John P. Forsyth

Measuring experiential avoidance: A preliminary test of a working model

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.

Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression

Mindfulness has received considerable attention as a correlate of psychological well-being and potential mechanism for the success of mindfulness-based interventions (MBIs). Despite a common emphasis of mindfulness, at least in name, among MBIs, mindfulness proves difficult to assess, warranting consideration of other common components. Self-compassion, an important construct that relates to many of the theoretical and practical components of MBIs, may be an important predictor of psychological health. The present study compared ability of the Self-Compassion Scale (SCS) and the Mindful Attention Awareness Scale (MAAS) to predict anxiety, depression, worry, and quality of life in a large community sample seeking self-help for anxious distress (N = 504). Multivariate and univariate analyses showed that self-compassion is a robust predictor of symptom severity and quality of life, accounting for as much as ten times more unique variance in the dependent variables than mindfulness. Of particular predictive utility are the self-judgment and isolation subscales of the SCS. These findings suggest that self-compassion is a robust and important predictor of psychological health that may be an important component of MBIs for anxiety and depression.

Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans.

The aim of the present study was to evaluate anxiety-related psychological risk factors (e.g., anxiety sensitivity, perceived uncontrollability, emotional avoidance) and their relation to drug of choice and addiction severity in an inpatient residential substance abuse population. Fully detoxified veterans (N=94) meeting criteria for Axis I substance abuse disorders were enrolled in a 28-day residential substance abuse treatment program and completed the following measures at intake and discharge: Anxiety Sensitivity Index, Body Sensations Questionnaire (BSQ), Acceptance and Action Questionnaire (AAQ), Beck Depression Inventory (BDI; intake only), and the Anxiety Control Questionnaire (ACQ). Consistent with the expectation, veterans who reported more distress over bodily sensations (anxiety sensitivity, BSQ) and depressive symptoms (BDI) were more likely to avoid experiencing negative affect (AAQ) and perceived themselves as lacking in control (ACQ). Further, extent of avoidance, and to a lesser extent, controllability, discriminated between participants as a function of primary and comorbid diagnostic status, whereas anxiety sensitivity did not. No relation was found between anxiety sensitivity and drug of choice, and relations between assessed psychological factors and domains of addiction severity were mixed. Findings suggest that heightened bodily sensitivity, emotional avoidance, and perceived uncontrollability are common sequelae of patients seeking residential substance abuse treatment, but they do not contribute uniquely to drug of choice and measures of addiction severity. Theoretical and treatment implications are discussed with particular emphasis on approaches that may increase coping with untoward bodily cues, decrease avoidance of negative affect, and improve patients sense of personal control over their responses and the environment.

Emotional avoidance and panicogenic responding to a biological challenge procedure

Healthy undergraduates high (n = 27) and low (n = 27) in experiential avoidance underwent twelve 20 s inhalations of 20% carbon dioxide-enriched air, while physiological (e.g., skin conductance, heart rate, EMG, and end-tidal CO2) and subjective (e.g., subjective units of distress, evaluative ratings, number and severity of panic symptoms endorsed) reactions were continuously monitored. Individuals high in experiential avoidance endorsed more panic symptoms, more severe cognitive symptoms, and more fear, panic, and uncontrollability than their less avoidant counterparts. Magnitude of autonomic response did not discriminate between groups, nor were the observed effects accounted for by other risk factors for challenge-induced panic such as anxiety sensitivity. Results are discussed in terms of the pathoplastic relation between emotional avoidance and exacerbation of unpleasant emotional responses and the view that emotional avoidance may constitute a risk factor in the development and maintenance of anxiety disorders.

Anxiety Sensitivity Dimensions in the Prediction of Body Vigilance and Emotional Avoidance

The present study evaluated 2 interrelated hypotheses concerning the relation between specific anxiety sensitivity dimensions and how one responds to bodily sensations in a population with no known history of psychopathology (N = 214). Specifically, the Physical Concerns subscale of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986) was found to be uniquely and statistically predictive of bodily vigilance, whereas the Mental Incapacitation ASI subscale was predictive of emotional avoidance. These effects were above and beyond the variance accounted for by demographic variables, treatment history for common interoceptive medical conditions, subclinical panic attack history, and trait anxiety. We discuss these findings in relation to differential predictive validity conceptualizations of anxiety sensitivity, with implications for understanding models of health functioning and panic disorder.

Taxometric and factor analytic models of anxiety sensitivity: Integrating approaches to latent structural research.

