Anxiety sensitivity and panic disorder

A Comparison of Symptom Structure between Panic Disorder with and without Comorbid Agoraphobia Using Network Analysis

PURPOSE

Panic disorder (PD) and PD with comorbid agoraphobia (PDA) share similar clinical characteristics but possess distinct symptom structures. However, studies specifically investigating the differences between PD and PDA are rare. Thus, the present study conducted a network analysis to examine the clinical networks of PD and PDA, focusing on panic symptom severity, anxiety sensitivity, anticipatory fear, and avoidance responses. By comparing the differences in network structures between PD and PDA, with the goal of identifying the central and bridge, we suggest clinical implications for the development of targeted interventions.

MATERIALS AND METHODS

A total sample (n=147; 55 male, 92 female) was collected from the psychiatric outpatient clinic of the university hospital. We conducted network analysis to examine crucial nodes in the PD and PDA networks and compared the two networks to investigate disparities and similarities in symptom structure.

RESULTS

The most influential node within the PD network was Anxiety Sensitivity Index-Revised (ASI-R1; fear of respiratory symptom), whereas Panic Disorder Severity Scale (PDSS5; phobic avoidance of physical sensations) had the highest influence in the PDA network. Additionally, bridge centrality estimates indicated that each of the two nodes met the criteria for "bridge nodes" within their respective networks: ASI-R1 (fear of respiratory symptom) and Albany Panic and Phobic Questionnaire (APPQ3; interoceptive fear) for the PD group, and PDSS5 (phobic avoidance of physical sensation) and APPQ1 (panic frequency) for the PDA group.

CONCLUSION

Although the network comparison test did not reveal statistical differences between the two networks, disparities in community structure, as well as central and bridging symptoms, were observed, suggesting the possibility of distinct etiologies and treatment targets for each group. The clinical implications derived from the similarities and differences between PD and PDA networks are discussed.

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.

The Association Between Parent-to-Child Fear Learning Pathways and Anxiety Sensitivity: A Systematic Review and Meta-analysis

Although anxiety sensitivity (AS), or the fear of anxiety-related symptoms, has been identified as a risk factor for the development of anxiety psychopathology, the pathways through which this fear is learned have not been fully elucidated. In the current review and meta-analysis, we aimed to systematically examine the association between parent-to-child fear learning pathways (vicarious learning, negative information, reinforcement, and punishment) and AS. A comprehensive search of literature was conducted in PsychINFO, PubMed, Embase, and Web of Science databases, using search terms combining categories related to fear learning pathways, anxiety-related symptoms, parents, children, and adolescents. Based on this search strategy, 28 studies were identified as relevant, of which 11 were included in the systematic review and 10 in the meta-analysis. The overall findings indicated that parent-to-child fear learning pathways are significantly associated with AS. The meta-analysis demonstrated a small but significant association between fear learning pathways and AS, although the type of fear learning pathway did not significantly moderate this relationship. However, age emerged as a significant moderator, suggesting a stronger association in children and adolescents compared to adults. Given that these findings are primarily based on cross-sectional studies, this review underscores the need for longitudinal and experimental research to further clarify the role of parent-to-child fear learning pathways in anxiety sensitivity. Additionally, a better understanding of these pathways may help inform existing interventions and fear prevention strategies, such as those aimed at reducing parental modeling of fearful behaviors or promoting positive verbal messages about anxiety symptoms.

Beyond neuroticism: mediators of personality traits and internalizing psychopathology

BACKGROUND

Neuroticism is considered the general antecedent of many specific psychopathological conditions. Even though previous studies addressed the issue of a mediated relationship by which it exerts its influence, they failed to encapsulate the changes that occur over time. Approaching the pathway between neuroticism and psychopathology from a longitudinal perspective might clarify its underlying mechanisms.

METHODS

The present study aimed to address this by examining the associations between neuroticism, social-cognitive vulnerabilities (anxiety sensitivity, intolerance of uncertainty, experiential avoidance, looming cognitive style), and internalizing psychopathology (depression, anxiety, panic) in an N = 373 student sample. Cross-lagged Panel Model (CLPM) and Random-Intercept Cross-Lagged Panel Model (RI-CLPM) were used to test the mediation analyses in a longitudinal three-wave design.

RESULTS

At the between-person level, the effect of neuroticism and social-cognitive vulnerabilities, such as experiential avoidance and intolerance of uncertainty, on depression and anxiety was found to be significant. An indirect effect of neuroticism was observed specifically for anxiety sensitivity and panic. No significant effects emerged at the within-person level.

CONCLUSIONS

Neuroticism and social-cognitive factors together contribute to depression and anxiety symptoms, while neuroticism's indirect influence better explains the onset of panic at a stable, between-person level. Theoretical considerations of the results and prospective research implications are discussed.

Influence of anxiety sensitivity on the observe facet of the five facet mindfulness questionnaire: differential item functioning in a clinical population

BACKGROUND

Many individuals who engage in mindfulness experience decreased anxiety. Yet some individuals, particularly those with panic disorder (PD) or elevated anxiety sensitivity (AS), note heightened anxiety when observing particular sensations. The Five Facet Mindfulness Questionnaire (FFMQ) is one of the most widely utilized mindfulness questionnaires. However, its Observe facet has shown variability in the literature. This study explored a transdiagnostic approach to determine whether specific aspects of the Observe facet of the FFMQ differ in individuals with elevated anxiety sensitivity (AS).

METHODS

We examined a clinical sample of 1521 Japanese individuals who completed the FFMQ and Anxiety Sensitivity Index 3 (ASI-3). A multiple indicator multiple cause (MIMIC) model approach was adopted utilizing latent variables to examine differential item functioning (DIF) of the Observe facet of the FFMQ, based on PD and/or AS diagnosis. This process was repeated to examine the relationship between the Anxiety Sensitivity Index-3 (ASI-3) subscales and particular items of the Observe facet.

RESULTS

The measurement model revealed good acceptability of a one-factor solution of the Observe facet (χ2 (20) = 208.73, p < 0.001). PD significantly predicted Observe (B = 0.09, R2 = 0.06, p = 0.008) and AS significantly predicted Observe (B = 0.02, R2 = 0.18, p < 0.001). Increased AS was associated with greater scores on observing internal items and lower scores on observing external items. When PD and AS were analyzed simultaneously, only AS remained significant. The cognitive subscale showed the same pattern of results as the total ASI-3 subscale.

