Margo C. Watt

Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood

OBJECTIVE the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. METHOD 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. RESULTS consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. CONCLUSIONS elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.

Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks.

We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.

A brief cognitive-behavioral approach to reducing anxiety sensitivity decreases pain-related anxiety.

Anxiety sensitivity (AS; fear of anxiety‐related sensations) is a known risk factor for anxiety disorders and recently has been linked to pain disorders. The present study was guided by the hypothesis that a program designed to reduce AS levels might also result in a decrease in anxiety related to pain sensations. Female undergraduates, selected as either high or low in AS according to screening scores on the Anxiety Sensitivity Index (ASI), were randomly assigned to participate in 3 1‐hour, small group sessions of either cognitive behavioral therapy (CBT; psycho‐education, cognitive restructuring, and interoceptive exposure) or a non‐specific treatment (NST). Immediately prior to and following the intervention, participants completed the 20‐item Pain Anxiety Symptoms Scale (PASS‐20). Consistent with hypothesis, results revealed a 3‐way interaction between AS group, intervention condition, and time on PASS‐20 total scores. Only participants with high pre‐morbid levels of AS assigned to the CBT condition showed a significant reduction in scores on the PASS‐20 from pre‐ to post‐treatment. Implications for improving CBT approaches for pain disorders are discussed.

Brief CBT for high anxiety sensitivity decreases drinking problems, relief alcohol outcome expectancies, and conformity drinking motives: Evidence from a randomized controlled trial

Background: High anxiety sensitivity (AS; fear of anxiety sensations) is associated with frequent and problem drinking (Stewart, Samoluk, & MacDonald, ). Aims: It was hypothesized that a program designed to reduce AS levels in young adult women would also result in a decrease in their dysfunctional drinking behavior. Method: The brief cognitive behavioral therapy (CBT) intervention was conducted in small group format. Participants were selected to form high and low AS groups, according to their scores on the Anxiety Sensitivity Index (ASI; Peterson & Reiss, ), and randomly assigned to participate in 3 one-hour sessions of either brief CBT (i.e., psycho-education, cognitive restructuring, and physical exercise interoceptive exposure) or a control group seminar (discussion about psychology ethics). Drinking measures were assessed at pre-treatment and 10 weeks post-intervention. Results: Following the intervention, high AS participants in the CBT condition revealed significant reduction in conformity motivated drinking and emotional relief expectancies, as well as a 50% reduction in proportion meeting criteria for hazardous alcohol use as compared to other three groups. Conclusion: Findings suggest that alcohol abuse might be effectively prevented among high risk individuals with a brief CBT approach targeting high AS, and that AS may operate as one underlying determinant of dysfunctional drinking behavior. Declaration of interests: None.

Relations between anxiety sensitivity and dimensions of alexithymia in a young adult sample.

This study was conducted to assess the relations between anxiety sensitivity (AS) and dimensions of alexithymia in a nonclinical sample. We also sought to determine whether these relations persist after controlling for trait anxiety levels and panic attack history, and after controlling for item redundancy between the Anxiety Sensitivity Index (ASI) and the 20-item Toronto Alexithymia Scale (TAS-20). A sample of 238 undergraduate students completed the ASI, the TAS-20, and measures of trait anxiety and panic. A group of high AS participants (n=36) was found to have a significantly higher TAS-20 total score than a group of low AS participants (n=41), both before and after conceptually redundant TAS-20 items were removed. ASI scores were found to be significantly positively correlated with scores on the two TAS-20 subscales suspected of sharing a functional relation with AS (i.e., difficulty identifying emotions; difficulty describing emotions), whereas ASI scores were not significantly correlated with scores on the TAS-20 subscale believed to be functionally unrelated to AS (i.e., external-oriented thinking). This pattern of correlations between ASI scores and alexithymia dimensions persisted following the removal of conceptually redundant TAS-20 items, suggesting that the relation between AS and alexithymia is not merely an artifact of item redundancy. ASI scores remained significantly correlated with scores on the TAS-20s difficulty identifying emotions subscale, and marginally correlated with scores on the TAS-20s difficulty describing emotions subscale, after accounting for the influences of trait anxiety and panic history. The results also revealed that individuals who both experience frequent anxiety and who greatly fear their anxiety symptoms report the greatest difficulties identifying and describing emotional states. Implications for understanding the alexithymia construct, as well as potential clinical implications of the findings, are discussed.

Illness Attitudes Scale dimensions and their associations with anxiety-related constructs in a nonclinical sample

The Illness Attitudes Scale (IAS) is a self-rated measure that consists of nine subscales designed to assess fears, attitudes and beliefs associated with hypochondriacal concerns and abnormal illness behavior [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger; Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico]. The purposes of the present study were to explore the hierarchical factor structure of the IAS in a nonclinical sample of young adult volunteers and to examine the relations of each illness attitudes dimension to a set of anxiety-related measures. One-hundred and ninety-seven undergraduate university students (156 F, 41 M; mean age = 21.9 years) completed the IAS as well as measures of anxiety sensitivity, trait anxiety and panic attack history. The results of principal components analyses with oblique (Oblimin) rotation suggested that the IAS is best conceptualized as a four-factor measure at the lower order level (with lower-order dimensions tapping illness-related Fears, Behavior, Beliefs and Effects, respectively), and a unifactorial measure at the higher-order level (i.e. higher-order dimension tapping General Hypochondriacal Concerns). The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986, 1987), as well as with the factor structures identified in previously-tested clinical and nonclinical samples [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469; Hadjistavropoulos, H. D. & Asmundson, G. J. G. (1998). Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behaviour Research and Therapy, 36, 1185-1195; Hadjistavropoulos, H. D., Frombach, I. & Asmundson, G. J. G. (in press). Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample. Behaviour Research and Therapy; Speckens, A. E., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95-104]. The Fears, Beliefs and Effects lower-order factors and the General Hypochondriacal Concerns higher-order factor, were shown to be strongly associated with anxiety sensitivity, even after accounting for trait anxiety and panic history. Implications for understanding the high degree of comorbidity between the diagnoses of panic disorder and hypochondriasis, as well as future research directions for exploring the utility of various IAS dimensions in predicting responses to lab-based bodily symptom-induction procedures, are discussed.

