Anxiety sensitivity: prospective prediction of anxiety among early adolescents

Moderators of the Link Between Social Preference and Persistent Peer Victimization for Elementary School Children

OBJECTIVE

Current antibullying programs can reduce overall rates of victimization but appear to overlook processes that give rise to persistent peer victimization. Needed are studies that delineate the interplay between social contextual and individual difference variables that contribute to persistent peer victimization. We examined the extent to which two individual-difference variables - internalizing symptoms (IS) and anxiety sensitivity (AS) - moderated the link between children's average social preference score across the school year and their status as persistent victims.

METHOD

Participants included 659 4th-grade students (Mage = 9.31 years, SD = 0.50, 51.8% girls; 42.3% Latinx, 28.9% non-Hispanic White, 10.2% Pacific Islander, 7.7% Bi/Multiracial, 1.9% Black, 1.7% Asian, 1.7% Native American, and 3.4% unreported) from 10 public elementary schools in the U.S.

RESULTS

As expected, higher social preference scores predicted a decreased likelihood of being persistently victimized. Conversely, IS and AS were positively linked to persistent victim status. AS significantly moderated the link between social preference and persistent victim status such that for children with high AS, compared to those with AS scores at or below the mean, the negative association between social preference and persistent victim status was attenuated.

CONCLUSIONS

Findings provide evidence that children who experience high levels of IS and AS are at risk for being persistently victimized by peers and that high AS could signal increased risk for persistent victimization even when children are generally liked by peers. We discuss the implications of these findings for efforts to develop focused interventions for chronically bullied children.

Learning to embrace one's stress: the selective effects of short videos on youth's stress mindsets

BACKGROUND AND OBJECTIVES

Stress is not inherently negative. As youth will inevitably experience stress when facing the various challenges of adolescence, they can benefit from developing a stress-can-be-enhancing mindset rather than learning to fear their stress responses and avoid taking on challenges. We aimed to verify whether a rapid intervention improved stress mindsets and diminished perceived stress and anxiety sensitivity in adolescents.

DESIGN AND METHODS

An online experimental design randomly exposed 233 Canadian youths aged 14-17 (83% female) to four videos of the Stress N' Go intervention (how to embrace stress) or to control condition videos (brain facts). Validated questionnaires assessing stress mindsets, perceived stress, and anxiety sensitivity were administered pre- and post-intervention, followed by open-ended questions.

RESULTS

The intervention content successfully instilled a stress-can-be-enhancing mindset compared to the control condition. Although Bayes factor analyses showed no main differences in perceived stress or anxiety sensitivity between conditions, a thematic analysis revealed that the intervention helped participants to live better with their stress.

CONCLUSIONS

Overall, these results suggest that our intervention can rapidly modify stress mindsets in youth. Future studies are needed to determine whether modifying stress mindsets is sufficient to alter anxiety sensitivity in certain adolescents and contexts.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Cognitive Behavioral Therapy for Children and Adolescents with Anxiety Disorders

Anxiety disorders are the most common class of psychiatric conditions among children and adolescents. The cognitive behavioral model of childhood anxiety has a strong theoretic and empirical foundation that provides the basis for effective treatment. Cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is the gold standard treatment for childhood anxiety disorders, with strong empirical support. A case vignette demonstrating CBT for childhood anxiety disorders in practice, as well as recommendations for clinicians, are also provided.

Risk Factors Associated With Increased Anxiety Sensitivity in Children and Adolescents in Northwest China During COVID-19 Pandemic Lockdown

Purpose

A large body of evidence has revealed that the sudden outbreak of public health emergencies induces dramatic effects on the mental health of the general public. We aimed to investigate the level of anxiety sensitivity and its risk factors in children and adolescents from northwest China during the COVID-19 pandemic lockdown in early 2020.

Methods

A cross-sectional survey was conducted through the Wenjuanxing platform using a convenience sampling method between 18 and 26 February 2020. The self-designed questionnaire contained sociodemographic characteristics, factors associated with the COVID-19 pandemic, and the Childhood Anxiety Sensitivity Index (CASI) scale. The data from 1,091 valid questionnaires from students aged 9–17 years were analyzed using ANOVA, multiple linear regression, and binary logistic regression.

Results

The average CASI scores were 11.47 ± 6.631, and 642 students (58.9%) had prominent anxiety sensitivity. Gender, education level, family members participating in anti-COVID-19 work, getting ill and needing medical help during the lockdown, feeling afraid or having heart palpitations on hearing things associated with COVID-19, believing that COVID-19 would have adverse impacts on themselves or their family in the future, and fear of infection were identified as significant factors for elevated levels of anxiety sensitivity (p < 0.05). We established a multiple linear regression model for the anxiety sensitivity score. Risk factors found for anxiety sensitivity in children and adolescents during the COVID-19 lockdown included studying in secondary or high school, becoming ill during the pandemic, feeling afraid or experiencing rapid heartbeat or palpitations on hearing about the COVID-19 pandemic, thinking that COVID-19 would have an adverse impact on themselves or their family in the future, and fear of infection.