CONCLUSIONS

The findings of this study reveal that AS, particularly cognitive AS, may modulate the mindfulness experience. The study reveals the importance of understanding where an individual observes and its results may be beneficial for tailoring mindfulness interventions for individuals.

Insomnia partially mediates the relationship between anxiogenic and depressogenic traits and state anxiety and depression in college students

OBJECTIVE

Insomnia, anxiety, and depression are common and co-morbid amongst college students. The mechanisms by which trait factors like intolerance of uncertainty and anxiety sensitivity connect to state anxiety and depression is unclear, but insomnia may mediate that relationship.

PARTICIPANTS

College students (N = 439) were recruited from national and local sources.

METHODS

Participants completed the Sleep Condition Indicator (SCI), Depression, Anxiety and Stress Scale (DASS), Anxiety Sensitivity Index (ASI), and Intolerance of Uncertainty Scales (IUS).

RESULTS

All models predicted a significant amount of variability in state anxiety and depression (R2 between 0.24 and 0.32). Mediation analyses revealed that the relationship between anxiogenic and depressogenic traits and state anxiety and depression is significantly mediated by insomnia.

CONCLUSIONS

Our findings support the role of insomnia in the expression of anxiety and depression in at-risk college students. Clinical sleep intervention, either reactive or prophylactic, may help reduce mental health burden on campus.

A taxometric analysis of panic disorder

Panic disorder is costly, and while evidence-based interventions for panic disorder are effective, obtaining a diagnosis often precludes access to such treatments. This is problematic because the categorical diagnosis of panic disorder (i.e. "you have it, or you don't") supported by modern diagnostic manuals contradicts empirically supported dimensional models of panic disorder. Taxometric analyses, which test the dimensional or categorical latent structure of constructs, have consistently revealed dimensional latent structures when applied to other anxiety disorders and panic-related processes, but taxometric analyses have never been applied to panic disorder. To address this gap in the literature, three nonredundant taxometric procedures were applied to seven theoretically-relevant indicators of panic disorder derived from Panic Disorder Severity Scale data collected from 663 participants recruited via Amazon Mechanical Turk. Simulated comparison plots and objective fit indices were also evaluated. The collective results provided consistent empirical support for a dimensional model of panic disorder, with an overall mean CCFI score of .39. The implications of the present findings for the measurement, assessment, diagnosis, and treatment of panic disorder are discussed.

Unraveling psychological burden: the interplay of socio-economic status, anxiety sensitivity, intolerance of uncertainty, and stress in first-year medical students

BACKGROUND

The escalating prevalence of mental health issues among young adults, set against the backdrop of a global healthcare system under pressure, underscores the necessity for cultivating a resilient medical workforce. This study investigates the influence of socio-economic status (SES) on psychological well-being, with a particular focus on Anxiety Sensitivity (AS) and Intolerance of Uncertainty (IU) among first-year medical students. Understanding the psychological dimensions affecting medical students is crucial for fostering a future medical workforce that is both capable and mentally healthy.

METHODS

This research involved 321 first-year medical students, evaluated using the Perceived Stress Questionnaire (PSQ), Anxiety Sensitivity Index (ASI), the Intolerance of Uncertainty Scale (UI-18), and the Student Self-Efficacy Scale (SSE), alongside socio-economic categorization. Employing descriptive statistics, ANOVA, and correlation analyses, the study aimed at elucidating the SES impact on AS and IU, among other psychological constructs.

RESULTS

The analysis revealed significant SES-related differences, especially in the realms of Anxiety Sensitivity and Intolerance of Uncertainty. Notably, ASI_C (cognitive concerns) exhibited strong positive correlations with both UI_A (reduced ability to act due to IU) (Pearson's r = 0.562, p < 0.001) and UI_B (burden due to IU) (Pearson's r = 0.605, p < 0.001), highlighting the link between cognitive aspects of anxiety and uncertainty intolerance. Furthermore, UI_C (vigilance due to IU) was significantly associated with SES (F(4, 316) = 2.719, p = 0.030, η² = 0.033), pointing to the complex ways in which socio-economic factors modulate responses to uncertainty. Self-efficacy emerged as a significant counterbalance, showing protective associations against the adverse effects of heightened Anxiety Sensitivity and Intolerance of Uncertainty.

CONCLUSION

Our findings indicate that lower socio-economic status is associated with higher levels of Anxiety Sensitivity and Intolerance of Uncertainty, which contribute to increased stress among first-year medical students. Additionally, Self-Efficacy emerged as a significant protective factor, mitigating the expressions of AS and IU. Although medical faculties cannot change SES characteristics within their student body, recognizing its impact allows for the development of tailored support systems to address the unique challenges faced by students from diverse socio-economic backgrounds. This study underscores the necessity of considering social diversity, particularly regarding AS and IU characteristics, to foster a supportive and effective medical education environment with an outlook on sustainable mental health in a demanding work context.

Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol

ABSTRACTThe Unified Protocol (UP) theoretically leads to reductions in emotional disorder symptoms by reducing aversive reactions to emotions. However, aversive reactions can take many forms (e.g., non-acceptance, behavioral avoidance). We examined if (1) multiple aspects of aversive reactivity predicted session-to-session changes in anxiety and depression in the UP, (2) these aspects reflected a single latent construct, and (3) changes in this latent construct predicted changes in anxiety and depression. Participants (N = 70, Mage = 33.74, 67.1% female, 74.3% white) completed six sessions of UP modules and measures of aversive reactivity, anxiety, and depression before each session. We used hierarchical linear modeling and random-intercept cross-lagged panel models to test aspects of aversive reactivity and a latent factor of aversive reactivity, respectively, as predictors of session-to-session changes in anxiety and depression. Within-person improvements in four of five aspects of aversive reactivity predicted decreases in anxiety, and improvements in two aspects predicted decreases in depression. However, within-person improvements in latent aversive reactivity predicted decreases in anxiety at five sessions and in depression across all sessions. These results add to the growing literature highlighting the role of aversive reactivity as a potential transdiagnostic process involved in improvements in emotional disorder symptoms during treatment.

