-Americans, Asian Americans, and sexual minorities.

Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder

Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.

Interplay between COMT Val158Met, childhood adversities and sex in predicting panic pathology: Findings from a general population sample

BACKGROUND

The single nucleotide polymorphism rs4680 of the catechol-O-methyltransferase (COMT) gene has been implicated to be involved in the etiopathogenesis of panic. However, it remains unresolved whether rs4680 modifies the risk-association between early life stress and subsequent development of panic pathology.

METHODS

The genotype of rs4680 was determined for n = 2242 adults with European ancestry from the Study of Health in Pomerania (SHIP, a regional longitudinal cohort study from northeastern Germany). Lifetime fearful spells, panic attacks and panic disorder were assessed according to DSM-IV in 2007-2010 (when participants were aged 29-89) using the Munich Composite International Diagnostic Interview (DIA-X/M-CIDI). Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ).

RESULTS

Logistic regressions with interaction terms (adjusted for sex and age) revealed that rs4680 interacted with total childhood adversity, emotional abuse and physical abuse in predicting panic disorder: Respective childhood adversities predicted panic disorder in carriers of the Val/Met or Met/Met genotype, but not Val/Val genotype. Moreover, a 3-way interaction was found between rs4680, emotional abuse and sex in predicting panic attacks: Emotional abuse predicted panic attacks among male carriers of the Val/Val genotype and female carriers of the Val/Met or Met/Met genotype, but not among male carriers of the Val/Met or Met/Met genotype or female carriers of the Val/Val genotype.

LIMITATIONS

Genotype data were derived by imputation. Childhood adversities and panic were assessed retrospectively.

CONCLUSIONS

Especially (female) carriers of the Val/Met or Met/Met genotype of rs4680 might profit from targeted early interventions to prevent the onset of panic after childhood adversities.

Anxiety sensitivity components in relation to alcohol and cannabis use, motives, and problems in treatment-seeking cigarette smokers

Anxiety sensitivity (AS)- fear of anxiety symptoms and their potential negative consequences-has been implicated in the development of substance use problems and motivation to use substances for coping with distress, though the AS components (physical, cognitive, and social concerns) have not been studied extensively in relation to alcohol- and cannabis-related variables. In a cross-sectional design, self-report measures of AS and alcohol and cannabis use, motives, and problems were administered to 364 treatment-seeking cigarette smokers with a history of alcohol and cannabis use. In both adjusted and unadjusted analyses, linear regression models indicated that AS cognitive concerns are related to cannabis-use conformity motives, alcohol-use coping motives, and alcohol problems; AS physical and cognitive concerns are related to greater cannabis problems specifically in males; and AS social concerns are associated with greater social, coping, enhancement, and conformity drinking motives. AS cognitive and physical concerns were also related to greater alcohol and cannabis problems, respectively, in subsamples limited to 214 current alcohol users and 170 current cannabis users. Together with prior work, current findings suggest that it may be beneficial to focus more on addressing AS cognitive concerns in individuals with tobacco-alcohol problem comorbidity, whereas it may be beneficial to focus on addressing both AS physical and cognitive concerns in males with tobacco-cannabis problem comorbidity. In addition, cigarette smokers high in AS social concerns may benefit from relaxation training to lessen their social anxiety as well as behavioral activation to enhance their positive affect.

Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: an examination among successful quitters

Anxiety sensitivity has been implicated as a potential risk factor for post-quit withdrawal symptoms. The present study examined relations between the extent of change in anxiety sensitivity and the course of nicotine withdrawal symptoms experienced during the initial two weeks of a quit attempt among treatment-seeking smokers. The sample consisted of 29 adult daily smokers (34% female; Mage = 47.7, SD = 13.1) who successfully quit and maintained their abstinence. After adjusting for the effects of gender, treatment condition, use of nicotine replacement therapy, nicotine dependence, alcohol use problems, baseline levels of anxiety sensitivity, and reductions in negative affect, greater reductions in anxiety sensitivity were related to faster decreases in withdrawal symptoms. The current data suggest that there may be merit to employ anxiety sensitivity reduction methods for the management of emergent withdrawal symptoms in smoking cessation treatment.

Positive alcohol use expectancies moderate the association between anxiety sensitivity and alcohol use across adolescence

Anxiety sensitivity (AS), or the fear of anxious symptoms and the belief that these symptoms may have negative physical, social, and cognitive consequences, is one personality trait that emerges in early adolescence and may be linked to alcohol use. However, findings are equivocal as to whether elevated AS during adolescence directly predicts alcohol use. Adolescents do report increases in positive alcohol use expectancies during this developmental period, and these expectancies have been found to be significantly associated with alcohol use. The current study examined whether positive alcohol use expectancies and AS in early adolescence predicted changes in alcohol use throughout adolescence. This aim was examined via secondary data analyses from a longitudinal study examining the development of risk behaviors in adolescents. Results of univariate latent growth curve modeling suggest that AS alone was not a significant predictor of baseline alcohol use or change in use over time after controlling for gender, age, and self-reported anxiety. However, AS in early adolescence was found to be a significant predictor of increases in alcohol use across adolescence for youth who reported greater positive alcohol use expectancies. These results indicate that beliefs regarding the positive effects of alcohol use are an important moderator in the relation between AS and change in alcohol use during adolescence.

Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, "gold standard" treatments for PTSD/SUD comorbidity are currently available. Thus, it is imperative to better understand cognitive-affective mechanisms, targetable via cognitive-behavioral intervention (i.e., malleable), that may be related to both disorders in order to improve the theory and treatment of PTSD/SUD. Anxiety sensitivity is a malleable cognitive-affective factor with relevance to both PTSD and SUD. This systematic review focused on the published literature on anxiety sensitivity and trauma/PTSD and substance use/SUD from 1966 - May 1, 2018, and includes a total of 35 manuscripts. The state of the literature, limitations, and future research directions are discussed.

Anxiety sensitivity and cannabis use problems, perceived barriers for quitting, and fear of quitting

Cannabis is among the most widely used psychoactive substances in the United States, and rates of cannabis use and cannabis-related problems are increasing. Anxiety sensitivity, or the fear of aversive interoceptive sensations, may be relevant to better understanding cannabis use problems and other significant cannabis use processes (e.g., beliefs about quitting). Previous research has primarily focused on the global anxiety sensitivity construct; however, anxiety sensitivity lower-order facets (Cognitive Concerns, Physical Concerns, and Social Concerns) tend to be differentially related to substance use processes in non-cannabis specific studies. The current study therefore explored anxiety sensitivity lower-order facets in relation to cannabis use problems, perceived barriers for cannabis cessation, and abstinence phobia (fear of not using cannabis) among a community sample of 203 cannabis-using adults. Results indicated that anxiety sensitivity Cognitive Concerns were significantly associated with each of the dependent measures and these effects were not explained by shared variance with the other lower-order factors or a range of other covariates (e.g., tobacco use). The present findings suggest future work may benefit from focusing on the role of anxiety sensitivity Cognitive Concerns in the maintenance of cannabis use.

The Contribution of Anxiety Sensitivity to Obsessive-Compulsive and Anxiety Symptoms in a Naturalistic Treatment Setting

Anxiety sensitivity, a fear of arousal-related sensations, is prevalent in a number of disorders. We examined the relationship between internalizing symptoms and the anxiety sensitivity components of physical, social, and cognitive concerns in a sample of 165 patients seeking treatment in a clinic specializing in CBT for anxiety-related disorders. Social anxiety symptoms were associated with greater social concerns. Cognitive concerns were characteristic of both depression and generalized anxiety symptoms, suggesting these two classes of symptoms may share AS symptomatology. Physical concerns were specifically related to panic symptoms. Although obsessive-compulsive symptoms were related to cognitive concerns using univariate regression, these symptoms were not strongly related to any of the anxiety sensitivity components when the correlation between disorders was taken into account. Thus, within the internalizing symptoms studied here, the anxiety sensitivity domains were most relevant to panic, social anxiety, generalized anxiety, and depressive symptoms and less related to obsessive-compulsive symptoms.

The Elicitation of Relaxation and Interoceptive Awareness Using Floatation Therapy in Individuals With High Anxiety Sensitivity

BACKGROUND

Floatation-REST (Reduced Environmental Stimulation Therapy), an intervention that attenuates exteroceptive sensory input to the nervous system, has recently been found to reduce state anxiety across a diverse clinical sample with high levels of anxiety sensitivity (AS). To further examine this anxiolytic effect, the present study investigated the affective and physiological changes induced by Floatation-REST and assessed whether individuals with high AS experienced any alterations in their awareness for interoceptive sensation while immersed in an environment lacking exteroceptive sensation.

METHODS

Using a within-subject crossover design, 31 participants with high AS were randomly assigned to undergo a 90-minute session of Floatation-REST or an exteroceptive comparison condition. Measures of self-reported affect and interoceptive awareness were collected before and after each session, and blood pressure was measured during each session.

RESULTS

Relative to the comparison condition, Floatation-REST generated a significant anxiolytic effect characterized by reductions in state anxiety and muscle tension and increases in feelings of relaxation and serenity (p < .001 for all variables). Significant blood pressure reductions were evident throughout the float session and reached the lowest point during the diastole phase (average reduction >12 mm Hg). The float environment also significantly enhanced awareness and attention for cardiorespiratory sensations.

CONCLUSIONS

Floatation-REST induced a state of relaxation and heightened interoceptive awareness in a clinical sample with high AS. The paradoxical nature of the anxiolytic effect in this sample is discussed in relation to Wolpe’s theory of reciprocal inhibition and the regulation of distress via sustained attention to present moment visceral sensations such as the breath.

Acculturative stress and mental health among economically disadvantaged Spanish-speaking Latinos in primary care: The role of anxiety sensitivity

The present study examined the role of anxiety sensitivity in the relation between acculturative stress and mood and anxiety symptoms and disorders among Latinos seeking health services at a primary healthcare facility. Participants included 142 adult Latinos (86.6% female, Mage = 39.05 years, SD = 12.46%, and 96.3% reported Spanish as their first language). Results indicated that acculturative stress was indirectly related to the number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through anxiety sensitivity. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between acculturative stress and anxiety sensitivity to better understand and inform interventions to reduce anxiety/depressive vulnerability among Latinos in primary care.