Conclusions

During the COVID-19 pandemic and home quarantine, scores measuring the prevalence of anxiety sensitivity in children and adolescents from northwest China were elevated. We should develop measures that especially target possible risk factors to intervene against and prevent anxiety sensitivity in children and adolescents in both the current and future pandemics.

Distress tolerance and posttraumatic stress disorder: a systematic review and meta-analysis

The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants (M_age = 29.96, SD = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.

Reciprocal longitudinal associations between anxiety sensitivity and alcohol consumption/problems across adolescence: Examining anxiety as a mediator and race/ethnicity as a moderator

The conditions and populations for which anxiety sensitivity (AS; i.e., the tendency to interpret unpleasant physiological sensations as dangerous) relates to adolescent alcohol use is unclear. This study tested latent-variable cross-lagged panel modeling of AS-alcohol relations in a racially/ethnically heterogenous longitudinal youth cohort (N = 3396; 53.4% female, 45.8% Latinx) assessed annually across high school. Anxiety and race/ethnicity were tested as mediators and moderators, respectively, of AS-alcohol associations. AS prospectively predicted alcohol problems (β's = 0.05-0.07) but not alcohol consumption (β's = 0.02-0.04) across high school. Alcohol problems predicted AS at the end (β = 0.09) but not beginning (β's = 0.01-0.03) of high school and alcohol consumption predicted lower AS at the beginning (β = -0.06) but not end (β's = -0.02-0.01) of high school. Anxiety mediated AS's predictive effects on alcohol problems (βindirect's = 0.01, 95% CI [0.003, 0.03]) across high school. Race/ethnicity did not moderate interrelations of AS, anxiety, and alcohol outcomes. These findings lend support to the risk factor model of AS on alcohol problems (but not consumption) through anxiety and the scar/complication model whereby alcohol problems may exacerbate AS later in adolescence. Addressing reciprocal risk processes between AS, anxiety, and alcohol problems warrant consideration in adolescent behavioral health promotion for various racial/ethnic populations.

Psychometric properties of the Anxiety Sensitivity Index-3 in adults with substance use disorders

Anxiety sensitivity, or the fear of anxiety-related sensations, has demonstrated relevance to a broad range of psychiatric conditions, including substance use disorders (SUDs). Anxiety sensitivity is typically measured through self-report instruments, most commonly the Anxiety Sensitivity Index-3 (ASI-3). Despite the widespread use of the ASI-3 in studies of SUDs, little is known about its psychometric properties within this population. Patients on an inpatient detoxification unit seeking treatment for SUDs (N = 1248) completed a battery of self-report measures, including the ASI-3. Psychometric properties of the ASI-3 were examined. An exploratory factor analysis with half of the sample (n = 624) supported a 3-factor structure corresponding to the ASI-3 subscales (Social Concerns, Cognitive Concerns, Physical Concerns). Confirmatory factor analysis was used to validate this 3-dimensional structure in a separate subsample (n = 624), resulting in adequate fit when testing a second-order hierarchical model. Internal consistency and convergent and discriminant validity results also supported the use of the ASI-3 in people with SUDs. Despite its widespread use in SUD research, this is the first psychometric investigation of the ASI-3 among individuals seeking treatment for SUDs.

Relationship of affect intolerance with anxiety, depressive, and obsessive-compulsive symptoms in youth

BACKGROUND

Structural research on the construct of affect intolerance (an overarching latent construct indicated by distress tolerance and anxiety sensitivity) has only been conducted in adults. Given that a self-report measure of distress tolerance was recently validated for youth and affect intolerance may be a core mechanism of transdiagnostic interventions for internalizing disorders, we examined how affect intolerance relates to internalizing symptoms in youth. We predicted that a latent affect intolerance factor (indicated by distress tolerance and anxiety sensitivity) would be associated with self and parent-reports of youth anxiety, depressive, and obsessive-compulsive symptoms, controlling for age and gender.

METHODS

At a pre-treatment evaluation, youth with a primary depressive, anxiety, or obsessive-compulsive spectrum disorder (N=277) aged 8-17, and their parent, completed questionnaires.

RESULTS

Greater levels of the affect intolerance factor predicted greater youth- and parent-reported youth anxiety, depression, and obsessive-compulsive symptoms, controlling for age.

LIMITATIONS

Future research should replicate findings in a sample with a greater proportion of depressed youth and utilize experimental or longitudinal methods.

CONCLUSIONS

Importantly, distress tolerance and anxiety sensitivity are core transdiagnostic processes that can be targeted in cognitive-behavioral interventions. Future research should examine how transdiagnostic interventions for youth with internalizing disorders can target these cross-cutting emotional vulnerabilities.