Abnormality in GABAergic postsynaptic transmission associated with anxiety in Bronx waltzer mice with an Srrm4 mutation

The homozygous Bronx waltzer (bv) mouse, which shows hearing impairment, also exhibits anxiety accompanied by a reduction in cortical parvalbumin (PV)-positive GABAergic interneurons. Recently, a mutation in splicing factor Ser/Arg repetitive matrix 4 (Srrm4) was found in bv mice. However, the cellular consequences of the Srrm4 mutation for anxiety remain unknown. Here, we tested our hypothesis that bv mutant primarily affects interneurons through a cell-intrinsic pathology that leads to a reduction of interneurons and consequently causes anxiety. We found that the anxiety becomes apparent at 6 weeks of age in bv/bv mice. However, in situ hybridization revealed that Srrm4 is not expressed in interneurons, but rather dominates in pyramidal neurons. In addition, the PV-positive GABAergic interneurons were not reduced in number in the bv/bv cortex when anxiety became evident. However, electrophysiological abnormality of GABAergic transmission from interneurons was concomitantly present. Pharmacological blockage of GABAA receptors revealed increased excitability in bv/bv mice, although no gross change occurred in the expression of an Srrm4-downstream gene, Kcc2, which regulates chloride flux upon GABAergic transmission. These findings suggest that the bv-associated Srrm4 mutation mainly involves post-synaptic GABAergic transmission in the central nervous system, which may be associated with the anxiety phenotype in bv/bv mice.

Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis

Given the high rate of trauma exposure among the general population, it is important to delineate the risk factors for post-traumatic stress disorder (PTSD). While historically implicated in panic disorder, anxiety sensitivity is increasingly found to play a role in PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among trauma exposed adults. A systematic search on multiple electronic databases (PTSDpubs, CINAHL, MEDLINE and PsycINFO) generated a total of 1025 records, among which 52 (n = 15173) met study inclusion criteria and were included in our random effects meta-analysis. Our results indicated a medium effect size (r = .46, 95% CI =.41,.50) for the relationship between anxiety sensitivity and PTSD symptoms. There was significant between-study heterogeneity. Furthermore, sub-group analyses revealed that study design (cross-sectional vs. longitudinal) may significantly moderate the association between anxiety sensitivity and PTSD severity. No moderation effect was found for assessment of PTSD through interview versus questionnaire, interpersonal versus non-interpersonal trauma, or low versus high study quality. Such patterns of results are consistent with cognitive models of PTSD. Clinical implications, strengths and limitations of the review were discussed.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

Executive Functioning, Internalizing and Externalizing Symptoms: Understanding Developmental Dynamics Through Panel Network Approaches

Objective

Early adolescence is a transition period during which many mental health disorders emerge. The interplay between different internalizing and externalizing mental health problems in adolescence is poorly understood at the within-person level. Executive functioning (EF) in early adolescence has been shown to constitute a transdiagnostic risk factor, but the specificity of the associations between different domains of EF and mental health problems remains unclear.

Method

Network dynamics (ie, temporal effects) of different internalizing and externalizing symptoms were investigated leveraging data from the Tracking Adolescents' Individual Lives Survey (TRAILS), a large longitudinal panel study of adolescents (>1,641 participants) assessed at ages 11, 13, and 15. Two novel methodological panel network approaches were used: cross-lagged panel network models and graphical vector autoregressive models. Hierarchical regression models were used to investigate prospective associations between different measures of EF and broadband transdiagnostic dimensions.

Results

Depressive problems predicted a range of other internalizing symptoms (ie, panic, somatic problems, separation anxiety, general anxiety, social phobia) over time, particularly during early adolescence. Important feedback loops with reciprocal associations between different anxiety symptoms were identified. Different facets of EF assessed at age 11, particularly sustained attention, showed weak but significant prospective associations with internalizing and externalizing symptoms at age 13.

Conclusion

The present findings emphasize the importance of targeting depressive problems in early adolescence to prevent a spiral of different internalizing symptoms from arising later on.

Health anxiety amplifies fearful responses to illness-related imagery

Severe health anxiety (HA) is characterized by excessive worry and anxiety about one's health, often accompanied by distressing intrusive imagery of signs of a serious illness or potentially receiving bad news about having a life-threatening disease. However, the emotional responses to these illness-related mental images in relation to HA have not been fully elucidated. Emotional responses to mental imagery of 142 participants were assessed in a well-controlled script-driven imagery task, systematically comparing emotional responses to illness-related imagery with neutral and standard fear imagery. The results revealed that participants reported higher anxiety, aversion, emotional arousal, and a stronger avoidance tendency during imagery of fear and illness-related scenes compared to neutral scenes. Importantly, the emotional modulation varied by the level of HA, indicating that individuals with higher HA experienced stronger emotional responses to illness-related imagery. This association between HA and fearful imagery could not be better accounted for by other psychological factors such as trait anxiety, anxiety sensitivity, somatic symptom severity, or symptoms of depression and anxiety. Fearful responding to standard threat material was not associated with HA. The present findings highlight the importance of considering fear responding to mental imagery in understanding and addressing HA.

Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis

People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.

Isolating unique variance in mental health outcomes attributable to personality variables and childhood emotional abuse

Introduction

University students are at high risk for anxiety and depression. Our main objective was to tease apart variance in symptom severity that was uniquely attributable to four associated variables that are frequently confounded: exposure to childhood emotional abuse, alexithymia, sensory processing sensitivity (SPS), and anxiety sensitivity (AS).

Methods

University students (N = 410) completed an online survey designed to measure our four key study variables along with several other potentially relevant variables including sex, physical activity levels, and perceived COVID-19 impacts.

Results

Over half of the participants reported moderate to extremely severe symptoms of anxiety and depression. Females reported stronger signs of SPS and AS and were more likely than males to have increased their moderate/vigorous exercise since the pandemic began. After controlling for the other variables, the best predictors of perceived COVID-19 impacts were SPS, childhood emotional abuse, and current levels of physical activity. Whereas all three personality variables and childhood emotional abuse emerged as significant predictors of both depression and anxiety, neither COVID-19 impacts nor physical activity levels accounted for unique variance in either model. Unexpectedly, male sex emerged as an additional risk factor for depression, raising the possibility that males experience unique stressors and societal pressures that increase their risk of depression.

Discussion

These findings help to clarify the links between childhood emotional abuse, personality traits implicated in emotional awareness and self-regulation, and mental health. They may have important implications for the development and implementation of individualized treatments for common mental disorders.

Development and initial validation of the menstrual sensitivity index

OBJECTIVE

The present study sought to develop and perform the initial validation of a scale assessing sensitivity to menstrual pain and symptoms.

