Anxiety sensitivity: predictor of sleep-related impairment and medication use in chronic insomnia

Associations between sleep disturbance, physical activity, and anxiety sensitivity among college students during the COVID-19 pandemic

The present study sought to examine associations between anxiety sensitivity and both sleep and physical activity among college students, who are particularly vulnerable to sleep disturbance, decreased physical activity, and the development of psychopathology, especially in the wake of the COVID-19 pandemic. Participants were 683 college students (Mage = 20.33, SD = 3.58; 72% female; 70.3% White) who completed self-report measures online for course credit. Results indicated that after controlling for the effects of age, gender identity, and race, greater sleep disturbance was significantly associated with higher overall anxiety sensitivity (7% unique variance; β = 0.27, t = 6.67, p < .001) as well as its three subdomains (physical concerns: 4% variance; β = 0.21, t = 4.97, p < .001; cognitive concerns: 6% variance; β = 0.25, t = 6.17, p < .001; social concerns: 6% variance; β = 0.26, t = 6.22, p < .001). Additionally, more time spent walking was associated with greater anxiety sensitivity physical concerns (1% variance; β = 0.11, t = 2.52, p = .012) and greater vigorous intensity physical activity was associated with lower anxiety sensitivity social concerns (1% variance; β = -0.13, t = -2.76, p = .006). These findings suggest that sleep problems may be more universally relevant to anxiety sensitivity than physical activity and interventions to promote healthier sleep may be useful for decreasing anxiety sensitivity in college students.

Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample?

Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.

Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among City Government Employees in Japan

It has recently been noted that a reduction in sleep reactivity, characterized as the trait-like degree to which exposure to stress interferes with sleep, and anxiety sensitivity are associated with reduced insomnia severity. This study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan. This cross-sectional study included 1810 city government employees of Koka City, Japan (mean age (standard deviation): 45.33 (12.20) years) who completely answered the scales for sleep reactivity, anxiety sensitivity, anxiety, and depression. Stepwise multiple regression analysis adjusted for demographic data showed that anxiety sensitivity (β = 0.39) was significantly linked to anxiety, and sleep reactivity (β = 0.36) was significantly linked to depression in individuals with insomnia. Additionally, the results of a logistic regression analysis adjusted for demographic data showed that anxiety sensitivity and sleep reactivity were relevant factors for anxious insomnia (OR = 12.69) and depressive insomnia (OR = 8.73), respectively. Whereas both sleep reactivity (OR = 14.67) and anxiety sensitivity (OR = 6.14) were associated with combined insomnia. These findings indicate that sleep reactivity is strongly associated with depressive symptoms, and anxiety sensitivity is strongly associated with anxiety symptoms in individuals with insomnia.

The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia

Introduction

Various transdiagnostic factors have been associated with insomnia severity. The current study aimed to predict insomnia severity based on a group of transdiagnostic factors including neuroticism, emotion regulation, perfectionism, psychological inflexibility, anxiety sensitivity, and repetitive negative thinking after controlling for depression/anxiety symptoms and demographic characteristics.

Methods

Two hundred patients with chronic insomnia disorder were recruited from a sleep disorder clinic. Participants completed the Insomnia Severity Index (ISI), Clinical Perfectionism Questionnaire (CPQ), Acceptance and Action Questionnaire-II (AAQ-II), Anxiety Sensitivity Index-3 (ASI-3), Repetitive Thinking Questionnaire (RTQ-10), Big Five Inventory (BFI-10), Emotion Regulation Questionnaire (ERQ), and Depression Anxiety Stress Scale (DASS-21).

Results

After controlling for the confounding variables (depression/anxiety symptoms and demographic characteristics), hierarchical multiple linear regression suggested the significant association of neuroticism (BFI), cognitive reappraisal (ERQ), personal standards (CPQ), evaluative concerns (CPQ), physical concerns (ASI), cognitive concerns (ASI), and repetitive negative thinking (RTQ) with insomnia severity.