Genetic variation in neuropeptide Y interacts with childhood trauma to influence anxiety sensitivity

BACKGROUND AND OBJECTIVES

Anxiety sensitivity (AS) refers to a fear of the negative implications of anxiety, and arises due to gene-environment interactions. We investigated whether genetic variation in two neuropeptides implicated in the stress response, neuropeptide Y (NPY) and pituitary adenylate cyclase-activating polypeptide receptor 1, interacted with childhood trauma (CT) to influence AS.

DESIGN AND METHODS

This cross-sectional study examined the CT x genetic variant effects on AS in 951 adolescents who self-identified as Xhosa or South African Colored (SAC) ethnicity.

RESULTS

In Xhosa females, the NPY rs5573 A allele and rs3037354 deletion variant were associated with increased (p = 0.035) and decreased (p = 0.034) AS, respectively. The interaction of CT and the NPY rs5574 A allele increased AS in SAC female participants (p = 0.043). The rs3037354 deletion variant protected against AS with increased CT in SAC male participants (p = 0.011).

CONCLUSIONS

The NPY rs5574 A allele and rs3037354 deletion variant interact with CT to act as risk and protective factors, respectively, for AS in an ethnicity- and sex- differentiated manner. Our results reaffirm the role of NPY and gene-environment interactions in anxiety-related behaviors and reinforce the need for psychiatric genetics studies in diverse populations.

Emotion regulation abilities as a predictor of anxiety, positive emotions, heart rate, and alpha asymmetry during an impromptu speech task

BACKGROUND AND OBJECTIVES

Recent approaches suggest that emotion regulation (ER) abilities represent potential predictors of emotional response among youths navigating stressful situations. To test this, we investigated whether ER abilities predicted the subjective and physiological emotional response experienced by youths during a stressful situation.

DESIGN

A cross-sectional design was employed.

METHOD

One hundred and thirty-four youths completed measures of ER abilities (emotional awareness, anxiety sensitivity, emotional control) and were asked to deliver a speech while their anxiety, positive emotions, heart rate, and alpha asymmetry were collected at four time points: baseline, anticipation, speech, and post-recovery.

RESULTS

Pearson r correlations showed that poor emotional control and awareness, as well as high anxiety sensitivity were related to greater anxiety and lower positive emotions experienced during the speech. Hierarchical multiple regressions also revealed that emotional control and emotional awareness predicted greater speech anxiety and lower positive emotions. Moreover, anxiety sensitivity was related to and predicted an increased heart rate experienced during speech.

CONCLUSIONS

Findings suggest that difficulties in emotional awareness, anxiety sensitivity, and emotional control predict the emotional response experienced by youths during a stressful situation. Interventions delivered by clinicians/teachers that target ER difficulties may be effective in improving emotional functioning when navigating stressful situations.

Internalized psychopathology dimensions in middle childhood: Cross-sectional and temporal associations

BACKGROUND

Anxiety, depression, and obsessive-compulsive symptoms often onset during middle childhood and are major causes of disability in young individuals. A better understanding of how these symptoms are linked and unfold over time is important to develop valid etiological models and effective prevention and treatment.

METHODS

In the present study, 950 community children (8-14 years) reported on a broad range of internalised symptoms at three time points over the course of a year. First, factor analysis was used to examine the overarching dimensions of these symptoms. Second, network analysis was used to examine unique cross-sectional associations among these empirically supported symptom dimensions. Last, longitudinal structural equation models (SEMs) were used to examine temporal associations among the symptom dimensions.

RESULTS

Six broad symptom dimensions fitted the self-report data well at all time points. These dimensions were conceptualized as depression, general anxiety, situational fears, compulsivity, intrusive thoughts, and somatic anxiety. Network analysis showed that these dimensions formed a highly interconnected network with general anxiety and somatic anxiety being most central (i.e., most strongly associated with other dimensions) at all time points. Longitudinal SEMs supported the central role played by general anxiety in the temporal associations among these dimensions.

CONCLUSIONS

Overarching expressions of internalized psychopathology are highly interconnected in middle childhood with possible central roles played by general and somatic anxiety. Interventions aimed at a general proneness for anxiety may be warranted in preventing and treating internalizing symptoms in middle childhood.

The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model

The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study

BACKGROUND

Anxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive-compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive-compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.

METHODS

Adolescent twins and siblings (N = 1,579) from the G1219 study completed self-report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross-lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations.

RESULTS

Anxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by nonshared environmental influences.

CONCLUSIONS

Our findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by nonshared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa.

Cognitive Vulnerability in the Context of Panic: Assessment of Panic-Related Associations and Interpretations in Individuals with Varying Levels of Anxiety Sensitivity

Background

Cognitive models of panic disorder (PD) highlight the role of panic-related associations and interpretations. However, results are mixed and rely on specific measures. This study examined panic-related associations and interpretations using established and new paradigms in individuals varying on anxiety sensitivity (AS).