METHODS

Data were taken from a larger parent study in which participants were recruited from a nationwide sample of individuals via the UniVox platform (www.univoxcommunity.com). In that study, participants were stratified by age and self-reported menstrual pain. Participants in the parent study completed 2 online surveys, one at baseline and one at a 3-month follow up. Participants who provided complete responses to the potential scale items, as well as a variety of validated questionnaires, were included in the present analyses. Final item selection was determined by factor analyses, and measures of validity and reliability were examined.

RESULTS

Factor analyses support an 8-item scale assessing menstrual sensitivity. This scale, the Menstrual Sensitivity Index, demonstrates excellent internal consistency, good item-total correlations, and good total score test-retest reliability. Convergent validity emerged for menstrual- and pain-specific measures, and divergent validity emerged for anxiety sensitivity, anxiety, depression, nonmenstrual bodily pain, and premenstrual symptoms.

CONCLUSIONS

Menstrual sensitivity is a unique construct that reflects women's attunement to and fear of menstrual symptoms, and the Menstrual Sensitivity Index is a valid and reliable measure of this construct. This scale could be useful in advancing research and clinical work targeting menstrual pain.

Anxiety, distress tolerance, and the relationship between complex posttraumatic stress disorder symptoms and alcohol use in veterans

OBJECTIVES

Little is known about whether distress tolerance and anxiety mediate the relationship between comorbid complex posttraumatic stress disorder (CPTSD) and alcohol use among military veterans. Here, we investigated the contribution of distress tolerance and anxiety on the strength of the CPTSD and alcohol use association. We hypothesized that the impact of a two-factor model of CPTSD derived from subscale scores on the International Trauma Questionnaire (ITQ)-namely ITQ PTSD and ITQ Disturbances in Self Organization (DSO; e.g., issues with affective regulation/self-belief and shame)-on alcohol use severity would be mediated by anxiety but not by distress tolerance.

METHODS

Participants included 403 community-dwelling United Kingdom (UK) veterans (91.64% male, Mage  = 51.15 years, SD = 12.48) recruited as part of a larger, online study.

RESULTS

Findings indicated that the influence of CPTSD symptoms on alcohol use severity was mediated by anxiety, not by distress tolerance, with greater relative impact due to ITQ DSO status than ITQ PTSD status.

CONCLUSIONS

We identified the mediational influence of anxiety and distress tolerance on the association between CPTSD subscales and alcohol use in UK veterans. Interventions for anxiety may be adapted for reducing problematic alcohol use and the impact of CPTSD symptoms in veterans with comorbid PTSD and alcohol use disorder.

Investigating Relations Between the Symptoms of Panic, Agoraphobia, and Suicidal Ideation: The Significance of Comorbid Depressive Symptoms in Veterans with Panic Disorder

Although panic disorder has been frequently associated with increased suicidal ideation and behaviors, there are multiple explanations for this association in the literature. For example, some research has demonstrated panic disorder symptoms to mediate agoraphobia and suicidal ideation, while other researchers have hypothesized that comorbid depression symptoms contribute to suicidal ideation across anxiety disorders. Of note, none of these studies were completed in veterans, a population at higher risk for suicide relative to civilian samples. The present study investigated relations between the symptoms of panic, agoraphobia, depression, and suicidal ideation in 58 veterans diagnosed with panic disorder via correlations, hierarchical regression, and exploratory path analyses. Multiple models were investigated based on prior research. The final path model demonstrated that symptoms of panic disorder predicted agoraphobia symptoms, with agoraphobia predicting symptoms of depression. Symptoms of depression, then, predicted suicidal ideation. Discussion of the findings related to comorbid depressive symptoms highlight considerations for the assessment and treatment practices for panic disorder, with a particular focus on veterans receiving care within Veterans Affairs Healthcare System.

Anxiety sensitivity in terms of mental health among a racially and ethnically diverse sample of sexual minority college students

Objective: Limited work has focused on understanding the function of individual difference factors in terms of mental health among sexual minority college students. Anxiety sensitivity is one individual difference factor which has received substantial empirical attention, but its role is presently understudied among racially/ethnically diverse sexual minority college students.Participants: Participants included a racially and ethnically diverse sample of sexual minority college students (N = 217; Mage = 20.82 years; SD = 3.06).Methods: The present investigation evaluated the role of anxiety sensitivity in relation to anxious arousal, social anxiety, depression, and suicidality.Results: Results indicated that anxiety sensitivity was significantly related to increased anxious arousal, social anxiety, depression, and suicidality after adjusting for age, sex, relationship status, subjective social status, and neuroticism.Conclusions: This investigation provides the first empirical evidence that anxiety sensitivity is related to poorer mental health outcomes for racially/ethnically diverse sexual minority college students.

Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women

Introduction

Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma.

Methods

In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed.

Results

Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma.

Discussion

These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.

Beyond generalized anxiety: the association of anxiety sensitivity with disordered eating

BACKGROUND

Anxiety and eating disorders (EDs) are rising at alarming rates. These mental health disorders are often comorbid, yet the factors associated with their comorbidity are not well understood. The present study examined a theoretical model of the pathways and relative associations of anxiety sensitivity (AS) with different dimensions of ED risk, controlling for generalized anxiety.

METHODS

Participants (N = 795) were undergraduate students with an average age of 21 (SD = 4.02), predominantly female (71%), and Hispanic (71.8%). Participants completed an online survey with established measures of AS (i.e., Anxiety Sensitivity Index-3; ASI-3), general anxiety (i.e., Beck Anxiety Inventory; BAI), and eating behaviors (i.e., Eating Attitudes Test-26; EAT-26).

RESULTS

The results of our structural equation models indicated that AS subscales were significantly associated with dimensions of the EAT-26, even when controlling for generalized anxiety. Specifically, the ASI-3 factors reflecting cognitive and social concerns provided the most consistent significant associations with EDs. Whereas reporting higher cognitive concerns was associated with higher ED symptoms (e.g., reporting the urge to vomit after a meal), reporting higher social concerns was associated with fewer ED symptoms. These differential results may suggest risk and resilience pathways and potential protective or buffering effects of social concerns on ED risk.

DISCUSSION

Findings advance understanding of the role of AS in the comorbidity of anxiety and EDs, demonstrating the strong association of AS with ED pathology. These findings provide cognitive indicators for transdiagnostic therapeutic intervention in order to reduce the risk of EDs.

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.

The four-factor personality model and its qualitative correlates among opioid agonist therapy clients

Background

The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice.

Method

Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis.

Results

Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected.