Anxiety Sensitivity Index (ASI-3) subscales predict unique variance in anxiety and depressive symptoms

Anxiety sensitivity (AS) has been implicated in the development and maintenance of a range of mental health problems. The development of the Anxiety Sensitivity Index - 3, a psychometrically sound index of AS, has provided the opportunity to better understand how the lower-order factors of AS - physical, psychological, and social concerns - are associated with unique forms of psychopathology. The present study investigated these associations among 85 treatment-seeking adults with high AS. Participants completed measures of AS, anxiety, and depression. Multiple regression analyses controlling for other emotional disorder symptoms revealed unique associations between AS subscales and certain types of psychopathology. Only physical concerns predicted unique variance in panic, only cognitive concerns predicted unique variance in depressive symptoms, and social anxiety was predicted by only social concerns. Findings emphasize the importance of considering the multidimensional nature of AS in understanding its role in anxiety and depression and their treatment.

Why Do They Exercise Less? Barriers to Exercise in High-Anxiety-Sensitive Women

Anxiety sensitivity (AS; fear of arousal sensations) is a risk factor for mental and physical health problems, including physical inactivity. Because of the many mental and physical health benefits of exercise, it is important to better understand why high-AS individuals may be less likely to exercise. The present studys aim was to understand the role of barriers to exercise in explaining lower levels of physical exercise in high-AS individuals. Participants were undergraduate women who were selected as high (n = 82) or low (n = 72) AS. High-AS women participated in less physical exercise and perceived themselves as less fit than low-AS women. Mediation analyses revealed that barriers to exercise accounted for the inverse relationships between AS group and physical exercise/fitness levels. Findings suggest that efforts to increase physical exercise in at-risk populations, such as high-AS individuals, should not focus exclusively on benefits to exercise but should also target reasons why these individuals are exercising less.

Psychometric Evaluation of the Multidimensional Inventory of Hypochondriacal Traits: Factor Structure and Relationship to Anxiety Sensitivity

The Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley, Watson, & Noyes, 2005) appears to address shortcomings of other common measures of health anxiety, but further research is required prior to using this measure in treatment planning and outcome assessment. This study was designed to explore the hierarchical structure of this health anxiety measure and relations of the various MIHT health anxiety components to anxiety sensitivity. A sample of 535 university students (362 women) was administered the 31-item MIHT and the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986). Confirmatory factor analyses of participants’ responses on the MIHT showed that this measure may be conceptualized either as involving four correlated factors (i.e., Affective, Cognitive, Behavioral, and Perceptual) or as being hierarchical in nature, with the four lower-order factors loading on a single higher-order global health anxiety factor. Correlational analyses revealed significant relations of anxiety sensitivity to each of the four MIHT subscales and to the MIHT total score. Of the three established anxiety sensitivity components, ASI Physical Concerns were most strongly and consistently related to the various dimensions of health anxiety on the MIHT. Additional analyses revealed that the ASI and MIHT are better represented as two correlated but independent traits as opposed to common manifestations of a single underlying trait. The results have implications for case conceptualization, treatment planning, and assessment of treatment outcome in cognitive psychotherapy with health-anxious populations.

Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: a randomized controlled trial.

OBJECTIVE High anxiety sensitivity (AS) is associated with the development and maintenance of anxiety and depressive symptoms and is theorized to be a mediator of treatment outcomes for anxiety and depression. The present study tested the efficacy of a telephone-delivered cognitive behavioral therapy (CBT) intervention in reducing high AS and its associated anxiety and depressive symptoms. METHOD Treatment-seeking participants with high AS were recruited from the community (N = 80; M age = 36 years; 79% women; 76% Caucasian) and were randomly assigned to an 8-week telephone-delivered CBT program or a waiting list control. Participants completed anxiety and depression symptom and diagnostic measures at pre- and posttreatment, after a subsequent 4 weeks of continued interoceptive exposure, and 8 weeks later. RESULTS Multilevel modeling showed the treatment was successful in reducing AS, as well as panic, social phobia, posttraumatic stress symptoms, and number of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses per participant when compared to a waiting list control. These gains were maintained at follow-up. Generalized anxiety and depressive symptoms, however, did not improve as a result of treatment. Mediated moderation analyses suggested that treatment-related changes in AS may mediate anxiety symptom changes. CONCLUSION RESULTS of the present study provide promising evidence for this transdiagnostic treatment approach. Reductions in anxiety symptoms across diagnostic categories stemming from this AS-targeted intervention may have implications for helping a broad array of clients with various anxiety disorders that share AS as a common risk or maintenance factor.