Incremental Validity of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy Mechanisms for Anxiety and Panic Symptomology.

Background: acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they differ in their putative vulnerability and maintenance processes. The present study examined the incremental validity of several of these models' proposed core processes, including anxiety sensitivity (AS), dispositional avoidance, experiential avoidance (EA), cognitive fusion (CF), and mindfulness, as well as the interaction of the processes within each model, in the prediction of anxiety and panic symptomology. Methods: a sample of US adults (n = 316) completed self-report measures of AS, dispositional avoidance, EA, CF, mindfulness, anxiety, and PD symptoms. A series of hierarchical multiple regression analyses were conducted. Results: hierarchical regression analyses indicated that AS, dispositional avoidance, and EA predicted anxiety and panic symptoms even after controlling for one another, CF, mindfulness, and demographic variables. Although mindfulness and CF was correlated with anxiety and panic at the univariate level, they did not predict either outcome above and beyond AS, dispositional avoidance, and EA. When interaction terms were added to the models, the interaction between AS and -dispositional avoidance was a significant predictor of panic and anxiety symptoms, whereas the interaction between EA and CF only predicted panic symptoms. None of the interactions that included mindfulness were significant predictors. Conclusions: these findings provide support the independent and interactive predictive value of traditional CBT (AS, dispositional avoidance, and AS-dispositional avoidance) and ACT (EA) processes for anxiety and panic symptoms, but raise questions about the incremental predictive utility of CF and mindfulness.

A Taxometric Analysis of Experiential Avoidance.

Experiential avoidance, a trait-like construct referring to the tendency to rigidly avoid or change unpleasant internal experiences stemming from an unwillingness to experience them, is believed to contribute to the development and maintenance of various forms of psychopathology. Despite significant research on this construct, it remains unclear whether experiential avoidance is dimensional or categorical at the latent level. The current study examined the latent structure of experiential avoidance using three taxometric analytic approaches (MAXimum Eigenvalue, Mean Above Minus Below A Curve, Latent-Mode Factor Analysis) applied to data from two independent samples and using three widely used measures of experiential avoidance. The first sample (n = 922) completed the Multidimensional Experiential Avoidance Questionnaire (Gámez, Chmielewski, Kotov, Ruggero, & Watson, 2011), while the second sample (n = 615) completed the Brief Experiential Avoidance Questionnaire (Gámez et al., 2014) and Acceptance and Action Questionnaire-II (Bond et al., 2011). Across both samples and all three measures, experiential avoidance exhibited a dimensional structure. The clinical and research implications of this finding for experiential avoidance are discussed.

Anxiety sensitivity mediates the relationship between exercise frequency and anxiety and depression symptomology.

The anxiolytic and antidepressant effects of regular physical exercise have been well documented, though the mechanisms through which exercise alleviates symptoms of emotion disorders require further investigation. Mounting research indicates that exercise reduces anxiety sensitivity, a known vulnerability factor for the development and maintenance of psychological disorders, presumably via repeated exposure to feared somatic sensations. The purpose of the present study was to examine whether anxiety sensitivity mediates the relation between exercise frequency and symptoms of anxiety and depression. A large community sample of 955 volunteers completed a demographic questionnaire, the Anxiety Sensitivity Index-3, and the Brief Symptom Inventory-18. Exercise frequency significantly predicted anxiety sensitivity, anxiety, depression, and somatization scores. Mediation analyses indicated that anxiety sensitivity mediated the association between exercise frequency and anxiety, depression, and somatization symptoms. The findings provide further support for the association between exercise and negative affective states and suggest that anxiety sensitivity may be one mechanism through which exercise reduces emotional disorder symptomology. The implications of these findings and recommendations for future research are discussed.

The latent structure of social anxiety disorder and the performance only specifier: a taxometric analysis.

Social anxiety disorder (SAD) is often treated as a discrete diagnostic entity that represents a naturally occurring class, though empirical evidence largely supports a dimensional conceptualization of social fears. Further, the inclusion of a "performance only" specifier in the DSM-5 implies that individuals who experience intense social anxiety exclusively in performance situations are distinct from those with broader social fears. The purpose of the present research was to examine the latent structure of SAD and the DSM-5 "performance only" specifier in a large nonclinical sample (n = 2019). Three taxometric procedures (MAXCOV, MAMBAC, and L-Mode) were applied to indicators derived from two commonly used measures of social anxiety. Results yielded convergent evidence indicating that social anxiety exhibits a dimensional latent structure. Further, social performance anxiety demonstrates continuous relationships with milder social fears, suggesting that the "performance only" specifier may not represent a discrete entity. The implications of these findings for the assessment, diagnosis, classification, and treatment of social anxiety are discussed.