Conclusion

Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.

Trauma-related disorders and the bodily self: current perspectives and future directions

Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems.

Anxiety Sensitivity Among Trauma-Exposed Non-Hispanic Black Adults: Relations to Posttraumatic Stress

ABSTRACT

The non-Hispanic Black population experiences trauma-related disparities. One potentially important individual difference construct for posttraumatic stress is anxiety sensitivity. There is limited work on anxiety sensitivity among non-Hispanic Black persons, and no research has focused on this construct in terms of posttraumatic stress among this population. This study sought to build on this limited knowledge by exploring whether this construct was uniquely associated with more severe posttraumatic stress among this population. Participants included non-Hispanic Black trauma-exposed adults ( N = 121; Mage = 21.79 years). Results indicated that anxiety sensitivity was related to more severe overall posttraumatic stress and greater severity of each posttraumatic stress symptom cluster; all effects were evident after adjusting for the variance accounted for by age, sex, education, subjective social status, neuroticism, and number of traumatic event types experienced (lifetime). The study provides the first empirical evidence that, among a trauma-exposed non-Hispanic Black sample of adults, anxiety sensitivity is related to more severe posttraumatic stress symptoms. This intraindividual difference factor could be a focus of intervention programming for this trauma disparity population.

Anxiety Sensitivity Among Non-Hispanic Black Adults: Relations to Mental Health and Psychosomatic States

The non-Hispanic Black adult population has notable disparities in mental and physical health compared to several other racial/ethnic groups. Yet, there is a lack of scientific knowledge about psychologically based individual difference factors that may be associated with an exacerbation of common mental and physical health symptoms among non-Hispanic Black persons. The present investigation sought to build on the limited knowledge about anxiety sensitivity among non-Hispanic Black adults by exploring whether this construct was uniquely associated with a range of prevalent mental health and psychosomatic symptoms commonly tied to disparities among this population. Participants included non-Hispanic Black adults (N = 205; Mage = 21.67 years; SDage = 5.39; age range: 18-60 years; 82.0% female). Results indicated that anxiety sensitivity was positively related to anxious arousal, general depression, insomnia, fatigue severity, and somatic symptom severity; effects were evident above and beyond the variance explained by a range of covariates, including age, sex, education, subjective social status, and neuroticism. Overall, the present findings uniquely build from past research on anxiety sensitivity and non-Hispanic Black adults by demonstrating that individual differences in this construct are consistently and relatively robustly associated with a wide range of mental health and psychosomatic symptoms. Future research that builds from this work may benefit from consideration of intervention programming targeting anxiety sensitivity reduction to offset mental and physical health impairments among the non-Hispanic Black population.

Transdiagnostic Processes Linking Posttraumatic Stress Disorder Symptoms to Alcohol Use Severity

Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; Mage = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.

The Influence of Transdiagnostic Vulnerability Factors on PTSD Symptom Clusters in a Veteran Sample

BACKGROUND

There is continuing debate as to the latent structure underpinning posttraumatic stress disorder symptomatology. The transdiagnostic vulnerability factors of negative affect, anxiety sensitivity (and subcomponents) and intolerance of uncertainty have previously demonstrated the ability to explain symptom clusters in a range of anxiety and depressive disorders, and may give further understanding of PTSD symptomatology.

METHOD

Within an Australian Defence Force veteran population, structural equation modeling is utilized to assess whether a hierarchical Original Model containing negative affect as the general cognitive factor, anxiety sensitivity and intolerance of uncertainty as mid-level factors, can explain variability among posttraumatic stress disorder symptom clusters as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A further hierarchical Anxiety Sensitivity Extended model consisting of the general cognitive factor of negative affect and the three sub-factors of anxiety sensitivity as mid-level factors was also tested upon PTSD symptom clusters.

RESULTS

Both the hierarchical Original and Anxiety Sensitivity Extended models fit the data well. Within both models, negative affect consistently showed significant direct effects upon the posttraumatic stress disorder symptom clusters. In the Original Model, anxiety sensitivity served as a significant mediator of negative affect for several symptom clusters, while intolerance of uncertainty was non-significant both as a direct effect and as a mediator of negative affect. In the Anxiety Sensitivity Extended Model, the cognitive concerns sub-factor of anxiety sensitivity served as a significant mediator of negative affect for several symptom clusters, while the social and physical concerns sub-factors did not have significant direct or mediating effects.

CONCLUSIONS

This study demonstrates a transdiagnostic hierarchical model significantly explains the severity of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition posttraumatic stress disorder symptom constructs within a subclinical population. Negative affect and anxiety sensitivity can each be targeted with specific interventions, suggesting new avenues to augment current gold standard psychotherapeutic interventions.

A molecular characterization and clinical relevance of microglia-like cells derived from patients with panic disorder

Few studies report the microglia involvement in the pathogenesis of panic disorder (PD), although the crucial role of microglia in other neuropsychiatric diseases is being emphasized. In addition, there is no report to characterize the phenotypic and functional levels of PD patient-derived microglia to find their clinical relevance. Herein, we used a model to induce patient-derived microglia-like cells (iMGs) to clarify the molecular characteristics and function of PD-iMGs. We established iMGs from 17 PD patients and 16 healthy controls (non-psychiatric controls, HC). PD-iMGs showed increased T-cell death-associated gene-8 expression per the proposal of a previous in vivo study. In addition, we found that patient-derived iMGs showed reduced phagocytosis and increased TREM2 expression. We analyzed the phenotype of the PD-iMGs by RNA sequencing. The PD-iMGs clustered together distinct from HC-iMGs. Gene set enrichment analysis revealed the involvement of cholesterol biosynthesis and steroid metabolism in PD-iMGs. Regarding the cholesterol synthesis pathway, we discovered ACAT2 and DHCR7 as the most impacted genes related to a character of PD-iMGs compared to HC-iMGs. The ACAT2, a major cholesterol esterifier, was increased in PD-iMGs. Nevertheless, PD-iMGs did not show lipid droplet accumulation. Interestingly, ACAT2 expression was inversely correlated with the severity of depression and anxiety sensitivity to publicly observable anxiety reactions. We propose that microglia of PD patients have unique characteristics with dysregulation of cholesterol biosynthesis pathway and impaired phagocytosis, reflecting clinical phenotype.