Methods

Associations were measured using a priming task and a novel Single Target Implicit Association Test (STIAT); interpretations were assessed using the Interpretation Bias Questionnaire (IBQ) and a novel Scrambled Sentences Task (SST). Symptoms were assessed via a provocation task (Straw Breathing Task, SBT).

Results

Panic-related interpretations correlated with AS and other PD-related measures. Of the association tasks, only the priming task correlated with one of the other PD-related measures. Panic-related interpretations assessed via the SST, but not priming, STIAT, and IBQ, predicted SBT reactivity. The relationship between AS and SBT reactivity was mediated by panic-related interpretations.

Conclusions

Our data provide support for panic-related interpretations as an important cognitive mechanism.

Anxiety Sensitivity and Children's Risk for Both Internalizing Problems and Peer Victimization Experiences

In this study, we examined the degree to which children's level of anxiety sensitivity (AS) was a precursor to both internalizing problems and peer victimization experiences. Participants were 581 fourth-grade children (M age = 9.31; 51.8% girls; 42.3% Hispanic/Latinx) and their teachers. Measures of AS, internalizing problems, and peer victimization were collected across a single academic year (Fall, Spring). Structural equation modeling and logistic regression analyses indicated AS predicted future internalizing symptoms as well as self- and teacher-reports of peer victimization. Also, children with heightened AS were 2.70 times more likely to reach elevated levels of self-rated peer victimization and 11.53 times more likely to have clinically elevated internalizing problems. This is the first study to examine prospectively the link between AS and children's peer victimization experiences. We discuss implications of the findings for developing preventative interventions for children at risk for peer victimization and internalizing difficulties.

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.

Examining the Hierarchical Influences of the Big-Five Dimensions and Anxiety Sensitivity on Anxiety Symptoms in Children

Anxiety sensitivity (AS), namely the fear of anxiety symptoms, has been described as a precursor of sub-threshold anxiety levels. Sexton et al. (2003) posited that increased AS would arise from an elevated neuroticism and that both would act as vulnerability factors for panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) symptoms. Accordingly, this study aimed to (1) evaluate the applicability of this model to a pediatric population and (2) examine the influences of the other Big-Five personality dimensions on the four lower-order dimensions of AS (cognitive, physical, control, and physical) and on social phobia (SP), separation anxiety disorder (SAD) and depression symptoms. 200 children (104 girls) aged between 8 and 12 years old (mean age = 132.52 months, SD = 14.5) completed the Childhood Anxiety Sensitivity Index (Silverman et al., 1991), the Big Five Questionnaire for Children (Barbaranelli et al., 2003), and the Revised’s Children Anxiety and Depression Scale (Chorpita et al., 2000). Regression analyses confirmed that AS and neuroticism together significantly predicted the presence of PD, OCD, and GAD symptoms but also SP, SAD, and depression symptoms. Moreover, neuroticism interacted with extraversion, conscientiousness and agreeableness to significantly predict SP, GAD, and depression. Surprisingly, the global AS score was only predicted by agreeableness, while AS dimensions also specifically related to openness. Finally, AS dimensions did not predict the presence of specific anxiety symptoms. To conclude, the predicting model of anxiety symptoms in children sets neuroticism and AS on the same level, with an unexpected influence of agreeableness on AS, raising the importance of other trait-like factors in the definition of such models. Moreover, AS should be considered as a unitary construct when predicting the presence of anxiety symptoms in children. Future interventions must consider these associations to help children detect and recognize the symptoms of their anxiety and help them to interpret them correctly.

Differential Associations of Distress Tolerance and Anxiety Sensitivity With Adolescent Internalizing Psychopathology

Distress tolerance and anxiety sensitivity may differentiate among internalizing disorders, though few studies have examined differential associations of distress tolerance and anxiety sensitivity with depression and anxiety symptoms while adjusting for their intercorrelation. In an adolescent genetic epidemiological sample (ages 15-21), the present study (N = 848, 56.97% female) examined concurrent associations of distress tolerance and anxiety sensitivity with internalizing psychopathology (i.e., symptoms of depression, anxiety, and general stress) at baseline and prospective, predictive associations of baseline distress tolerance and anxiety sensitivity with internalizing psychopathology at 2-year follow-up. In addition, the present study assessed distress tolerance with two laboratory-based tasks, a carbon dioxide challenge and the mirror-tracing task, to distinguish between tolerance of physiological and cognitive distress, respectively. Elevated anxiety sensitivity was broadly associated with elevated symptoms of internalizing psychopathology at baseline and prospectively predicted elevated depression, anxiety, and stress symptoms at 2-year follow-up. Higher tolerance of cognitive distress was associated with lower concurrent anxiety symptoms but not with anxiety symptoms at follow-up. The present results clarify previously mixed findings; during adolescence, anxiety sensitivity showed broad concurrent and prospective associations with internalizing disorder risk whereas distress tolerance, specifically regarding cognitive distress, was associated with only elevated concurrent anxiety symptoms.