Nonsuicidal Self-Injury and Suicidal Self-Injury: A Taxometric Investigation.

The present research examined the latent structure of self-injurious behavior (SIB) to determine whether suicidal self-injury (SSI) and nonsuicidal self-injury (NSSI) reflect categorically distinct types of SIB or dimensional variations of the same construct. Participants consisted of 1,525 female undergraduates across several universities in the United States who completed the Survey of College Mental Health and Well Being and endorsed a history of SIB. Empirically derived indicators representing intent to die, suicidal history, frequency of SIB, severity of SIB, and number of methods of SIB were submitted to three mathematically independent taxometric procedures. Results of multiple consistency tests converged to indicate that the latent structure of SIB is continuous, with individuals who engage in SSI and NSSI differing in degree rather than kind. The implications of these dimensional findings for the theoretical conceptualization, assessment, and treatment of SIB are discussed.

Effects of a Single Bout of Aerobic Exercise Versus Resistance Training on Cognitive Vulnerabilities for Anxiety Disorders.

The purpose of this study was to compare the relative effects of a single bout of aerobic exercise versus resistance training on cognitive vulnerabilities for anxiety disorders. Seventy-seven participants (60% female; 84% Caucasian) were randomized to complete 20 min of moderate-intensity aerobic exercise, resistance training, or rest, followed by a 35% CO2/65% O2 inhalation challenge task. Results indicated that aerobic exercise and resistance training were significantly and equally effective in reducing anxiety sensitivity (AS) compared with rest ((η(2)(p ) = 52), though only aerobic exercise significantly attenuated reactivity to the CO2 challenge task. Neither form of exercise generated observable effects on distress tolerance, discomfort intolerance, or state anxiety (all ps >.10). The results of this study are discussed with regard to their implications for the use of exercise interventions for anxiety and related forms of psychopathology, and potential directions for future research are discussed.

Perceived stress and ADHD symptoms in adults.

OBJECTIVE: Given that ADHD has been linked to dysfunction across development and in many life domains, it is likely that individuals experiencing these symptoms are at increased risk for experiencing stress. The current study examines the association between ADHD and other psychiatric symptoms and perceived stress in a community sample of adults. METHOD: Perceived stress data collected from 983 participants (M(age) = 45.6 years) were analyzed primarily via hierarchical multiple regression using ADHD symptom clusters, demographic variables, and anxiety and depression scale variables as predictors. RESULTS AND CONCLUSION: ADHD symptoms positively associated with perceived stress. Inattention and sluggish cognitive tempo (SCT), as opposed to hyperactivity-impulsivity and newly proposed executive dysfunction symptoms, were the most consistent predictors. These findings reinforce that the experience of ADHD symptoms in adulthood is associated with stress and suggest that SCT could play an important role in assessing risk for negative adult outcomes.

Anxiety sensitivity and risk-taking behavior.

High trait anxiety has been linked with risk-avoidant decision-making, though little is known regarding the specific facets of anxiety contributing to this negative association. Anxiety sensitivity (AS), a transdiagnostic vulnerability factor for anxiety-related pathology, may be particularly relevant to risk decision-making given that risk-taking behaviors generate heightened somatic arousal and produce many of the sensations feared by individuals with high AS. Two studies were conducted to investigate the relation between AS and risk decision-making. In the first study, 268 undergraduate students completed a series of questionnaires that included measures of AS and gambling behaviors. Significant negative correlations were observed between AS and several gambling-related risk-taking activities, and hierarchical multiple regression analyses indicated that AS scores added significant incremental validity in predicting risk-taking over and above demographic variables, negative affect, and trait anxiety. In the second study, 43 participants who had screened for high (n=20) or low (n=23) AS completed the Iowa gambling task, a behavioral measure of risk-taking. Results indicated that, when placed under conditions of risk, individuals with high AS engaged in significantly less risk-taking than their low AS counterparts. The implications of these findings and potential directions for future research 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).

A taxometric investigation of the latent structure of eating disorders.