This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), as indexed by the 16-item Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986), by using taxometric and factor-analytic approaches in an integrative manner. Taxometric analyses indicated that AS has a taxonic latent class structure (i.e., a dichotomous latent class structure) in a large sample of North American adults (N=2,515). As predicted, confirmatory factor analyses indicated that a multidimensional 3-factor model of AS provided a good fit for the AS complement class (normative or low-risk form) but not the AS taxon class (high-risk form). Exploratory factor analytic results suggested that the AS taxon may demonstrate a unique, unidimensional factor solution, though there are alternative indications that it may be characterized by a 2-factor solution. Findings suggest that the latent structural nature of AS can be conceptualized as a taxonic latent class structure composed of 2 types or forms of AS, each of these forms characterized by its own unique latent continuity and dimensional structure.

Sex differences in salivary cortisol in response to acute stressors among healthy participants, in recreational or pathological gamblers, and in those with posttraumatic stress disorder

Sex differences in incidence and severity of some stress-related, neuropsychiatric disorders are often reported to favor men, suggesting that women may be more vulnerable to aberrant hypothalamic-pituitary-adrenal (HPA) axis responses to stress. In this review, we discuss several investigations that we, and others, have conducted assessing salivary cortisol as a measure of HPA function. We have examined basal cortisol among healthy men and women and also following acute exposure to stressors. Among healthy participants, men had higher basal cortisol levels than did women. In response to acute stressors, such as carbon dioxide or noise, respectively, cortisol levels were comparable between men and women or higher among women. We have also examined cortisol levels among those with problem eating, gambling, or posttraumatic stress disorder (PTSD). Women with restrained eating habits have higher basal cortisol levels than do women without restrained eating habits. Pathological gamblers have more aberrant stress response to gambling stimuli than do recreational gamblers, and these effects are more prominent among men than women. Men who have motor vehicle accident related PTSD, demonstrate more aberrant cortisol function, than do their female counterparts. Although these sex differences in cortisol seem to vary with type of stress exposure and/or pathophysiological status of the individual, other hormones may influence cortisol response. To address this, cortisol levels among boys and girls with different stress-related experiences, will be the subject of future investigation.

The structure of perceived emotional control: Psychometric properties of a revised anxiety control questionnaire

The psychometric properties of the Anxiety Control Questionnaire (ACQ) were evaluated in 1,550 outpatients with DSM-1V anxiety and mood disorders and 360 nonclinical participants. Counter to prior findings, exploratory factor analyses produced a 3-factor solution (Emotion Control, Threat Control, Stress Control) based on 15 of the ACQs original 30 items. Factor analyses in two independent clinical samples (e.g., confirmatory factor analysis, CFA) replicated the 3-factor solution. Multiple-groups CFAs indicated that the measurement properties of the ACQ were invariant in male and female patients, and that the ACQ was largely form and parameter equivalent in a clinical versus nonclinical sample. Hierarchical analysis supported the existence of a higher-order dimension of perceived control. Structural regression analyses indicated that each of the ACQ factors accounted for significant unique variance in one or both latent factors representing the dimensions of autonomic anxiety and depression. The results are discussed in regard to their conceptual and psychometric implications to the construct of perceived emotional control.

Response intensity in content-specific fear conditioning comparing 20% versus 13% CO2-enriched air as unconditioned stimuli

This study examined the relation between the intensity of CO2-induced psychophysiological responses and content-specific fear conditioning. Sex-balanced groups of undergraduates (N = 96) were assigned to 1 of 3 conditioned stimuli (CSs) differing in fear-relevance, and within each CS, to either 20% or 13% CO2-enriched air (unconditioned stimuli [UCS]). Several psychophysiological measures were assessed before, during, and following conditioning phases. Consistent with expectation, electrodermal and cardiac conditioned responses were larger and more resistant to extinction when associated with fear-relevant compared with fear-irrelevant stimuli, and this overall effect of fear-relevance was more robust to the more intense UCS. Severity and frequency of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) panic symptoms also varied reliably with UCS intensity, and women reported more distress and symptoms than men. Overall, the findings suggest that content-specific fear conditioning is mediated, in part, by the intensity of the bodily response. The authors discuss clinical and theoretical implications for understanding fear onset in the absence of obvious environmental pain or trauma.

Evoking analogue subtypes of panic attacks in a nonclinical population using carbon dioxide-enriched air ☆

The increasing recognition that panic attacks are heterogeneous phenomena necessitates better and more objective criteria to define and examine what constitutes a panic attack. The central aim of the present study was to classify subtypes of panic attacks (i.e. prototypic, cognitive, and non-fearful) in a nonclinical sample (N = 96) based on the concordance/discordance between subjective and physiological responding to multiple inhalations of 20 and 13% CO2-enriched air. Results show that a substantial proportion of this nonclinical sample (55.2%) responded to the CO2 challenge in a manner consistent with clinical and research definitions of different subtypes of panic attacks. The implications of this dimensional approach for discriminating subtypes of panic in the laboratory are discussed as a means to better understand the phenomenology and nature of panic attacks.