Amanda M. Raines

Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns.

OBJECTIVE Anxiety sensitivity (AS) is a well-established, malleable risk factor for anxiety and other forms of psychopathology. Structural evaluation models of AS suggest it can be decomposed into physical, social, and cognitive concerns, and emerging work indicates that these components may be differentially related to various adverse outcomes. In particular, AS cognitive concerns have been consistently linked with suicide. Prior work has also shown that brief interventions can effectively reduce overall AS, but these treatments tend to focus on its physical subcomponent. The aim of the current investigation was to design and evaluate the efficacy of an AS treatment more specifically focused on its cognitive component. METHOD Non-treatment-seeking participants (N = 108) with elevated AS were randomly assigned to a 1-session intervention utilizing psychoeducation and interoceptive exposure techniques to target AS or a health information control intervention and assessed posttreatment and at 1-month follow-up. RESULTS The active treatment condition produced significantly greater reductions in AS at posttreatment. Group differences persisted at 1-month follow-up that were specific to AS cognitive concerns. Moreover, changes in cognitive AS mediated symptom change at follow-up including suicide outcomes. CONCLUSIONS Despite the brevity of the treatment intervention, findings demonstrate that it resulted in substantial reductions in AS cognitive concerns that were linked with symptom improvement.

Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology

BACKGROUND Intolerance of uncertainty (IU) is a cognitive vulnerability factor associated with a wide range of anxiety psychopathology. Other cognitive vulnerabilities such as anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI) have also been investigated as constructs of interest across anxiety disorders. As researchers increasingly uncover viable transdiagnostic vulnerabilities to anxiety, it becomes important to determine the degree of overlap between these constructs. METHODS The present studies examined the unique relationships between IU, other vulnerability factors (AS, DT, and DI) and social anxiety, obsessive-compulsive, and worry symptoms across two nonclinical samples (n=217, n=241). RESULTS Findings were highly consistent across samples. IU was significantly associated with anxiety symptoms in all analyses, even when accounting for other transdiagnostic risk variables. Anxiety sensitivity, was uniquely related to social anxiety and obsessive-compulsive symptoms in all analyses, but was related to worry in only one study. Distress tolerance was only uniquely associated with worry. Discomfort intolerance was not uniquely related to the anxiety symptoms in any analyses. LIMITATIONS Future research should attempt to replicate the findings in a clinical population and utilize a longitudinal design. CONCLUSIONS The robust and incremental relationships between IU and anxiety symptoms suggests the potential benefit of targeting IU in the context of transdiagnostic anxiety treatments.

Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation.

Anxiety sensitivity (AS) is composed of three lower-order dimensions, cognitive concerns, physical concerns, and social concerns. We examined the relations between AS dimensions using a more adequate assessment of subscales (ASI-3) than has previously been used, and measures of anxiety and mood disorders as well as suicidal ideation in a sample of 256 (M age = 37.10 years, SD = 16.40) treatment-seeking individuals using structural equation modeling. AS cognitive concerns was uniquely associated with generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation. AS physical concerns was uniquely associated with OCD, social anxiety disorder (SAD), panic disorder (PD), and specific phobia. AS social concerns was uniquely associated with SAD, GAD, OCD, and MDD. These results highlight the importance of considering the lower-order AS dimensions when examining the relations between AS and psychopathology.

Reduction of cognitive concerns of anxiety sensitivity is uniquely associated with reduction of PTSD and depressive symptoms: a comparison of civilians and veterans.

PTSD and comorbid depression are common among civilians and veterans, resulting in substantial impairment. Anxiety sensitivity (AS) may be a common malleable vulnerability factor for PTSD and depression. The AS cognitive concerns subscale is most strongly related to symptoms of PTSD and depression, and thus, may be an efficient route to reduce these symptoms. The current study evaluated a brief computerized intervention targeting AS cognitive concerns. Specifically, we evaluated whether reduction in AS cognitive concerns was associated with reduction in symptoms of PTSD and depression. Also, we evaluated whether there was a significant difference between civilians and veterans in response to the intervention. The single session intervention utilized psychoeducation and interoceptive exposure to target AS cognitive concerns. This intervention was compared to a health information condition among a sex-matched sample of civilians and veterans with elevated AS cognitive concerns (N = 56). Reduction in AS cognitive concerns over one month was uniquely associated with reduction in PTSD and depressive symptoms in the same time frame. There were no significant differences between civilians and veterans in response to the intervention suggesting the intervention has efficacy for both groups. Treatment implications are discussed.

A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation.

Objective: Anxiety sensitivity (AS) is a well-established transdiagnostic risk factor for anxiety and mood psychopathology including suicide. A variety of interventions using cognitive–behavioral skills as well as cognitive bias modification (CBM) suggest that AS can be quickly and effectively reduced in nonclinical and nontreatment seeking samples. However, it is unclear whether AS reduction protocols will have efficacy for more severe clinical samples. Moreover, the combination of cognitive–behavioral techniques with CBM focused on changing interpretation bias (CBM-I) related to AS has not been evaluated. Method: A patient sample with co-occurring anxiety psychopathology and active suicidal ideation (N = 74) was randomly assigned to a brief 1-session computerized treatment including: (a) psychoeducation and interoceptive exposure (i.e., cognitive anxiety sensitivity treatment [CAST]) plus CBM-I for AS; or (b) health information condition plus sham CBM for AS. Participants were assessed immediately after the 1-hr intervention as well as at 1- and 4-month follow-ups. Results: Consistent with hypotheses, participants in the active treatment showed significantly greater AS reduction that was maintained through follow-up (effect sizes ranged from medium to large for the overall AS and the AS subscales). Mediation analyses suggested that changes in AS mediated suicide outcomes. Conclusions: In sum, these are the first findings to suggest that brief AS reduction protocols have efficacy both in terms of risk and symptom outcomes in patient samples showing active suicidal ideation.

