Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y).

OBJECTIVE: Adult research supports the efficacy of targeting the malleable risk factor of anxiety sensitivity (AS) in preventing anxiety and related psychopathology. However, very little work has evaluated the impact of AS reduction among youth, which is unfortunate given adolescence is a "core risk" period in terms of disorder onset. METHOD: The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10-14 years with elevated AS. High AS youth and a parent were randomly assigned to either the ASAP-Y, which consisted of psychoeducation and experimenter-led and parent-led exposures, or a general health information control condition. RESULTS: Youth in the intervention condition sustained low AS levels across the intervention period, and although AS levels in both conditions decreased from baseline to the one-month assessment, this decrease was more pronounced at one-month for youth in the intervention condition. Further, significant indirect effects of condition on one-month anxiety and depression symptoms via reduced AS were detected. Homework compliance rates and self-report data support the acceptability of the ASAP-Y. Contrary to hypotheses, differences between conditions in emotional reactivity elicited using experimental psychopathology methods were not observed. CONCLUSIONS: The current findings offer preliminary support for the ASAP-Y as an acceptable selective preventive intervention for at-risk youth, with specific anxiety- and depression-related effects through reduced AS.

Effects of a brief anxiety sensitivity reduction intervention on obsessive compulsive spectrum symptoms in a young adult sample.

OBJECTIVE: Anxiety sensitivity (AS) has been identified as a transdiagnostic cognitive risk factor for a wide range of affective disorders, including conditions within the obsessive compulsive (OC) spectrum. A growing body of research has demonstrated that directly reducing AS leads to subsequent reductions of other psychiatric symptoms, including anxiety, worry, and mood. To date, no study has examined the efficacy of a brief AS intervention on reducing OC and hoarding symptoms. METHOD: Non-treatment seeking young adults (N = 104; 83.7% female; 81.7% Caucasian) were selected for having elevated levels of AS, and were then randomized into a single-session, computer-assisted AS intervention or a control condition. OC and hoarding symptoms were assessed at post-treatment, as well as at one week and one month follow-ups. RESULTS: Results revealed that the intervention, but not the control condition, reduced OC symptoms across the post-intervention follow-up period. Mediation analysis demonstrated that changes in AS mediated changes in OC symptoms due to the intervention. In contrast, the intervention did not have a specific effect on reducing hoarding symptoms. CONCLUSIONS: These findings have important ramifications for understanding the relationship between AS and OC spectrum symptoms, and raise interesting treatment and prevention implications.

Direct and Mediating Effects of an Anxiety Sensitivity Intervention on Posttraumatic Stress Disorder Symptoms in Trauma-Exposed Individuals.

Anxiety sensitivity (AS), or fear of anxious arousal, is a higher-order cognitive risk-factor for posttraumatic stress disorder (PTSD) composed of lower-order physical, cognitive, and social concerns regarding anxiety symptoms. Brief and effective interventions have been developed targeting AS and its constituent components. However, there is limited evidence as to whether an intervention aimed at targeting AS would result in reductions in PTS symptoms and whether the effects on PTS symptoms would be mediated by reductions in AS. Furthermore, there is no evidence whether these mediation effects would be because of the global or more specific components of AS. The direct and indirect effects of an AS intervention on PTS symptoms were examined in a sample of 82 trauma-exposed individuals (M age = 18.84 years, SD = 1.50) selected based on elevated AS levels (i.e., 1 SD above the mean) and assigned to either a treatment (n = 40) or an active control (n = 42) condition. Results indicated that the intervention led to reductions in Month 1 PTS symptoms, controlling for baseline PTS symptoms. Furthermore, this effect was mediated by changes in global AS and AS social concerns, occurring from intervention to Week 1. These findings provide an initial support for an AS intervention in amelioration of PTS symptoms and demonstrate that it is primarily reductions in the higher-order component of AS contributing to PTS symptom reduction.

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.

The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: mediation through affect tolerances.