The present study examined the latent structure of eating disorder symptoms in a large sample of patients with a diagnosis of anorexia nervosa restricting type, anorexia nervosa binge eating/purging type, and bulimia nervosa (n=3747). Three taxometric procedures (MAXimum EIGenvalue (MAXEIG), Mean Above Minus Below A (MAMBAC), and Latent-Mode Factor Analysis (L-Mode)) were applied to self-reported symptoms of bulimia, drive for thinness, body dissatisfaction, as well as body mass index. Taxometric analysis among patients with the restricting and binge eating/purging subtype of anorexia and those with bulimia nervosa supported a dimensional latent structure of eating disorder symptoms. Taxometric analysis also revealed a dimensional latent structure of eating disorder symptoms among patients with the restricting and binge eating/purging subtype of anorexia suggesting that the two anorexia subtypes may not represent discrete categories. These findings suggest that the diagnosis and assessment of eating disorder symptoms should be conceptualized from a dimensional framework.

Exercise frequency is related to psychopathology but not neurocognitive function.

INTRODUCTION: In this study, we measured neurocognitive function, perceived stress, quality of life (QOL), and psychopathology in community-dwelling adults, with data contrasted across tertiles of exercise frequency. METHODS: A group of 998 adults (age 18-85 yr) was measured for neurocognitive function using a computerized neuropsychological test from CNS Vital Signs (Morrisville, NC). They also completed the Brief Symptom Inventory (BSI), which measures psychopathology, as well as the World Health Organization QOL questionnaire and the Perceived Stress Scale. General linear modeling was used to examine relationships between exercise frequency and neurocognitive function, BSI, QOL, and the Perceived Stress Scale. Backward selection in the GLMSELECT procedure in SAS (version 9.1.3; SAS Institute, Inc., Cary, NC) was used to identify confounding variables including age, gender, body mass index, marital status, education level, stress level, alcohol, smoking, and chronic disease. A contrast to test linear trend was performed after adjusting for confounders. Pairwise comparisons were performed across exercise frequency tertiles using the Tukey-Kramer method. RESULTS: P values for trend tests and pairwise comparisons were nonsignificant for all five cognition function domains across exercise frequency tertiles after adjustment for confounders. Age and education level emerged as the best correlates of neurocognitive function. P values for trend were significant for all BSI domains and indices, QOL, and perceived stress, across exercise frequency tertiles. CONCLUSIONS: In conclusion, nine BSI psychopathology domains, perceived stress, and QOL but not five neurocognitive function domains were modestly but significantly associated with aerobic exercise frequency in a heterogeneous group of community-dwelling adults after adjustment for demographic and lifestyle factors.

The effects of quercetin supplementation on cognitive functioning in a community sample: a randomized, placebo-controlled trial.

BACKGROUND: The purpose of the present study was to examine the effects of quercetin supplementation on neurocognitive functioning. METHODS: A large community sample (n = 941) completed a 12-week supplementation protocol, and participants were randomly assigned to receive 500 mg/day or 1000 mg/day quercetin, or placebo. RESULTS: Results failed to indicate significant effects of quercetin on memory, psychomotor speed, reaction time, attention, or cognitive flexibility, despite large increases in plasma quercetin levels among the quercetin treatment groups. DISCUSSION: Consistent with recent research, this study raises concerns regarding the generalizability of positive findings of in vitro and animal quercetin research, and provides evidence that quercetin may not have an ergogenic effect on neurocognitive functioning in humans.

The effects of physiological arousal on cognitive and psychomotor performance among individuals with high and low anxiety sensitivity.

Information-processing models of anxiety posit that anxiety pathology is associated with processing biases that consume cognitive resources and may detract from one's ability to process environmental stimuli. Previous research has consistently indicated that high anxiety has a negative impact on cognitive and psychomotor performance. Anxiety sensitivity, or the fear of anxiety and anxiety-related arousal sensations, is an anxiety vulnerability factor that has been shown to play a role in the development and maintenance of panic attacks and panic disorder. However, relatively little is known regarding the potential impact of anxiety sensitivity on performance. In the present study, 105 college students who scored either high (≥ 24) or low (≤ 14) on the Anxiety Sensitivity Index were randomly assigned to complete a series of arousal-induction tasks or no activity, followed immediately by three cognitive and psychomotor performance tasks: digit span - backward, math fluency, and grooved pegboard. Results indicated that participants with high anxiety sensitivity performed comparably to individuals with low anxiety sensitivity on each task, regardless of arousal level.

A taxometric study of hypochondriasis symptoms.

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

Categorical or dimensional: a reanalysis of the anxiety sensitivity construct.

