Darin R. Lerew

The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress.

Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.

Body vigilance in panic disorder : Evaluating attention to bodily perturbations

Body vigilance, consciously attending to internal cues, is a normal adaptive process. The present report investigated whether body vigilance is exaggerated among those with panic disorder, a condition characterized by intense fear and worry regarding bodily sensations. The Body Vigilance Scale is validated in nonclinical and anxiety disorder samples. Study 1 suggests that body vigilance is normally distributed in a nonclinical sample (n = 472) but vigilance is related to a history of spontaneous panic attacks, anxiety symptomatology, and anxiety sensitivity. Study 2 suggests that body vigilance is elevated in panic disorder patients (n = 48) relative to social phobia patients (n = 18) and nonclinical controls (n = 71). During cognitive-behavioral treatment, panic disorder patients show substantial reductions in body vigilance associated with reductions in anxiety symptomatology. Anxiety sensitivity was found to be related to body vigilance and to predict changes in body vigilance during treatment.

Anxiety sensitivity and the pathogenesis of anxiety and depression: evidence for symptom specificity

Expectancy theory posits that anxiety sensitivity (AS) acts as a specific risk factor for the development of anxiety pathology (Reiss, 1991). Previous work suggests that AS is a risk factor for anxiety but several reports have found that AS is also related to depression. The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety and depression in both a large nonclinical sample (N = 1401) as well as a patient sample (N = 53). A covariance analytic strategy indicated that AS possesses symptom specificity with respect to anxiety but is not predictive of depression when accounting for changes in anxiety symptoms. Component analyses suggest, however, that one first-order factor (phrenophobia) is likely to account for the association between AS and depression because it is non-specific (i.e. associated with unique aspects of both anxiety and depression). It is concluded that much of the general association noted between anxiety sensitivity and depression is likely to be due to covariation among symptoms of anxiety and depression.

Evaluating Latent Discontinuity in Cognitive Vulnerability to Panic: A Taxometric Investigation

Taxometrics is a statistical tool that can be used to discern psychopathological categories from continua. In this study, taxometric analyses were conducted to determine whether a psychopathological category (or taxon) underlies a cognitive vulnerability to panic (i.e., fear of anxiety symptoms and body vigilance). The construct was operationalized with 3 variables: the Anxiety Sensitivity Index, the Body Sensations Questionnaire, and the Body Vigilance Scale. The test was performed in a large nonclinical sample (N = 1,224). Analyses and consistency tests support the taxonic conjecture for the existence of a latent cognitive vulnerability taxon with a base rate of about 18% in this population. Moreover, tests of the taxon’s utility indicated that taxon membership has incremental validity in predicting future panic attacks.

Prospective Evaluation of Perceived Control, Predictability, and Anxiety Sensitivity in the Pathogenesis of Panic

Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. Perceived control and predictability have also been implicated as factors relevant to the genesis of anxiety. The principal aim of this study was to extend this work to examine independent and interactive effects of perceived control, predictability, and AS in the pathogenesis of panic. A large nonclinical sample of young adults (N = 1296) was prospectively followed over a 5- week highly stressful period of time (i.e., military basic training). Perceived control and predictability did not independently predict panic. However, there was evidence suggesting that AS interacted with perceived control such that high perceived control regarding basic training was protective against panic for individuals with high AS. Similarly, high perceived predictability during basic training reduced anxiety symptoms for individuals with high AS.

Latent structure of anxiety: Taxometric exploration.

Taxometrics is a statistical tool that can be used to discern categories from continua. Taxometric analyses (MAXCOV and MAXEIG) were conducted in a large nonclinical sample (N=1,215) to determine whether extreme anxiety forms a distinct psychopathological category, an anxiety taxon. Anxiety was operationalized with self-report measures of subjective anxiety, anxious cognitive style, physiological arousal, and anxiety-related impairment. Procedures consistently identified a taxon with a prevalence of approximately 11%. Examination of the taxons convergent and discriminant validity revealed that it reflects general distress rather than physiological arousal. Taxon membership showed some evidence of incremental validity.

Prospective Evaluation of Psychological Risk Factors as Predictors of Functional Impairment During Acute Stress

Increasing evidence suggests that psychological risk variables (e.g., anxiety sensitivity) may act as premorbid risk factors for the development of physical illness and psychopathology such as clinical anxiety and cardiovascular disease. The principal aim of the present study was to prospectively evaluate the degree to which these factors affected mental and physical health-related impairment and disability. A large nonclinical sample of young adults (N = 1296) was prospectively followed during a highly stressful period of time (i.e., military basic training). Consistent with expectation, each of the hypothesized risk factors contributed to the prediction of at least one index of impairment (e.g., visits to health clinic) after controlling for demographic factors, fitness, and history of psychiatric treatment. Moreover, gender interacted with risk factors in predicting outcomes suggesting that females with high anxiety sensitivity, relative to males with high anxiety sensitivity, are particularly prone to develop impairment during stress.

Differential roles of depressive and anxious symptoms and gender in defensiveness.

Among a sample of Air Force cadets facing the prospect of basic training (N = 1,190; 1,005 men and 185 women), the influence of a defensive test-taking style on measures of depressive and anxious symptoms was examined. Participants completed the Beck Depression Inventory (Beck & Steer, 1987) and the Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988), as well as the MMPI (Hathaway & McKinley, 1943) L scale. Results supported hypotheses that defensiveness would affect a self-report measure of depression but not a self-report measure of anxiety and would do so more among men than women. Applied implications of the results are discussed.

Imaginal provocation of panic in patients with panic disorder

An imaginal challenge was designed to determine the degree to which cognitive manipulations, in isolation from specific biological challenge agents, might be sufficient for the production of panic in patients with panic disorder. Patients with panic disorder (n = 20) and nonclinical controls (n = 18) were exposed to four audiotaped vignettes (physical threat, social threat, loss of control threat, control). In relation to a composite measure of panic, the experimental vignettes produced panic in 30% of the patient sample compared to 0% of the control sample. There was also evidence for increased subjective reactivity to personally relevant panicogenic stimuli.