Recently there has been increased interest in emotional and physical tolerance risk factors for mood and anxiety disorders. Three tolerance risk factors that have been shown to be related are anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI). Although previous research has demonstrated these constructs are malleable, no research has investigated the effects of an AS intervention on DT or DI. Further, no studies have investigated whether changes in DT or DI play a role in mood and anxiety symptom amelioration due to an AS intervention. Participants (N = 104), who were selected for elevated levels of AS, completed a single-session computer-assisted AS intervention or a control intervention and follow-up assessments at 1-week and 1-month post intervention. Results revealed that the intervention reduced AS and increased DT, but did not affect DI at the 1-week follow-up. Mediation analyses revealed that changes in AS and DT both mediated changes in symptoms (depression, anxiety, worry) due to the intervention at 1-month follow-up, however, when AS and DT were considered in the same model only the effect via AS remained significant. These results have important implications for the nature of the relationships between AS, DT, and DI as well as the specific mechanistic pathways through which an AS intervention ameliorates symptoms.

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: a comparison of three models.

Emerging work has identified several related constructs that appear to be relevant to anxiety psychopathology including anxiety sensitivity (AS), distress tolerance (DT) and discomfort intolerance (DI). AS refers to the fear of the consequences of anxiety-related sensations. DT measures tolerance of negative emotions, whereas DI measures tolerance of uncomfortable physical sensations. Questions, however, have been raised regarding the overlap among AS, DT, and DI. The present study conducted confirmatory factor analyses to test three models of emotional and physical tolerance to determine which model provided the best fit for the associations among AS, DT, and DI. Nonclinical individuals (N = 411) and individuals with anxiety psychopathology (N = 253) completed self-report questionnaires. Results supported a hierarchical factor structure with 2 higher order factors with AS as a lower order factor of DT. The implications of these findings for the conceptualization of the relationships among AS, DT, and DI are discussed.

A taxometric exploration of the latent structure of hoarding.

Despite controversy regarding the classification and diagnostic status of hoarding disorder, there remains a paucity of research on the nosology of hoarding that is likely to inform the classification debate. The present investigation examined the latent structure of hoarding in three, large independent samples. Data for three well-validated measures of hoarding were subjected to taxometric procedures, including MAXimum EIGenvalue, Mean Above Minus Below A Cut, and Latent-Mode factor. Two symptom measures, one of which closely mirrors the proposed diagnostic criteria for hoarding disorder, and a measure of hoarding beliefs were analyzed. Sample 1 (n=2,501) was representative of the general German population, while Samples 2 (n=1,149) and 3 (n=500) consisted of unselected undergraduate students. Findings across all three samples and taxometric procedures provided converging evidence that hoarding is best conceptualized as a dimensional construct, present in varying degrees in all individuals. Results have implications across research and treatment domains, particularly with respect to assessment approaches, treatment response determination, and policy decisions. These findings underscore the need for further investigations on the nosology of hoarding, to help validate this construct as we move forward with respect to our research and treatment efforts, as well as the potential inclusion of hoarding disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2012).

Refinement of a brief anxiety sensitivity reduction intervention.

OBJECTIVE: Anxiety disorders are the most prevalent psychiatric disorders in the United States and result in substantial burden to the individual and society. Although effective treatments for anxiety disorders have been developed, there has been substantially less focus on interventions aimed at the amelioration of anxiety-related risk and maintenance factors. Anxiety sensitivity (AS) is a well-established, malleable risk and maintenance factor for panic disorder and other psychopathology. The aim of the current investigation was to enhance the efficacy of AS treatment through the refinement of a previously validated intervention. METHOD: This 1-session intervention utilized psychoeducation and interoceptive exposure to target AS and was compared with a health-focused control intervention among a nontreatment seeking sample (N = 104) of individuals with elevated AS. RESULTS: Study findings indicate that the active treatment group demonstrated significantly greater reductions in AS than the control group at posttreatment and across the 1-month study period. These treatment gains were seen across the ASI subscales. A Month 6 follow-up assessment indicated that the treatment group retained the majority of their AS reduction, whereas the control group retained their elevated AS scores. The intervention responses of participants meeting Axis I diagnostic criteria did not differ from the responses of those without a current diagnosis. CONCLUSIONS: Despite the brevity of the treatment intervention, findings demonstrate that it resulted in substantial reductions in AS that were largely maintained 6 months posttreatment. Anxiety treatment and prevention implications are discussed.

Attentional control moderates fearful responding to a 35% CO(2) challenge.