Biological and cognitive theories explaining panic disorder: A narrative review

The current narrative review summarizes and examines several theories of panic disorder (PD) including biological theories, encompassing neurochemical factors, metabolic and genetic theories, respiratory and hyperventilation theories and cognitive theory. Biological theories have informed the development of psychopharmacological treatments; however, they may be limited in their utility given the efficacy of psychological treatments. In particular, behavioral and, more recently, cognitive models have garnered support due to the efficacy of cognitive-behavior therapy (CBT) in treating PD. The role of combination treatments has been found to be superior in the treatment of PD in particular cases, lending support for the need for an integrated approach and model for PD given that the etiology of PD is complex and multifactorial.

How vestibular dysfunction transforms into symptoms of depersonalization and derealization?

BACKGROUND

Psychiatric Depersonalization/Derealization (DPDR) symptoms were demonstrated in patients with peripheral vestibular disorders. However, only semicircular canals (SCCs) dysfunction was evaluated, therefore, otoliths' contribution to DPDR is unknown. Also, DPDR symptoms in patients with central vestibular dysfunction are presently unknown. DPDR was also studied in the context of spatial disorientation and anxiety, but the relation of these cognitive and emotional functions to vestibular dysfunction requires clarification.

METHODS

We tested patients with peripheral Bilateral Vestibular Hypofunction (pBVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. Participants completed the video Head Impulse Test (vHIT) for SCCs function, cervical Vestibular Evoked Myogenic Potentials test (cVEMPt) for sacculi function, Body Sensation Questionnaire (BSQ) for panic anxiety, Object Perspective-Taking test (OPTt) for spatial orientation and Cox & Swinson DPDR inventory for DPDR symptoms.

RESULTS

pBVH patients showed significant SCCs and sacculi dysfunction, spatial disorientation, elevated panic anxiety, and DPDR symptoms. MJD patients showed significant SCCs hypofunction but preserved sacculi function, spatial disorientation but normal levels of panic anxiety and DPDR symptoms. Only pBVH patients demonstrated a positive correlation between the severity of the DPDR and spatial disorientation and panic anxiety.

CONCLUSIONS

DPDR develops in association with sacculi dysfunction, either with or without SSCs dysfunction. Spatial disorientation and anxiety seem to mediate the transformation of vestibular dysfunction into DPDR symptoms. DPDR does not develop in MJD with central vestibular hypofunction but a normal saccular response. We propose a three-step model that describes the development of DPDR symptoms in vestibular patients.

VR for Studying the Neuroscience of Emotional Responses

Emotions are frequently considered as the driving force of behavior, and psychopathology is often characterized by aberrant emotional responding. Emotional states are reflected on a cognitive-verbal, physiological-humoral, and motor-behavioral level but to date, human research lacks an experimental protocol for a comprehensive and ecologically valid characterization of such emotional states. Virtual reality (VR) might help to overcome this situation by allowing researchers to study mental processes and behavior in highly controlled but reality-like laboratory settings. In this chapter, we first elucidate the role of presence and immersion as requirements for eliciting emotional states in a virtual environment and discuss different VR methods for emotion induction. We then consider the organization of emotional states on a valence continuum (i.e., from negative to positive) and on this basis discuss the use of VR to study threat processing and avoidance as well as reward processing and approach behavior. Although the potential of VR has not been fully realized in laboratory and clinical settings yet, this technological tool can open up new avenues to better understand the neurobiological mechanisms of emotional responding in healthy and pathological conditions.

Caffeine Motives and Expectancies for Individuals with High Anxiety Sensitivity

Background: Anxiety Sensitivity (AS) is a transdiagnostic risk factor that includes fear of the potential physical and psychological consequences of anxiety-related symptoms. Caffeine consumption in high amounts is associated with symptoms of anxiety. Research on the relationship between AS and caffeine consumption has yielded inconsistent results. Objectives: In this study, we conducted an exploratory analysis to examine whether caffeine motives moderated the relationship between AS and high caffeine consumption. We also examined whether caffeine expectancies moderated the relationship between AS and high caffeine consumption. In addition, we assessed the bivariate relationships between AS and caffeine motives and between AS and caffeine expectancies. N = 317 participants completed an online survey using Amazon Mechanical Turk. Results: Results revealed that neither expectancies nor motives interacted with AS to predict high caffeine consumption. There was also no significant main effect of AS on high caffeine consumption. The only significant main effect in the prediction of high caffeine consumption was the use of caffeine for symptom management motives. In our follow-up analyses, high AS participants in the study expected that caffeine consumption would provoke anxiety. They also reported using caffeine for symptom management, taste, and social reasons. Conclusions: These findings suggest that the utility of AS as a predictor or foundation for higher amounts of substance use is not uniform across substances but rather depends on the type of substance in question.

Evaluation of Psychiatric Comorbidities and Quality of Life As Well As Brain-Derived Neurotrophic Factor (BDNF) Concentrations Among Patients Suffering From Acne Vulgaris: A Systematic Review and Meta-Analysis

Acne vulgaris usually affects the dermal layer of the skin and is revealed frequently in young adulthood and adolescence. It has serious psychosocial comorbidities. We conducted the present systematic review and meta-analysis to elucidate the association of acne vulgaris with psychiatric comorbidities and quality of life as well as the brain-derived neurotrophic factor (BDNF) level. A systematic review and meta-analysis of the published articles were carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We investigated diverse databases: Web of Science, PubMed, the Cochrane Library, Embase, PsycINFO, and CINAHL to search for articles reporting the prevalence of psychosocial comorbidities among patients with acne vulgaris from database inception through June 2022. The outcomes were depression, anxiety, symptom checklist-90-R (SCL-90-R), quality of life, self-esteem, stress, loneliness, and BDNF concentrations. Of 3647 articles identified, 23 met the inclusion criteria. Patients with acne vulgaris have a significantly higher level of anxiety, depression, and stress (P<0.05). Yet, the reported findings of the SCL-90-R, self-esteem, loneliness, and BDNF scores among patients suffering from acne vulgaris were variable and did not differ significantly compared to healthy participants (P>0.05), hampering any conclusive findings on absolute prevalence. Subgroup analysis and comparison showed that heterogeneity between studies was likely due to factors, including country, study design, and assessment tools. This comprehensive review and meta-analysis revealed that anxiety, depression, and stress are significantly more frequent among patients suffering from acne vulgaris. These findings confirm that acne vulgaris has both psychiatric and medical characteristics and requires a multidisciplinary approach.