Discussion

The findings support the role of transdiagnostic factors, especially physical concerns, repetitive negative thinking, and neuroticism in chronic insomnia. Future research using longitudinal designs is required to verify the causal status of transdiagnostic variables.

Anxiety Regarding COVID-19 Is Related to Attentional Control: The Mediating Role of Anxiety Sensitivity

Background: As an emergent public health event, COVID-19 has had a significant impact on mental health, particularly causing anxiety. Some cognitive-affective related studies have demonstrated that attentional control is related to levels of anxiety. More specifically, recent research has shown that anxiety sensitivity is uniquely associated with mental health responses to COVID-19. The aim of the current study was to investigate the role of anxiety sensitivity during COVID-19 outbreak period, especially physical and cognitive concerns, in relation to attentional control and anxiety. Methods: It is a questionnaire study. A total of 464 participants were recruited through online sampling between February and March, 2020. They were surveyed by the Attentional Control Scale (ATTC), Anxiety Sensitivity Index-3 (ASI-3) and Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using descriptive statistics and correlation analysis. We also tested the mediating effect. Results: The results showed that attentional control is negatively correlated with physical concern, cognitive concern and anxiety. And results support that physical and cognitive concerns play a mediating role between attentional control and anxiety. Conclusions: Anxiety sensitivity plays a mediating role between attentional control and anxiety. These findings can help effective prevention and intervention of anxiety.

The Role of Anxiety Sensitivity in terms of Weight-related Impairment and Fatigue Severity among Adults with Obesity and Chronic Low Back Pain

BACKGROUND

Obesity and chronic low back pain often co-occur and are associated with psychosocial and physical impairments such as weight-related impairment and fatigue. Yet, there is little understanding of psychological factors that may be associated with weight-related impairment and fatigue (a psychosocial factor) among this vulnerable population.

METHODS

Thus, the current study examined the role of anxiety sensitivity as it relates to self-reported weight-related impairment and fatigue severity among persons with obesity and chronic low back pain. Participants included a nationally representative sample of adults (N = 616) with co-occurring obesity and chronic low back pain (77.3% female, M age = 45.9 years, SD = 11.53).

RESULTS

Results revealed that anxiety sensitivity was associated with greater levels of weight-related impairment and fatigue severity after controlling for age, sex, body mass index (BMI), pain interference, and perceived general health.

CONCLUSIONS

The findings suggest that anxiety sensitivity may be a mechanistic target for better understanding and addressing weight-related impairment and fatigue severity among individuals with obesity and chronic low back pain.

Anxiety sensitivity and sleep disturbance: Investigating associations among patients with co-occurring anxiety and substance use disorders

Sleep disturbance is a common problem among individuals with anxiety and substance use disorders (SUD). Anxiety sensitivity (AS) is elevated in patients with anxiety disorders and SUD and has been linked to sleep-related problems, including insomnia and somnolence (i.e., daytime sleepiness). We examined the unique roles of AS cognitive, physical, and social concerns in sleep disturbance among a sample of 99 residential SUD patients with anxiety disorders. Clinical levels of insomnia or somnolence were evidenced by 53.5% of the sample. Consistent with predictions, AS physical concerns was significantly associated with insomnia, and AS cognitive concerns was significantly related to insomnia and somnolence. Hierarchical linear regression models were conducted to test the association of AS cognitive and physical concerns with insomnia and somnolence symptoms while controlling for relevant factors. AS cognitive concerns accounted for unique variance, above and beyond withdrawal symptoms, anxiety, and depressive symptoms, in the model examining insomnia symptoms (B=0.30, SE=0.13, p=0.023). Results suggest that AS cognitive concerns may represent an important transdiagnostic mechanism underlying sleep disturbance among individuals with dual diagnosis.