The effectiveness of stress-management-based cognitive-behavioral treatments on anxiety sensitivity, positive and negative affect and hope

Background and objective: Anxiety sensitivity, positive and negative affection and hope are the important factors in promoting mental health of students. The purpose of this study was to investigate the effectiveness of stress-management-based cognitive-behavioral treatments on anxiety sensitivity, hope, positive and negative affect in female students of Medical Sciences.

Materials and methods: This research was a trail study with pre-test, post-test and control group. A sample of 30 subjects, were selected by available sampling and were randomly assigned using Block Randomization Method of two groups (experimental and control groups). Schneider’s hope questionnaire, Watson’s positive and negative affect questionnaire, Clarke and Tolgman’s questionnaire, Reiss et al.’s anxiety sensitivity of the revised index questionnaire, were completed in two stages (pre-test and post-test) by all subjects. A 6-session protocol of cognitive-behavioral group treatment was performed only on the experimental group. The data were analyzed using ANOVA and MANOVA analysis of variance.

Results: Two experimental and control groups with the mean 22, standard deviationl. 13, average age is 22 years. Stress-management-based cognitive-behavioral treatments were effective on the level of anxiety sensitivity and hope (p <0.016), however, it had no significant positive effect on the amount of positive and negative affect (p <0.016).

Conclusion: According to the results, it can be concluded that cognitive-behavioral treatments are effective on anxiety sensitivity and hope. Therefore, stress-management-based cognitive-behavioral training can reduce students’ anxiety sensitivity and increase their hopes for coping with challenges.

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.

Nonmedical benzodiazepine use in adults with alcohol use disorder: The role of anxiety sensitivity and polysubstance use

BACKGROUND AND OBJECTIVES

The nonmedical use of benzodiazepines-defined as use without a prescription or at a dose or frequency higher than prescribed-is increasing among adults in substance use disorder treatment and is associated with risk for overdose. The aim of the current study was to characterize the prevalence of nonmedical benzodiazepine use among adults seeking treatment for alcohol use disorder and to examine whether nonmedical benzodiazepine use was associated with: (1) polysubstance use and (2) greater anxiety sensitivity.

METHODS

A sample of 461 treatment-seeking adults with alcohol use disorder who were recruited for a cross-sectional study were included in this analysis.

RESULTS

A total of 89 participants (19%) reported nonmedical benzodiazepine use in the previous 30 days. Results of a logistic regression indicated that polysubstance use (number of substances used in the past month) was associated with nonmedical benzodiazepine use. The association between anxiety sensitivity and nonmedical benzodiazepine misuse was moderated by gender; anxiety sensitivity was associated with benzodiazepine use among women, but not men.

DISCUSSION AND CONCLUSIONS

These results replicate findings from research on opioid use disorder suggesting that anxiety sensitivity is associated with nonmedical benzodiazepine use in women and not men.

SCIENTIFIC SIGNIFICANCE

Targeted intervention to those with polysubstance use-including education on overdose risk when benzodiazepines are combined with other substances-is indicated in men and women with alcohol use disorder. Anxiety sensitivity may be a potential therapeutic target to reduce nonmedical benzodiazepine use among women with alcohol use disorder. (Am J Addict 2018;27:485-490).

Predictors and consequences of health anxiety symptoms: a novel twin modeling study

OBJECTIVE

The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population.

METHOD

Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates.

RESULTS

Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001).

CONCLUSION

Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.

No gene-by-environment interaction of BDNF Val66Met polymorphism and childhood maltreatment on anxiety sensitivity in a mixed race adolescent sample

Background: Anxiety disorders in youth are attributable to multiple causal mechanisms, comprising biological vulnerabilities, such as genetics and temperament, and unfavourable environmental influences, such as childhood maltreatment (CM). Objective: A gene-environment (G x E) interaction study was conducted to determine the interactive effect of the BDNF Val66Met polymorphism and CM to increase susceptibility to anxiety sensitivity (AS) in a sample of mixed race adolescents. Method: Participants (n = 308, mean age = 15.8 years) who were all secondary school students and who completed measures for AS and CM were genotyped for the BDNF Val66Met polymorphism. Hierarchical multiple regression analysis was conducted to assess G x E influences on AS. Age and gender were included in the models as covariates as age was significantly associated with AS total score (p < .05), and females had significantly higher AS scores than males (p < .05). Results: A main effect of CM on AS was evident (p < .05), however, no main effect of BDNF genotype on AS was observed (p > .05). A non-significant G x E effect on AS was revealed (p < .05). Conclusions: Our results suggest that CM does not have a moderating role in the relationship between the BDNF Val66Met genotype and the increased risk of anxiety-related phenotypes, such as AS. Given the exploratory nature of this study, findings require replication in larger samples and adjustment for population stratification to further explore the role of BDNF Val66Met and CM on AS in mixed race adolescents.