Attentional control (AC) is an individual difference variable indexing the ability to voluntarily focus attention and shift attention when desired. AC is thought to impact the experience of fear by facilitating the disengagement of attention from threat and promoting the deployment of attentional resources toward regulatory or coping strategies. Whereas previous research has focused on visual threat cues, in the current study we examined whether this model also applies to interoceptive threat by evaluating the extent to which individual differences in AC moderated the relationship between trait anxiety and self-reported fear in response to a single vital capacity inhalation of a 35% CO(2), 65% balanced O(2) gas mixture. The sample comprised a large nonclinical group of young adults (N=128). Results indicated that AC moderated the relationship between trait anxiety and fearful responding to the challenge. Findings suggest that AC plays a significant and clinically important role in modulating self-reported fear.

Ethnoracial differences in anxiety sensitivity: examining the validity of competing anxiety sensitivity index subscales.

Despite the increasing number of Americans who are considered to be a part of an ethnoracial minority group, there have been few investigations of the cross-cultural validity of measures of psychopathology. The limited existing literature suggests potential differences between African American (AA) and European American (EA) individuals with respect to the utility of self-report measures, including anxiety sensitivity. Physical, mental, and social domains of anxiety sensitivity are measured using subscales derived from a 3-factor model reported in EA samples despite evidence suggesting that anxiety sensitivity in AA samples is characterized by more distinct physical concerns. The current study compared the concurrent and predictive validity of the traditional anxiety sensitivity subscales representing 3 domains and a 4-subscale formulation based on predictions about the construct in AA samples. Comparisons of both AA (N=41) and EA (N=298) samples are included. Findings suggest some ethnoracial group differences in the concurrent and predictive validity of anxiety sensitivity subscales, specifically supporting the appropriateness and specificity of the 4-factor model of anxiety sensitivity in AA samples. Implications are discussed, including identification of sociocultural mechanisms that might influence psychometric properties of measures of anxiety.

Anchoring the Panic Disorder Severity Scale.

The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend its clinical meaningfulness by examining its association with quality of life. A total of 63 individuals with a primary diagnosis of panic disorder were assessed on completion of a 6- or 8-week psychotherapy or pharmacotherapy trial for the treatment of panic disorder. As expected, the PDSS was correlated with both the CGI-S and quality of life. These results provide further support for the validity and clinical utility of the PDSS and provide simple anchors to help guide the potential use of the PDSS scale to measure treatment progress in clinical practice.

Excessive reassurance seeking and anxiety pathology: tests of incremental associations and directionality.

Excessive reassurance-seeking (ERS) is hypothesized to play a key role in emotional disorders but has been studied mostly in relation to depression. Study 1 reports a new measure of reassurance seeking that assessed ERS related to general and evaluative threats in a non-clinical student sample, and its factor structure was further examined in Study 2. In Study 3, the scale, along with other symptom-related measures and an existing measure of depressive ERS, was administered to an undergraduate sample at two different time points, one month apart. Greater ERS was associated with greater symptoms of social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder (OCD), even after controlling for trait anxiety, depression, and intolerance of uncertainty. Among OCD symptoms, only thoughts of harm were uniquely related to ERS, a finding consistent with emerging literature. ERS involving general threats also predicted changes in social anxiety and GAD symptoms one month later. Overall, the findings implicate an important role for ERS across anxiety disorders.

The association between irritable bowel syndrome and the anxiety vulnerability factors: body vigilance and discomfort intolerance.

Individuals with Irritable Bowel Syndrome (IBS) endorse greater negative affect, including anxiety psychopathology. To examine the role anxiety plays in the maintenance and exacerbation of IBS the links between IBS and two anxiety related constructs, body vigilance and discomfort intolerance, were examined. A non-treatment seeking college sample (N = 476) completed measures that assessed IBS symptomatology, vigilance to bodily sensations and ability to tolerate physical discomfort. A total of 4.2 percent of the sample met Rome II criteria for IBS. Consistent with the hypotheses, IBS symptoms were associated with increased vigilance to bodily sensations and increased desire to avoid these sensations.

Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity.