A randomized clinical trial examining the effects of an anxiety sensitivity intervention on insomnia symptoms: Replication and extension

Insomnia disorder is impairing and prevalent, particularly among individuals with comorbid anxiety disorders. Despite the availability of effective computerized treatments for insomnia, there are few that target both insomnia as well as co-occurring anxiety symptoms. The current study tests the efficacy of a computerized treatment for anxiety sensitivity cognitive concerns, a transdiagnostic risk factor for anxiety, mood, and insomnia symptoms, against a repeated contact control, on reducing insomnia symptoms. Hypotheses were tested in a mixed clinical sample of community individuals presenting for a treatment study (n = 151) who were followed up 1-, 3- and 6-months after treatment. Results indicated that the anxiety sensitivity intervention resulted in reductions in insomnia symptoms and clinically significant insomnia scores at 3- and 6-month follow-ups. These reductions remained significant when covarying for concurrent reductions in depression and anxiety. Models accounted for 15-54% of the variance in follow-up insomnia symptoms. Current findings add to a growing body of literature suggesting anxiety sensitivity may play a causal role in insomnia symptoms. Results also suggest that targeting anxiety sensitivity may be an effective way to reduce insomnia symptoms in a brief and portable intervention that also reduces symptoms commonly comorbid with insomnia disorder.

Examining the Role of Anxiety Sensitivity in Sleep Dysfunction Across Anxiety Disorders

Anxiety Sensitivity (AS) has been associated with sleep difficulties in certain anxiety disorder populations, but no studies have examined cross-diagnostically the role of anxiety sensitivity in sleep dysfunction. Three hundred one participants with generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD) completed an ancillary questionnaire-based study. Linear regression was used to examine AS and sleep dysfunction, and mediation analyses were used to examine whether AS was a mediator of the effect of primary diagnosis on sleep. AS was associated with increased sleep dysfunction across anxiety disorders, and primary anxiety disorder diagnosis was significantly associated with sleep dysfunction. However, after controlling for AS, primary diagnosis was no longer significant. AS significantly mediated the effects of PD versus SAD and of PD versus GAD on sleep dysfunction, but did not significantly mediate the effect of GAD versus SAD on sleep dysfunction. Taken together, AS appears to be a more important predictor of sleep dysfunction overall, emphasizing the cross-diagnostic nature of AS and bolstering the RDoC initiative approach for treating psychological dysfunction.

Anxiety sensitivity and racial differences in sleep duration: Results from a national survey of adults with cardiovascular disease

Although Blacks sleep between 37 and 75min less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (<7h of sleep/night), and whether anxiety sensitivity mediated race differences in sleep duration in a nationally representative sample of adults with cardiovascular disease. Overall, 1289 adults (115 Black, 1174 White) with a self-reported physician/health professional diagnosis of ≥1 myocardial infarction completed an online survey. Weighted multivariable logistic regressions and mediation analyses with bootstrapping and case resampling were conducted. Anxiety sensitivity and Black vs. White race were associated with 4%-84% increased odds, respectively, of short sleep duration. Anxiety sensitivity mediated Black-White differences in sleep duration. Each anxiety sensitivity subscale was also a significant mediator. Implications for future intervention science to address sleep disparities are discussed.

Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion

Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors-anxiety sensitivity (AS) and working memory capacity (WMC)-for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.

Sleep, Circadian Rhythms, and Anxious Traits

Anxiety is adaptive and plays an important role in keeping us safe. However, when anxiety becomes too extreme, it can cause significant disruptions and distress. Understanding the mechanisms underlying excessive anxiety and how to best treat it is a priority for researchers and clinicians. There is increasing recognition that disruptions in the amount and timing of sleep are associated with anxiety symptoms and characteristics. In the current paper, we explore the intersections between sleep, circadian rhythms, and anxiety. First, we review accumulating evidence that anxiety is associated with disruptions in sleep and circadian rhythms in both clinical and nonclinical samples and across ages. Next, we discuss the data linking sleep disruptions with anxiety-related traits (anxiety sensitivity, neuroticism, and perfectionism) and patterns of cognition and emotion. Finally, potential treatment implications are highlighted. Overall, these data suggest that delineating the role of disruptions in the amount and timing of sleep holds promise for improving the lives of individuals with heightened anxiety.