The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis

BACKGROUND

Anxiety and depression are among the most common mental disorders during childhood and adolescence. Among the instruments for the brief screening assessment of symptoms of anxiety and depression, the Revised Child Anxiety and Depression Scale (RCADS) is one of the more widely used. Previous studies have demonstrated the reliability of the RCADS for different assessment settings and different versions. The aims of this study were to examine the mean reliability of the RCADS and the influence of the moderators on the RCADS reliability.

METHODS

We searched in EBSCO, PsycINFO, Google Scholar, Web of Science, and NCBI databases and other articles manually from lists of references of extracted articles.

RESULTS

A total of 146 studies were included in our meta-analysis. The RCADS showed robust internal consistency reliability in different assessment settings, countries, and languages. We only found that reliability of the RCADS was significantly moderated by the version of RCADS. However, these differences in reliability between different versions of the RCADS were slight and can be due to the number of items.

LIMITATIONS

We did not examine factor structure, factorial invariance across gender, age, or country, and test-retest reliability of the RCADS.

CONCLUSIONS

The RCADS is a reliable instrument for cross-cultural use, with the advantage of providing more information with a low number of items in the assessment of both anxiety and depression symptoms in children and adolescents.

New Evidence on the Construct Validity of the ASI-3 and the Dimensional Conceptualization of Trait Anxiety Sensitivity From IRT Modeling

Abstract. Anxiety Sensitivity (AS) denotes the tendency to fear anxiety-related sensations. Trait AS is an established risk factor for anxiety pathology. The Anxiety Sensitivity Index-3 (ASI-3) is a widely used measure of AS and its three most robust dimensions with well-established construct validity. At present, the dimensional conceptualization of AS, and thus, the construct validity of the ASI-3 is challenged. A latent class structure with two distinct and qualitatively different forms, an adaptive form (normative AS) and a maladaptive form (AS taxon, predisposing for anxiety pathology) was postulated. Item Response Theory (IRT) models were applied to item-level data of the ASI-3 in an attempt to replicate previous findings in a large nonclinical sample (N = 2,603) and to examine possible interpretations for the latent discontinuity observed. Two latent classes with a pattern of distinct responses to ASI-3 items were found. However, classes were indicative of participant’s differential use of the response scale (midpoint and extreme response style) rather than differing in AS content (adaptive and maladaptive AS forms). A dimensional structure of AS and the construct validity of the ASI-3 was supported.

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.

Anxiety sensitivity and nonmedical benzodiazepine use among adults with opioid use disorder

Nonmedical benzodiazepine use is common among adults with opioid use disorder; however, little is known about this co-occurrence. Anxiety sensitivity-the fear of anxiety symptoms and sensations-motivates behaviors to escape and avoid distressing states, and accordingly is associated with coping motives for substance use. This might be particularly relevant among women, who report using substances to cope with negative emotions more often than men. The aim of the current study was to examine whether nonmedical benzodiazepine use was associated with higher anxiety sensitivity among treatment-seeking adults diagnosed with opioid use disorder, and to investigate whether gender moderated this association. A sample of adults (ranging in age from 18 to 81years) receiving inpatient treatment for opioid use disorder (N=257) completed measures of anxiety, anxiety sensitivity, and benzodiazepine use frequency. Results of an analysis of variance indicated that frequency of past-month nonmedical benzodiazepine use was associated with significantly higher anxiety sensitivity. This effect remained when controlling for the effect of anxiety symptoms (F[1, 251]=3.91, p=0.049, η_p²=0.02). Gender moderated this association, and post-hoc analyses found a strong association between nonmedical benzodiazepine use and anxiety sensitivity in women, and not men. Anxiety sensitivity, which can be reduced with treatment, might be a candidate therapeutic target in this population, particularly in women.

The role of parental anxiety sensitivity and learning experiences in children's anxiety sensitivity

This study evaluated the impact of the mother's and father's anxiety sensitivity (AS) and learning experiences on children's AS, and the influence of two moderators: the children's femininity orientation and the children's emotional intelligence (EI). The sample comprised 200 non-clinical children, aged 9-13 years, and their parents (mothers and fathers). Results revealed that the effect of parental AS on children's AS is moderated by the children's EI for maternal AS and by their femininity traits for paternal AS. Learning experiences following somatic sensations influenced the children's level of AS. More specifically, special attention by parents following a child's somatic sensations (reinforcement and transmission of information) was associated with high AS in children. Parental reactions of fear following a parent's somatic sensations (modelling) seem to predict higher scores for AS when the link is moderated by the child's femininity orientation. The implications of these findings are discussed. Statement of contribution What is already known on this subject The influence of parental factors in child's AS has been demonstrate, but these studies are limited. Specific mechanisms might condition the relationship between child's AS and parental factors. What does this study add? Learning experiences and parental AS influence the child's level of AS. It is important to consider the influence of mothers and fathers in child's AS. Child's emotional intelligence and expressive traits may moderate the effect of parental factors.