Anxiety sensitivity, or the fear of anxiety sensations, has been implicated in the etiology of anxiety disorders, particularly panic disorder. Recently, inconsistent findings have been reported regarding the latent structure of anxiety sensitivity. Whereas some taxometric studies of anxiety sensitivity have reported evidence of categorical latent structure, others have found evidence of a latent dimension. The purpose of the present research was to further examine the latent structure of anxiety sensitivity using taxometric procedures and commonly utilized measures of anxiety sensitivity. To this end, three mathematically independent taxometric procedures (MAXEIG, MAMBAC, and L-Mode) were applied to data collected from two large nonclinical samples (n's=1,171 and 2,173) that completed the Anxiety Sensitivity Index and the Anxiety Sensitivity Index-Revised. Results from both studies converged in support of a dimensional conceptualization of anxiety sensitivity. A third study was conducted using indicators derived from the newly revised Anxiety Sensitivity Index-3 in a separate sample of 1,462 nonclinical participants. Results of these analyses provided further support for a dimensional anxiety sensitivity solution. The implications of these results for anxiety sensitivity research are discussed, and several potential directions for future research are considered.

A taxometric investigation of the latent structure of worry: dimensionality and associations with depression, anxiety, and stress.

Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n=1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n=1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.

The latent structure of posttraumatic stress disorder among adolescents.

Debate has arisen over whether posttraumatic stress disorder (PTSD) is most accurately conceptualized as representing a discrete clinical syndrome or an extreme reaction to traumatic life events. Recent taxometric research using predominantly adult samples appears to support a dimensional model of PTSD, raising questions about the utility of current psychiatric nosology which depicts PTSD as a distinct entity. The present study sought to use taxometric procedures to examine the latent structure of posttraumatic stress reactions among a national epidemiologic sample of 2,885 adolescents. Results were consistent with previous taxometric studies in supporting a dimensional model of posttraumatic stress reactions. The implications of these findings for public policy, as well as the etiology and assessment of posttraumatic stress reactions, are discussed.

The Anxiety Sensitivity Index--Revised: confirmatory factor analyses, structural invariance in Caucasian and African American samples, and score reliability and validity.

The most commonly used measure of anxiety sensitivity is the 36-item Anxiety Sensitivity Index-Revised (ASI-R). Exploratory factor analyses have produced several different factors structures for the ASI-R, but an acceptable fit using confirmatory factor analytic approaches has only been found for a 21-item version of the instrument. We evaluated the fit of all published factor models for the 36- and 21-item ASI-R, modified the hierarchical model using an approach that does not eliminate items, evaluated the invariance of the modified model across Caucasian and African-American subsamples, and compared the reliability and validity of the 36-item and 21-item versions. The 21-item version of the ASI-R fit a four factor model, as did the 36-item version after several meaningful model modifications. The modified 36-item model was replicable in independent cases and its structural properties were generally invariant across race. Scores from the 36-item version exhibited superior reliability and criterion-related validity.

Latent structure of aversion: taxometric exploration.

Recent research has identified specific disorders that appear to be better characterized by the experience of aversion, rather than anxiety, which evolve from disgust-related affect. Three mathematically distinct taxometric procedures--MAXEIG, MAMBAC, and L-Mode--were applied to data from a large undiagnosed sample (N=909) to determine whether aversion forms a distinct psychopathological category (i.e., an aversion taxon). Aversion was operationalized with self-report measures of the frequency of disgust experiences (Disgust Propensity), the perceived emotional impact of disgust experiences (Disgust Sensitivity), and contamination ideation and excessive washing (Contamination Fear). The collective results across procedures, consistency tests, and analysis of simulated comparison data produced converging evidence in support of the conclusion that the latent structure of aversion is dimensional. Implications of these findings for the clinical assessment of aversion and its disorders are discussed.

Phenomenon of declining anxiety sensitivity scores: a controlled investigation.

BACKGROUND: Repeated administration of anxiety sensitivity measures can often produce declining scores, even in ostensible control groups, which is a significant concern for researchers. The reasons for these changes are as yet unknown, but could be because of regression to the mean in samples selected on extreme scores, exposure to general information about anxiety contained in psychiatric interviews, or mere exposure to anxiety sensitivity information. METHODS: This study sought to experimentally evaluate these potential explanations using a comprehensive measure of anxiety sensitivity and its subcomponents, a non-anxiety sensitivity measure (self-esteem), and participants representing the full spectrum of anxiety sensitivity. RESULTS: Results indicated significant decreases in anxiety sensitivity scores (but not self-esteem scores) that could not be accounted for by regression to the mean or exposure to information about anxiety in general. CONCLUSIONS: Several potential explanations for these findings are reviewed and implications for research study designs are discussed.