Obsessive-compulsive symptom dimensions and insomnia: The mediating role of anxiety sensitivity cognitive concerns

Existing research on the relationship between obsessive-compulsive disorder (OCD) and insomnia is scarce. Moreover, no research has examined potential mechanisms that may account for the observed relations among OCD and sleep difficulties. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of mental incapacitation, has been linked to both symptoms of OCD and insomnia and may serve as a mechanism for increasing sleep disturbance among patients with OCD. The current study examined the relationship between OCD symptoms and insomnia and the potential mediating role of AS cognitive concerns. The sample consisted of 526 individuals recruited through Amazon's Mechanical Turk (Mturk), an online crowdsourcing marketplace. Results revealed distinct associations between the unacceptable thoughts domain of OCD and symptoms of insomnia. Additionally, AS cognitive concerns mediated the relationship between these constructs. Future research should seek to replicate these findings using clinical samples and prospective designs.

Anxiety sensitivity and sleep-related problems in anxious youth

Anxiety disorders constitute the most common mental health disturbance experienced by youth. Sleep-related problems (SRPs) are highly prevalent among anxious youth and encompass a variety of problems including nighttime fears, insomnia, and refusal to sleep alone. Given that chronic sleep disturbance is associated with a range of behavioral and physical problems in youth and predicts future psychopathology, it is important to elucidate the nature of SRPs in anxious youth. The present study investigated the relationship between sleep problems and anxiety sensitivity in a sample of 101 anxious youth, ages 6-17. Heightened anxiety sensitivity significantly predicted prolonged sleep onset latency across the sample, even after accounting for severity of anxiety, depression, and age. Results support previous research indicating that SRPs are common among anxious youth and suggest that anxiety sensitivity may play a particularly important role in sleep onset latency.

Psychosocial predictors of sleep dysfunction: the role of anxiety sensitivity, dysfunctional beliefs, and neuroticism

The present study examined the relationship of anxiety sensitivity, dysfunctional beliefs about sleep and neuroticism on sleep disturbance. Previous research of these three related concepts-each describing a different kind of reactivity to interoceptive or environmental events-have served as predictors of insomnia and insomnia-related distress; however, it is not known how these concepts have distinctive prediction of sleep outcomes. We completed an Internet survey of 149 undergraduate student participants, a population with elevated risk for disturbed sleep. Participants completed a demographics questionnaire, the Anxiety Sensitivity Index (ASI), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the NEO Five-Factor Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results revealed a significant association between PSQI total score and the three variables of interest, ASI, DBAS, and neuroticism. However, in a stepwise regression, neuroticism was the statistically most important predictor of sleep disturbance. The DBAS was a statistically more important predictor than ASI total score; however, when the ASI was examined by subscale, DBAS was replaced in the model by the ASI Mental Incapacitation Concerns subscale. Our findings highlight the continued value of higher order concepts like neuroticism in the development of disorder-specific measures like the DBAS, as well as indicate that distress in response to cognitive symptoms (AS-mental incapacitation) may play a role in maintaining sleep dysfunction.

Anxiety sensitivity and sleep quality: independent and interactive predictors of posttraumatic stress disorder symptoms

A cardinal feature of posttraumatic stress disorder (PTSD) is decreased sleep quality. Anxiety sensitivity (AS) is one factor that has shown early theoretical and empirical promise in better understanding the relation between sleep quality and PTSD outcomes. The current study is the first to test the independent and interactive effects of sleep quality and AS on PTSD symptoms. Consistent with hypotheses, AS and sleep quality were found to be independent and interactive predictors of PTSD symptom severity in our sample of male military veterans seeking treatment for PTSD. Slope analyses revealed that AS was differentially related to PTSD symptom severity as a function of quality of sleep. The veterans with good sleep quality and relatively lower levels of AS had the lowest level of PTSD symptoms, whereas the veterans with poor sleep quality and low AS evidenced severity of PTSD symptoms similar to those with high AS.