Serotonin transporter variants play a role in anxiety sensitivity in South African adolescents

OBJECTIVES

Anxiety sensitivity (AS) has predictive potential for the development of anxiety disorders. We investigated the role that gene-environment (G × E) interactions, focussing on childhood trauma (CT) and selected SLC6A4 variants, play in modulating levels of AS in a South African adolescent population.

METHODS

All adolescents (n = 951) completed measures for AS and CT. Six SLC6A4 polymorphisms were genotyped. G × E influences on AS levels were assessed using multiple linear regression models. Relevant confounders were included in all analyses.

RESULTS

Xhosa (n = 634) and Coloured (n = 317) participants were analysed independently of one another. The 5-HTTLPR-rs25531 L-G haplotype associated with reduced AS among Xhosa adolescents (P = 0.010). In addition, the rs1042173 CC-genotype protected against increased levels of AS in Xhosa participants who had experienced increased levels of CT (P = 0.038). Coloured males homozygous for the S-allele had significantly increased levels of AS compared to Coloured males with at least one L-allele (P = 0.016).

CONCLUSIONS

This is the first study to be conducted on AS in adolescents from two ethnically diverse populations. Results indicate that the L-G haplotype confers protection against high AS levels in a Xhosa population. Furthermore, increased CT was found to protect against high levels of AS in Xhosa rs1042173 CC-carriers.

Anxiety sensitivity is associated with attentional bias for pain-related information in healthy children and adolescents

This investigation explored the association between anxiety sensitivity and attentional bias for threatening information in children and adolescents ( N = 40). Participants completed a pictorial version of the visual-probe task, featuring pain-related, health-threat and general-threat images presented for 500 and 1250 ms. Regression analyses revealed significant associations between anxiety sensitivity and attentional bias towards pain-related images presented for 500 ms and between state anxiety and attentional bias towards general-threat images presented for 1250 ms. These results suggest that in children and adolescents, anxiety sensitivity is associated with attentional bias for negative information of personal relevance.

The Psychometric Properties of the Cognitive Fusion Questionnaire in Adolescents

Abstract. Cognitive fusion can be defined as the inability to view thoughts as just thoughts, which is hypothesized to increase the impact of those thoughts on behavior. Cognitive fusion is a core concept of Acceptance and Commitment Therapy, a therapeutic approach that is being increasingly studied as a treatment for a plethora of chronic health problems. The objective of this study was to evaluate the psychometric properties of the Cognitive Fusion Questionnaire (CFQ) in a sample of adolescents. Three hundred eight adolescents (11–20 years) completed the Catalan version of the questionnaire (CFQ-C) as well as measures assessing anxiety sensitivity and acceptance. The results supported a one-factor solution for the CFQ-C, and indicated an adequate level of internal consistency (Cronbach’s α = 0.79). The validity of the CFQ-C was supported by a significant positive association between the CFQ-C total score and the measure of anxiety sensitivity and by a significant negative association with the measure of acceptance. The findings support the psychometric properties of the CFQ to study the role that cognitive fusion may play in functioning among adolescents.

Fear of the unknown: One fear to rule them all?

The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.

Factor Structure and Psychometric Properties of the Anxiety Sensitivity Index-3 in an Italian Community Sample

Anxiety Sensitivity (AS) is defined as the fear of anxiety and of arousal-related bodily sensations, arising from erroneous beliefs that these sensations will have adverse consequences. AS plays a key role both in the onset and in the maintenance of several disorders, particularly anxiety disorders. To date, only two studies on American samples have examined the bifactor structure of the Anxiety Sensitivity Index-3 (ASI-3); therefore, findings on different cultures are needed. The main purpose of the present study was to assess the factor structure and psychometric properties of the ASI-3 in an Italian community sample. Participants were recruited from the general population (N = 1507). The results of a series of confirmatory factor analyses indicated that the bifactor structure fitted the data better than the most commonly accepted structure for the measure and that it was invariant across gender. Moreover, the current study provided evidence regarding the ASI-3’s reliability and its convergent and divergent validity. Lastly, results pertaining incremental validity of the ASI-3 Physical and Cognitive Concerns subscales above and beyond the total showed that the former was not associated with a measure of physiological anxiety, whereas the latter was weakly associated with a measure of worry. Findings suggest that the ASI-3 is comprised of a dominant general factor and three specific independent factors; given the dominance of the general factor, the use of the ASI-3 total score as a measure of the general fear of anxiety is recommended in both clinical and research settings.