Factor structure of the anxiety sensitivity index-3 in a sample of older adults

Anxiety sensitivity is a transdiagnostic risk factor for internalizing psychopathology in children and adults. Several factor analytic studies have examined the factor structure of anxiety sensitivity in children, adolescents, and adults. However, to date, no studies have specifically examined the factor structure of the Anxiety Sensitivity Index-3 in older adults. The purpose of the current study was to compare the fit of a correlated three-factor, higher-order, and bifactor model of the Anxiety Sensitivity Index-3 (ASI-3) in a sample of older adults. Participants were 856 older adults aged 60-94 recruited through Qualtrics Panels. Confirmatory factor analyses demonstrated good model fit for the bifactor model and the higher-order model and adequate fit for the correlated three-factor model. These results suggests that the ASI-3 is a valid tool assessing anxiety sensitivity in older adults. Limitations and future directions are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00736-9.

Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study

Anxiety sensitivity, or fear of anxious arousal, is cross-sectionally associated with a wide array of adverse posttraumatic neuropsychiatric sequelae, including symptoms of posttraumatic stress disorder, depression, anxiety, sleep disturbance, pain, and somatization. The current study utilizes a large-scale, multi-site, prospective study of trauma survivors presenting to emergency departments. Hypotheses tested whether elevated anxiety sensitivity in the immediate posttrauma period is associated with more severe and persistent trajectories of common adverse posttraumatic neuropsychiatric sequelae in the eight weeks posttrauma. Participants from the AURORA study (n = 2,269 recruited from 23 emergency departments) completed self-report assessments over eight weeks posttrauma. Associations between heightened anxiety sensitivity and more severe and/or persistent trajectories of trauma-related symptoms identified by growth mixture modeling were analyzed. Anxiety sensitivity assessed two weeks posttrauma was associated with severe and/or persistent posttraumatic stress, depression, anxiety, sleep disturbance, pain, and somatic symptoms in the eight weeks posttrauma. Effect sizes were in the small to medium range in multivariate models accounting for various demographic, trauma-related, pre-trauma mental health-related, and personality-related factors. Anxiety sensitivity may be a useful transdiagnostic risk factor in the immediate posttraumatic period identifying individuals at risk for the development of adverse posttraumatic neuropsychiatric sequelae. Further, considering anxiety sensitivity is malleable via brief intervention, it could be a useful secondary prevention target. Future research should continue to evaluate associations between anxiety sensitivity and trauma-related pathology.

Impact of ambient air pollution on outdoor employees’ performance: Mediating role of anxiety

This paper aims to examine the direct and indirect impact of ambient air pollution (AAP) on employees’ performance. This study has used cross sectional survey design to collect the data from the outdoor employees of the pharmaceutical industry of Pakistan. The data were collected in time lags from 299. Partial least squares- structural equation modeling (PLS-SEM) approach was applied to analyze the data. The results show that AAP has a significant negative impact on the employees’ performance, and anxiety partially mediates the association between AAP and employees’ performance. This study reveals that AAP brings anxiety among outdoor employees, which in turn decreases their working performance. The implications, limitations, and future research directions are presented in the last section of this study.

Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity

The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.

Do symptoms of depression and anxiety contribute to heavy episodic drinking? A 3-wave longitudinal study of adult community members

Heavy episodic drinking (or binge drinking) is a significant public health concern. Self-medication using alcohol is often thought to explain the co-occurrence of heavy episodic drinking with depression and anxiety. Yet, there is little longitudinal work examining both depressive and anxiety symptoms and how they are independently related to heavy episodic drinking in adult community samples. To this end, we invited adult community members (N = 102) to come to the lab to complete validated measures of depressive symptoms (composite of CES-D-SF, SCL-90-D, and DASS-21-D), anxiety symptoms (DASS-21-A), and heavy episodic drinking (composite of frequency, severity, and perceptions) at baseline, and again three and six months later. Using a three-wave cross-lagged panel model, we tested reciprocal relations between heavy episodic drinking and each internalizing symptom. We found strong temporal stability in our study variables. Depressive symptoms were associated with increases in heavy episodic drinking, and anxiety symptoms were associated with decreases in heavy episodic drinking. In contrast, heavy episodic drinking did not predict either internalizing symptom over time. Results are consistent with the notion that individuals with greater depressive symptoms use alcohol to self-medicate, and that anxiety symptoms (particularly autonomic arousal) may be potentially protective against future heavy episodic drinking.

Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization

BACKGROUND OBJECTIVES

Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization.

DESIGN

We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention.

METHODS

Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires.

RESULTS

As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship.

CONCLUSIONS

These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.

Mental health correlates of quitting cigarette smoking in youth experiencing homelessness

Smoking prevalence among youth experiencing homelessness (YEH) is three times higher than smoking prevalence among the general population. Many YEH who smoke are interested in quitting smoking, but also report smoking to cope with mental health symptoms. Research on factors that facilitate or impede successful smoking cessation among YEH is limited. This study examined mental health correlates (i.e., anxiety and depression symptoms) of quitting-related factors (i.e., quit attempts, perceived barriers to quitting) and whether smoking to cope moderates these relationships among this vulnerable population. The sample consisted of 77 YEH cigarette smokers between the ages of 18-25 who were interested in quitting. Participants completed a survey assessing various behavioral and cognitive factors related to tobacco use. Analyzing two separate models, hierarchical negative binomial and hierarchical linear regression were used to examine hypothesized correlates of the number of past year quit attempts and perceived barriers to quitting. Smoking to cope moderated the relationships of depression with past year quit attempts and perceived barriers to quitting. Those high in depression and smoking to cope had the fewest number of quit attempts and reported the greatest perceived barriers. Anxiety symptoms were not significantly associated with quit attempts or perceived barriers. Smoking cessation interventions that address using smoking to cope with mental health symptoms may be important for YEH with depression.

From alcohol to aggression: Examining the structure and nomological network of dysregulated behaviors in a trauma-exposed community sample

OBJECTIVE

A large body of research has shown that alcohol use, drug use, aggression, and self-harm often co-occur within the same individuals, suggesting the possibility of shared etiologies. Research has yet to determine the factor structure of these dysregulated behaviors.

METHODS

Participants (Mage  = 40.33; 74% women) completed self-report and interview-based measures of dysregulated behaviors (alcohol use, drug use, aggression, and self-harm), emotion dysregulation, maladaptive personality traits, and symptoms of DSM disorders (e.g., borderline personality disorder [BPD], depression).