Research focused on psychological risk factors for anxiety psychopathology has led to better conceptualization of these conditions as well as pointed toward preventative interventions. Anxiety sensitivity (AS) has been well-established as an anxiety risk factor, while distress tolerance (DT) is a related construct that has received little empirical exploration within the anxiety psychopathology literature. The current investigation sought to extend the existing literature by examining both DT and the relationship between DT and AS across a number of anxiety symptom dimensions, including panic, generalized anxiety, social anxiety, and obsessive-compulsive anxiety. Participants (N=418) completed a number of measures that assessed DT, AS, anxiety symptomatology, and negative affect. Findings indicated that DT was uniquely associated with panic, obsessive compulsive, general worry, and social anxiety symptoms, but that DT and AS were not synergistically associated with each of these symptom dimensions. These findings indicate that an inability to tolerate emotional distress is associated with an increased vulnerability to experience certain anxiety symptoms.

Suppressing the White Bears interacts with Anxiety Sensitivity in the prediction of Mood and Anxiety Symptoms.

Suppression is a commonly used strategy to manage unwanted thoughts by attempting to actively remove them from awareness. However, research has shown that this cognitive strategy often results in the paradoxical effect of increasing the frequency of unwanted thoughts. While the association between thought suppression and mood and anxiety symptoms has been repeatedly demonstrated, relations between this cognitive strategy and other anxiety risk factors such as anxiety sensitivity (AS) are unexplored. Using a nonclinical sample of young adults (N = 414), the current investigation sought to more thoroughly investigate the association between AS and thought suppression as well as explore their synergistic effect on anxiety symptomatology. As hypothesized, thought suppression and AS were positively associated. Moreover, AS and thought suppression interacted to predict elevated levels of panic and obsessive compulsive symptomatology.

Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication.

Research has accumulated over the past several years demonstrating a relationship between childhood abuse and anxiety disorders. Extant studies have generally suffered from a number of methodological limitations, including low sample sizes and without controlling for psychiatric comorbidity and parental anxiety. In addition, research has neglected to examine whether the relationships between anxiety disorders and childhood abuse are unique to physical abuse as opposed to sexual abuse and vice versa. The current study sought to examine the unique relationships between anxiety disorders and childhood physical and sexual abuse using data from the National Comorbidity Survey-Replication. Participants (n=4141) completed structured interviews from which data on childhood abuse history, lifetime psychiatric history, parental anxiety, and demographics were obtained. After controlling for depression, other anxiety disorders, and demographic variables, unique relationships were found between childhood sexual abuse and social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD); in contrast, physical abuse was only associated with PTSD and specific phobia (SP). Further, among women, analyses revealed that physical abuse was uniquely associated with PTSD and SP, while sexual abuse was associated with SAD, PD, and PTSD. Among men, both sexual and physical abuse were uniquely associated with SAD and PTSD. Findings provide further evidence of the severe consequences of childhood abuse and help inform etiological accounts of anxiety disorders.

Anxiety sensitivity: prospective prediction of anxiety among early adolescents.

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks as well as clinical syndromes in adult samples. The primary aim of the present study was to determine whether AS similarly acts as a vulnerability factor in the pathogenesis of anxiety symptoms among youth in early adolescence (ages 9-13). A large nonclinical community sample of youth (n=277) was prospectively followed over 1 year. The Childhood Anxiety Sensitivity Index (CASI: Silverman, Fleisig, Rabian, & Peterson, 1991) served as the primary predictor. After controlling for baseline anxiety symptoms as well as depression, AS significantly predicted the future development of anxiety symptoms. Consistent with the adult literature and expectancy theory, AS appears to act as a risk factor for anxiety symptoms in youth.

Comorbid panic attacks among individuals with posttraumatic stress disorder: associations with traumatic event exposure history, symptoms, and impairment.

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n=203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.

Treatment of panic.

The present review summarizes empirical developments in the psychosocial treatment of panic and panic disorder by focusing on four key themes that have been emphasized in this literature: (a) treatment efficacy, effectiveness, and innovation; (b) modulating and process variables in treatment; (c) effective dissemination of treatment; and (d) prevention of panic. Cognitive behavioral treatments (CBTs) for panic are very good, even in the context of comorbidity, but the level of efficacy does not appear to be increasing over time. Unfortunately, there have been relatively few substantive innovations in CBT protocols since the 1980s, and despite progress in the use of computer technology, dissemination of these treatments is lagging. The prevention of panic-spectrum psychopathology is a promising area linked with advances in the identification of panic-relevant risk factors that appear to modulate CBT outcomes.

Anxiety disorders and suicidality in the National Comorbidity Survey-Replication.

OBJECTIVE: The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide. METHOD: Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed. RESULTS: Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men. CONCLUSIONS: Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.