Transdiagnostic processes in emotional disorders and insomnia: results from a sample of adult outpatients with anxiety and mood disorders

Conceptual similarities between recent models of insomnia and emotional disorders suggest there may be common factors that underlie or maintain these difficulties. Maladaptive cognitive and behavioral processes similar to those described in connection with emotional disorders have been cited as key mechanisms in the maintenance of primary insomnia. Unfortunately, research on this potential overlap is lacking. The present study examined the relationship among anxiety sensitivity (AS), dysfunctional beliefs, fatigue, safety behaviors, and insomnia severity in 59 outpatients with anxiety and mood disorders. Key insomnia processes (dysfunctional beliefs, fatigue, safety behaviors) were all related to insomnia severity in the comorbid sample, although AS was not. However, as hypothesized, AS did moderate the relationship of both dysfunctional beliefs and fatigue with insomnia severity. The relationships between key insomnia processes and insomnia severity was strongest among individuals high in AS. Results support the hypothesis that common mechanisms are involved for insomnia and emotional disorders. AS might function as a mechanism for the maintenance of sleep disturbance in the context of anxiety and mood disorders, suggesting a promising avenue for future research.

Association of temperament with subjective sleep patterns

BACKGROUND

Emotional and cognitive functioning have been involved in insomnia etiology, and sleep disturbances are closely related to psychiatric disorders and personality traits. This study investigates the association of temperament with subjective sleep parameters.

METHODS

In this web-survey, 5129 subjects (25.3% males) completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, anger, drive and control) and affective (e.g. cyclothymic, hyperthymic) temperaments. Subjects also answered questions regarding subjective sleep parameters, psychiatric diagnosis, psychotropic medication intake and cigarette smoking.

RESULTS

As control scores decreased, the later were the bed and the wake up time. Total sleep time was weakly associated with emotional temperaments. The higher the score of anger and the lower the score of control, the higher was the sleep-onset latency. As the anger score increased and the drive, fear and control scores decreased, the higher the number of nightly awakenings. The higher the drive and the control and the lower the anger scores, the better the sleep quality. For affective temperaments, depressives, labiles (related to ADHD) and cyclothymics (related to bipolar II disorders) go to bed and wake up later and have a worse profile regarding other sleep parameters. Hyperthymics and euthymics showed favorable sleep profiles.

LIMITATIONS

Sample included a significant number of subjects with psychiatric diseases and on psychotropic medication.

CONCLUSION

Dysregulated emotional activation (expressed as higher anger, and lower control and drive), as well as depressive, labile and cyclothymic affective temperaments were related to more dysfunctional sleep patterns.

Linking impulsivity to dysfunctional thought control and insomnia: a structural equation model

According to cognitive models of insomnia, excessive mental activity at bedtime may be viewed as an important impediment to the process of falling asleep. A further assumption of these models is that 'cognitive arousal' may be perpetuated and exacerbated by counterproductive strategies of thought management. As yet, little is known about factors that may predispose people to rely on these strategies when confronted with thoughts that keep them awake at night. This study examined the relations between impulsivity, use of different thought-control strategies and insomnia severity. A sample of 391 university students completed the UPPS Impulsive Behavior Scale, the Thought Control Questionnaire Insomnia-Revised and the Insomnia Severity Index. Correlation analyses revealed that two facets of impulsivity (urgency and lack of perseverance), two strategies of thought control (aggressive suppression and worry) and insomnia severity were positively associated. Follow-up structural equation modeling analyses showed that the two mentioned thought-control strategies mediated the effects of the two facets of impulsivity on sleep problems. These findings extend existing cognitive accounts of insomnia by suggesting how predisposing and perpetuating factors may be related: specific personality traits may incline individuals to respond with dysfunctional thought-control strategies to unwanted mental activity at night.