RESULTS

Results showed support for a bifactor model (i.e., all indicators load on a common dysregulated behavior factor and on unique alcohol, drug, aggression, and self-harm factors), which provided a better fit to the data than other models. In line with our hypotheses, the general dysregulated behavior factor was positively associated with emotion regulation difficulties, negative affect, and BPD symptoms.

CONCLUSIONS

These results have implications for several areas of psychopathology and intervention research.

Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety

It is a defining feature of anxiety disorders that fear is elicited by a circumscribed class of stimuli rather than by only one specific exemplar of that class. Therefore, fear generalization, a mechanism by which associative fear extends from one conditioned stimulus to similar cues, has been central to theories on anxiety. Yet, experimental evidence for the link between generalization and pathological anxiety, as well as its moderators, has not been formally integrated. This systematic review and meta-analysis of empirical findings clarifies the relationship between fear generalization and pathological anxiety. In conclusion, enhanced fear generalization is associated with several anxiety disorders and stress-related disorders, which is supported statistically by a small, but robust effect size of g = 0.44 for risk ratings as an index of fear generalization. However, empirical results are inconsistent across disorders and they rarely allow for conclusions on their causality in the disorders' etiology. Therefore, based on theoretical considerations, we recommend directions for intensified research, especially on the causal relationship between overgeneralization and pathological fear.

Heightened false alarms of conditioned threat predict longitudinal increases in GAD and SAD symptoms over the first year of college

Lab-based fear-conditioning studies have repeatedly implicated exaggerated threat reactivity to benign (unreinforced) stimuli as concurrent markers of clinical anxiety, but little work has examined the strength of false alarms as a longitudinal predictor of anxiety problems. As such, we tested whether heightened false alarms of conditioned threat assessed in participants' first semester of college predicted second-semester symptoms of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) - two anxiety conditions that are common in college students, have been associated with excessive false alarms, and have yet to be assessed with longitudinal conditioning designs. Here, we focused on the predictive effects of behavioral threat responses (threat expectancy, subjective anxiety, avoidance) given their greater potential for translation to the clinic. Results implicate conditioning-related increases in anxiety to safe stimuli resembling the danger-cue as prospective predictors of GAD. In contrast, SAD was predicted by non-specific elevations in anxiety to a broad set of safe stimuli, as well as by increased threat expectancy toward cues least resembling the conditioned danger cue. These findings suggest that risk for GAD and SAD are captured by distinct, behavioral indicators of false-alarms that may be more feasibly collected in clinical settings compared to alternative experimental anxiety measures like psychophysiological responses.

Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; M_age = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.

The Relationship Between Attentional Bias, Anxiety Sensitivity, and Depression and Anxiety Symptoms: Evidence From the COVID-19 Pandemic in China

Background

The COVID-19 pandemic has led to observed increases in reported mental health issues, such as depression and anxiety symptoms. There is evidence attentional bias is associated with depression and anxiety, and it has been further suggested that anxiety sensitivity has a role in both the development and maintenance of depression and anxiety symptoms. Understanding these relationships may help inform preventative interventions for those at risk of mental health concerns. The present study explores the role of anxiety sensitivity, specifically physical and cognitive concerns, as a potential mediator of the relationship between attentional bias with depression and anxiety symptoms.

Method

Participants (n = 460) were recruited from the general population in China, and completed an online survey between February and March, 2020 which included the Attention to Positive and Negative Information Scale (APNI), Anxiety Sensitivity Index-3 (ASI-3) and Depression, Anxiety and Stress Scale (DASS-21). After exploring the correlations between the measures, mediation analysis was performed to explore the role of anxiety sensitivity (physical and cognitive subscales) in the relationship between attentional bias and depression and anxiety (as measured by the DASS-21).

Results

The results indicated that negative attention bias was significantly positively correlated with physical and cognitive concerns, physical and cognitive concerns were significantly positively correlated with depression and anxiety, and negative attention bias was significantly positively correlated with depression and anxiety (all ps < 0.001). Physical and cognitive anxiety sensitivity mediated the relationship between negative attention bias and both anxiety and depression symptoms.

Conclusion

Negative bias was associated with levels of anxiety and depression, and physical and cognitive anxiety sensitivity mediated associations between negative bias and anxiety and depression symptoms. The study provides theoretical support for intervention and guidance on individual mental health during the pandemic, and helps individuals increase their concern to negative emotions.

Evaluating the Role of Anxiety Sensitivity on Behavioral Health Outcomes among Latinx Persons

Background

Mexican Americans represent the largest subpopulation among Latinx persons and experience numerous health inequalities for psychological symptoms and behavioral health problems. First generation Mexican Americans are particularly vulnerable to such disparities and past work suggests that the experience of acculturative stress may play a vital role in terms of mental and physical health problems among this population. The current study sought to bridge past work on acculturative stress among first-generation Mexican Americans by exploring the role of anxiety sensitivity (AS; fear of the negative consequences of internal sensations) as a potential mediational factor in terms of psychological and behavioral health problems among this group.

Methods

The current study consisted of 369 first generation Mexican American persons (86.2% female, 40.1 years of age (SD = 11.1) years in the U.S. attending a Federally Qualified Healthcare Center located in an urban southwestern community. We explored whether AS served as a mediator between acculturative stress and some of the most common and disabling clinical problems among this group, including social anxiety, anxious arousal, general depression, insomnia and pain intensity and disability.

Result

Consistent with prediction, there was a statistically significant indirect effect of acculturative stress via AS across all criterion variables apart from pain intensity (depression [ab = - 0.17, SE = 0.05, 95% CI [0.08, 0.26]], insomnia [ab = 0.07, SE = 0.02, 95% CI [0.03, 0.10]], social anxiety [ab 0.05, SE = 0.02, 95% CI [0.02, 0.08]], anxious arousal [ab = 0.08, SE = 0.03, 95% CI [0.03, 0.12]], pain disability [ab = 0.05, SE = 0.02, 95% CI [0.02, 0.09]]). Comparative models were run to evaluate the specificity of hypothesized statistically significant models. For all models except anxious arousal and general depression, the alternative model was rejected, adding support to the hypothesized pathway.

Conclusion

Overall, this work provides initial support for the role of AS in terms of the relation between acculturative stress and numerous psychological and behavioral health problems among Mexican American adults in a clinical setting.

Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study

BACKGROUND

Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19.

METHODS

In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes.

RESULTS

Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes.

LIMITATIONS

Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear.

CONCLUSIONS

The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.