Anxiety sensitivity not distress tolerance as a predictor of generalized anxiety symptoms and worry

Amygdala-insula response to neutral stimuli and the prospective prediction of anxiety sensitivity

BACKGROUND

Anxiety sensitivity (AS) - the tendency to perceive benign physiological stimuli as harmful - is a risk factor for anxiety disorders. Cross-sectionally, AS has been linked to increased negative > neutral neural activity in key nodes implicated in threat detection and interoceptive - i.e., the amygdala (AMYG) and insula (INS). Examining the unique contributions of AMYG-INS blood‑oxygen-level-dependent (BOLD) response to neutral and negative stimuli to the prospective prediction of AS could increase understanding of the factors predisposing individuals to worsening AS over time.

METHODS

Forty-six participants, including 33 patients with mixed internalizing disorders, underwent fMRI scans to assess insula and amygdala activation in response to neutral and negative pictures. AS was measured via self-report at baseline (Time 1) and approximately 1.5 years later (Time 2). We assessed whether BOLD to negative and/or neutral pictures at baseline predicted changes in AS over time.

RESULTS

Greater insula and amygdala activation in response to neutral pictures at baseline predicted higher AS 1.5 years later, controlling for initial levels of AS and BOLD response to negative pictures. Cross-sectionally, greater insula and amygdala activation in response to negative pictures relative to neutral pictures was associated with higher Time 1 AS.

CONCLUSIONS

Heightened AMYG-INS BOLD to benign stimuli precedes and may place individuals at risk for increased AS. Once established, heightened AS appears to be characterized by a neural pattern that is more often-observed in the internalizing disorders - i.e., exaggerated response to negative (> neutral) stimuli.

Generalized Anxiety Disorder: Does the Emotion Dysregulation Model Predict Symptoms Beyond the Metacognitive Model?

While the Metacognitive Model (MCM) of generalized anxiety disorder (GAD) is well-established, the Emotion Dysregulation Model (EDM) of GAD has received less attention. This study examined whether the EDM helps explain GAD above and beyond the MCM. The influence of gender was also explored. A non-clinical university sample (N = 626) completed measures of GAD symptoms, worry severity, the MCM, and the EDM. In support of the EDM, it was found that fear of depression predicted GAD symptoms for men, while fear of anxiety predicted GAD symptoms for women. However, across genders, the strongest predictor of GAD symptoms and worry severity was negative beliefs about worry. While these findings support the MCM view that holding the beliefs that worry is harmful and dangerous is the strongest predictor of GAD overall, incorporating aspects of the EDM into our understanding and treatment of GAD may be beneficial.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10942-022-00479-7.