Incremental associations between facets of anxiety sensitivity and posttraumatic stress and panic symptoms among trauma-exposed adults

The present investigation examined incremental associations between anxiety sensitivity (AS) subfactors (e.g. physical, psychological, and social concerns) and posttraumatic stress and panic symptoms among trauma-exposed adults. These effects were examined above and beyond other theoretically relevant factors, including negative affectivity and number of types of trauma exposures. The 239 participants were selected from a university- and community-based sample (129 women; mean age = 23.0 years; SD = 9.6, range = 18-65), all of whom endorsed exposure to traumatic life events. The AS psychological concerns and AS physical concerns lower order factors evidenced distinct associations with posttraumatic stress symptoms and panic-relevant symptoms, respectively. Specifically, the AS psychological concerns facet was significantly incrementally predictive of posttraumatic stress-relevant avoidance symptoms. The AS physical concerns facet was significantly incrementally predictive of panic-relevant symptoms, including anxious arousal, body vigilance, and perceived control over anxiety-related events. Results are discussed in the context of the relevant theoretical literature pertaining to shared vulnerability and comorbidity between posttraumatic stress and panic.

Sleep disorders in Chinese patients with Parkinson's disease: validation study of a Chinese version of Parkinson's disease sleep scale

To evaluate the Chinese version of the Parkinson's disease sleep scale (PDSS) as an instrument for measuring sleep disorders in Chinese patients with Parkinson's disease (PD). The objective of the present study was to carry out a metric analysis of a Chinese version of PDSS using a cross-sectional study of 126 patients with PD who participated in the study. Usual measures for PD patients including the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA) were applied by neurologists. The intra-class correlation coefficient was 0.880, and test-retest reliability for total PDSS score was 0.914. The Mean total PDSS score was 118.38+/-26.07. There was a significant correlation between the PDSS and PSQI, between the PDSS and ESS, between the PDSS and GDS, between the PDSS and HAMA, between the PDSS and the disease durations, and between the PDSS and the LDE, respectively. The Chinese version of PDSS met some basic standards required for sleep disorders measures. It could lead to better understanding the sleep disorders of PD of China in future studies.

Understanding the Role of Injury/Illness Sensitivity and Anxiety Sensitivity in (Automatic) Pain Processing: An Examination Using the Extrinsic Affective Simon Task

Three fundamental fears are assumed to underlie psychopathology: Anxiety Sensitivity (AS), Injury/illness sensitivity (IS), and Fear of Negative Evaluation (FNE). Both AS and IS may form risk factors for the development and exacerbation of chronic pain. The current research examines the relation between these fears and automatic threat appraisal for pain-related stimuli. Study 1 (n=48) additionally examined content-specific associations of AS and FNE with the automatic threat appraisal of, respectively, panic and social evaluative cues. Study 2 (n=60) additionally focused on the association of IS and AS with the engagement in health protecting behavior, and the use of health care services. Both studies found evidence for an automatic threat appraisal of aversive stimuli. Study 2 demonstrated a positive association between the automatic threat appraisal for pain-related stimuli and individuals' IS levels. IS was found to be the single best predictor of the tendency to engage in health protecting behavior, whereas AS was the single best predictor of the reported use of health care services.

PERSPECTIVE

This study contributes to the field of knowledge on putative risk factors for chronic pain. Results demonstrate an automatic threat appraisal toward pain-related stimuli that is related to vulnerability traits for pain. This automatic threat appraisal might initiate relatively spontaneous (nonstrategic) pain-maintaining behavioral responses.

Anxiety sensitivity as a prospective predictor of alcohol use disorders

Emerging evidence suggests that elevated anxiety sensitivity (AS) is associated with substance use disorders. However, prospective evidence regarding this association is currently lacking. The primary aim of the present study was to determine whether AS is involved in the pathogenesis of substance-related psychopathology. A large, nonclinical sample of young adults (N = 404) was prospectively followed for approximately 2 years. AS (i.e., 16-item Anxiety Sensitivity Index total scores) at study entry and gender served as the primary predictor variables. Findings indicated that AS was uniquely associated with the later development of alcohol use disorder diagnoses. Data indicated that gender and AS did not act synergistically to predict alcohol use disorders. These data provide novel evidence for the unique effects of AS as a prospective risk factor in the development of alcohol-related disorders.