Anxiety Sensitivity in School Attending Youth: Exploratory and Confirmatory Factor Analysis of the 18-Item CASI in a Multicultural South African Sample

Anxiety sensitivity (AS) is a risk factor for the development of anxiety disorders in youth. To date, the applicability of the Childhood Anxiety Sensitivity Index (CASI) in youth from a low or middle income country (LMIC) setting on the African continent has not been assessed. A representative sample of 1149 secondary school learners from 29 schools in Cape Town, South Africa, participated in the study. Participants completed the CASI on a single occasion. One-, two-, and four-factor models of the CASI were assessed. A one-factor solution that comprised items predominantly represented by physical concerns appeared to provide the best fit to our data, however, relatively low variance (26%) was explained. Subsequent item deletion resulted in a 9-item ‘physical concerns’ factor that showed good construct reliability (0.83) but also explained a low amount of variance (35%). In terms of gender, a one-factor model provided the best fit, however, low variance was explained (i.e., 25%). Configural, metric and scalar invariance of the CASI by gender was determined. Our results suggest that the 18-item CASI is not applicable to our target population and may require adaptation in this population; however, replication of this study in other multicultural adolescent samples in South Africa is first needed to further assess the validity of the AS construct as measured by the CASI.

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.

Identifying Moderators of the Link Between Parent and Child Anxiety Sensitivity: The Roles of Gender, Positive Parenting, and Corporal Punishment

A substantial body of literature suggests that anxiety sensitivity is a risk factor for the development of anxiety problems and research has now begun to examine the links between parenting, parent anxiety sensitivity and their child's anxiety sensitivity. However, the extant literature has provided mixed findings as to whether parent anxiety sensitivity is associated with child anxiety sensitivity, with some evidence suggesting that other factors may influence the association. Theoretically, specific parenting behaviors may be important to the development of child anxiety sensitivity and also in understanding the association between parent and child anxiety sensitivity. In this study, 191 families (n = 255 children and adolescents aged 6-17 and their parents) completed measures of child anxiety sensitivity (CASI) and parenting (APQ-C), and parents completed measures of their own anxiety sensitivity (ASI) and their parenting (APQ-P). Corporal punishment was associated with child anxiety sensitivity and the child's report of their parent's positive parenting behaviors moderated the association between parent and child anxiety sensitivity. The child's gender was also found to moderate the association between parent and child anxiety sensitivity, such that there was a positive association between girls' and their parents anxiety sensitivity and a negative association in boys. The findings advance the understanding of child anxiety sensitivity by establishing a link with corporal punishment and by showing that the association between parent and child anxiety sensitivity may depend upon the parenting context and child's gender.

Anxiety sensitivity: changes with puberty and cardiovascular variables

BACKGROUND

Anxiety sensitivity (AS) is a relatively stable dispositional variable that may increase the risk for anxiety-related symptoms, particularly panic attack, among individuals of all age groups. Changes in AS during adolescence in healthy individuals, however, has not been previously investigated. The aim of this study was therefore to investigate the relationship of AS with puberty level, pulse rate, and blood pressure in healthy adolescents.

METHODS

The sample consisted of 133 healthy adolescents (70 boys, 63 girls) aged 10-17 years. Puberty stage (i.e. Tanner stage), pulse rate, and blood pressure of each participant were determined. The Childhood Anxiety Sensitivity Inventory was used to identify AS. The correlations between AS and the clinical variables were assessed.

RESULTS

AS was negatively correlated with pubertal stage when age and gender were controlled. Also, AS was correlated with diastolic blood pressure when age, gender, and pubertal stage were controlled (P < 0.05). Neither systolic blood pressure nor heart rate were correlated with AS.

CONCLUSION

AS, which is reported to be a trait-like variable, may change during adolescence, due to the effect of pubertal growth and blood pressure interacting with AS during adolescence.

Anxiety Sensitivity: An Examination of the Relationship With Authoritarian, Authoritative, and Permissive Parental Styles

A substantial literature has investigated the role of parenting on a child’s development. Several classifications of parenting styles (i.e., permissive, authoritarian, authoritative) have been linked to a wide range of negative outcomes such as mood and anxiety problems; however, their respective associations to anxiety sensitivity (AS) remain unclear. Using a nonclinical sample of young adults (N = 227), this study is the first to empirically investigate whether parenting styles were differentially associated with AS, controlling for general depression and anxiety symptoms. Hierarchical linear regression analyses showed that authoritarian and permissive styles were associated with elevated AS. Permissive parenting was associated with the AS physical subfactor, whereas authoritarian parenting was associated with the AS social subfactor. Moreover, AS was found to mediate the relationship between specific parental styles and anxiety symptoms as well as depressive symptoms. Findings suggest that AS may mediate the relationship between parenting styles and negative psychological outcomes.

Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity

Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.

Developmental trajectories of anxiety symptoms in early adolescence: the influence of anxiety sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.