Intolerance of uncertainty as a predictor of post-traumatic stress symptoms following a traumatic event

Intolerance of uncertainty (IU) has been associated with elevated post-traumatic stress symptoms (PTSS) in the extant literature. However, no research to date has investigated whether pre-trauma IU predicts PTSS following trauma exposure. The current study prospectively examined the relationship between IU and PTSS within a sample of individuals with various levels of exposure to a university campus shooting. We hypothesized that pre-trauma IU would predict elevated PTSS following a campus shooting, even after covarying for anxiety sensitivity (AS), a known correlate of PTSS. Participants included undergraduates (n=77) who completed a self-report battery in Introductory Psychology. After a campus shooting, they were invited to complete measures of PTSD symptoms and level of exposure to the shooting. As anticipated, results revealed pre-trauma IU as a significant predictor of elevated PTSS following the campus shooting. These results remained significant after covarying for pre-trauma levels of AS. Our results are the first to demonstrate that elevated pre-trauma levels of IU predict later PTSS following exposure to a traumatic event. This finding is discussed in terms of promising directions for future research and treatment strategies.

The effects of an anxiety sensitivity intervention on insomnia symptoms

OBJECTIVE Recent work suggests a link between a transdiagnostic vulnerability factor, anxiety sensitivity (AS), and sleep disturbance. Although research has indicated that AS is malleable through brief interventions, no studies have yet examined whether interventions targeting AS will reduce symptoms of insomnia. Considering this gap in previous research, the current study tested the direct and indirect effects of a brief, computerized intervention targeting AS on self-reported insomnia symptoms. METHODS Community participants (N = 97) were randomized into either the AS intervention (consisting of psychoeducation and interoceptive exposure) or a health information control condition, and they were assessed at baseline and at 1-month follow-up. RESULTS Findings indicated that symptoms of insomnia were related to AS and its subfactors at baseline and follow-up. Moreover, there was an indirect effect of the treatment on insomnia symptoms through AS and its subfactors, which held after covarying for baseline symptoms of anxiety and depression. CONCLUSIONS These preliminary findings suggest that targeting AS may be a brief and effective way to reduce symptoms of insomnia, but it should be replicated in a clinical sample of individuals with a diagnosis of insomnia disorder.

Identification of anxiety sensitivity classes and clinical cut-scores in a sample of adult smokers: Results from a factor mixture model

Anxiety sensitivity (AS), a multidimensional construct, has been implicated in the development and maintenance of anxiety and related disorders. Recent evidence suggests that AS is a dimensional-categorical construct within individuals. Factor mixture modeling was conducted in a sample of 579 adult smokers (M age=36.87 years, SD=13.47) to examine the underlying structure. Participants completed the Anxiety Sensitivity Index-3 and were also given a Structured Clinical Interview for DSM-IV-TR. Three classes of individuals emerged, a high AS (5.2% of the sample), a moderate AS (19.0%), and a normative AS class (75.8%). A cut-score of 23 to identify high AS individuals, and a cut-score of 17 to identify moderate-to-high AS individuals were supported in this study. In addition, the odds of having a concurrent anxiety disorder (controlling for other Axis I disorders) were the highest in the high AS class and the lowest in the normative AS class.

Factor mixture modeling of anxiety sensitivity: a three-class structure.

Anxiety sensitivity (AS) is a multidimensional construct composed of several lower order factors and has been implicated in the development and maintenance of anxiety and depression symptoms and disorders. Recently, it has been suggested that AS is a dimensional-categorical construct, reflecting classes of individuals with different levels of and relations between AS factors. Factor mixture modeling was applied to examine the latent structure of AS in a sample of 1,151 college students (M age = 18.88, SD = 1.91). Results indicated that the best fitting model comprised three classes consisting of individuals with normative AS (n = 953), moderate AS (n = 124), and high AS (n = 74). Relations among the factors appeared to be different across groups, with the highest relations found in the normative AS class and the lowest relations found in the high AS class. There were significant differences in mean levels of anxiety and depression symptoms across classes, with the exception of social anxiety disorder symptoms. This study was the first to find and provide support for a third AS class. Implications for research and clinical utility are discussed, including the benefit of developing cut scores for AS classes based on this and similar studies.

Anxiety sensitivity facets in relation to tobacco use, abstinence-related problems, and cognitions in treatment-seeking smokers

Anxiety sensitivity (AS)--fear of anxiety-related experiences--has been implicated in smoking motivation and maintenance. In a cross-sectional design, we examined AS facets (physical, cognitive, and social concerns) in relation to tobacco use, abstinence-related problems, and cognitions in 473 treatment-seeking smokers. After controlling for sex, race, age, educational attainment, hypertension status, and neuroticism, linear regression models indicated that AS physical and cognitive concerns were associated with tobacco dependence severity (β=.13-.14, p<.01), particularly the severity of persistent smoking regardless of context or time of day (β=.14-.17, p<.01). All three AS facets were related to more severe problems during past quit attempts (β=.23-.27, p<.001). AS cognitive and social concerns were related to negative affect reduction smoking motives (β=.14, p<.01), but only the social concerns aspect of AS was related to pleasurable relaxation smoking motives and positive and negative reinforcement-related smoking outcome expectancies (β=.14-.17, p<.01). These data suggest that AS physical and cognitive concerns are associated with negative reinforcement-related smoking variables (e.g., abstinence-related problems), whereas the social concerns aspect of AS is associated with positive and negative reinforcement-related smoking variables. Together with past findings, current findings can usefully guide AS-oriented smoking cessation treatment development and refinement.