Symptom-focused rumination and sleep disturbance

Rumination can prolong negative mood, disrupt sleep, and increase depression risk. Although there is evidence that poor sleepers ruminate, no studies have identified the ruminative content relevant for sleep disturbance. This study investigated (a) the association between rumination and sleep and (b) the ruminative content of poor sleepers. Results revealed that self-defined poor sleepers (n = 104) were more prone than self-defined good sleepers (n = 139) to ruminate and that the ruminative content was symptom focused (e.g., poor sleepers ruminated on causes of dysphoria, concentration, and fatigue symptoms). As dysphoria, reduced concentration, and fatigue are all commonly experienced daytime symptoms of insomnia, this preliminary finding of symptom-focused rumination should be further evaluated as a risk factor for further sleep disturbance in clinical samples as well as a possible link between insomnia and depression.

From psychophysiological insomnia to organic sleep disturbances: a continuum in late onset insomnia - with special concerns relating to its treatment

The population suffering from insomnia in old age onset (LOI) is quite large. LOI might include a larger scale of syndromes ranging from typical psychophysiological insomnia to night delirium. The correlation between the biological, biochemical changes and the quantitative as well as the qualitative alterations of the sleep process through aging has not been fully explored. One can suppose that any cerebral lesion leading to a dysfunction in mental performance can also act on the sleep. The majority of LOI brain metabolic disturbances might therefore have some etiological role. The authors suggest the application of this concept in the clinical evaluation of LOI. The authors constructed a heuristic model for the pathophysiology and treatment of LOI. It is a bipolar axis containing the most typical symptoms of LOI. On the opposite margins psychophysiological insomnia and organic/metabolic insomnia (up to delirious states) are settled. The position on the axis (i.e., its distance from the "edge syndromes") gives information on the probability of its organic nature. Based on their clinical experiences and considering the data of the very few studies, they suppose that with the help of a detailed analysis of the symptoms of LOI and using some additional (electrophysiological and neuroimaging) laboratory methods most patients with LOI can get a strict diagnostic position on the LOI axis. Using the LOI axis not only a detailed evaluation of the symptomatology but also more sophisticated therapeutic interventions become possible. Symptoms on the "metabolic side" can be cured by a single evening application of any drugs improving the function of the brain (like nootropics, neuroprotective agents or even slight stimulants, e.g., caffeine) might show a "paradoxical hypnotic" effect, or in combination with sleeping pills they can cause an additive effect in LOI patients. The efficacy of this treatment can also have a diagnostic value: i.e., it helps to differentiate between the primary (organic) and psychophysiological (exogenous or emotional/psychic) forms of LOI.

Associations between chemical odor intolerance and sleep disturbances in community-living adults

OBJECTIVE

To investigate associations between sleep disturbances and chemical odor intolerance (COI), which is the subjective report of feeling ill from common odors, such as carpet glue or pesticides.

METHODS

This cross-sectional study consisted of government employees and their family members (n=140; 61% women, mean age=46.3 years) derived from a stratified cluster population living in Pima County, Tucson, AZ. Subjects completed a standard survey that included sleep symptoms, a validated measure of COI, and two questions regarding anxiety and depression. Odds ratios (OR) with 95% confidence intervals (CI) were computed to test the association between COI and sleep symptoms. Stratification according to the Mantel-Haenszel method and logistic regression models were used to test for confounding and/or effect modification.

RESULTS

After adjusting for age and gender, subjects with COI were significantly more likely to report difficulty staying asleep (OR=3.06; CI=1.17-8.03), insufficient sleep (OR=3.93; CI=1.43-10.79), and nightmares (OR=3.17; CI=1.14-8.81) compared to persons without COI. Associations between COI, sleep maintenance problems and insufficient sleep were still significant after adjusting for gender and depression; however, the association between COI and nightmares became borderline.

CONCLUSIONS

Compared to the non-COI, persons with COI are more likely to report sleep maintenance insomnia and insufficient sleep independent of self-reported depression. Nightmares appear to be related more to depression than to COI.