Anxiety sensitivity in adolescents: factor structure and relationships to trait anxiety and symptoms of anxiety disorders and depression

The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents aged 13-16 years (n=819). Children completed the Childhood Anxiety Sensitivity Index (CASI; Silverman, W. K., Fleisig, W., Rabian, B. & Peterson, R. A. (1991). Journal of Clinical Child Psychology, 20, 162-168) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular of panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability.     

Anxiety reactivity and anxiety perseveration represent dissociable dimensions of trait anxiety

Trait anxiety is an individual-difference variable reflecting variation in state-anxiety elevations resulting from exposure to a stressor. It is usually measured using questionnaire instruments, such as the Spielberger State-Trait Anxiety Inventory (STAI-T). The present research conceptually distinguishes, and independently assesses, two hypothetical dimensions of anxiety vulnerability which, it is argued, could plausibly make independent contributions to variance in trait-anxiety scores. These dimensions are anxiety reactivity, the probability of experiencing an anxiety reaction to a stressor, and anxiety perseveration, the persistence of anxiety symptoms once elicited. Participants were asked three questions about each STAI-T item. The traditional STAI-T question assessed how much of the time this symptom was experienced; the anxiety-reactivity question assessed the probability of experiencing the symptom in response to a stressor; and the anxiety-perseveration question assessed how long the symptom persisted, if elicited. Regression analysis determined that anxiety reactivity and anxiety perseveration scores both accounted for independent variance in trait-anxiety scores. It is argued that models of anxiety vulnerability should seek to differentiate both the causes and the consequences of elevated anxiety reactivity and increased anxiety perseveration. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Structural differentiation of disgust from trait anxiety in the prediction of specific anxiety disorder symptoms

Research has begun to implicate the role of disgust in the etiology of specific phobias and obsessive–compulsive disorder (OCD). However, it remains unclear if the association between disgust and specific anxiety disorder symptoms is an artifact of trait anxiety or a potential mechanism through which trait anxiety effects specific anxiety disorder symptoms. The present study employed structural equation modeling to differentiate disgust from trait anxiety in the prediction of four types of specific anxiety disorder symptoms in a non-clinical sample (N=352). Results indicate that disgust and trait anxiety latent factors were independently related to spider fears, blood-injection-injury (BII) fears, general OCD symptoms, and OCD washing concerns. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with the anxiety disorder symptoms, whereas the association between latent trait anxiety and the anxiety disorder symptoms became non-significant or was substantially reduced. Statistical tests of intervening variable effects converged in support of disgust as a significant intervening variable between trait anxiety and spider fears, BII fears, and OCD symptoms (particularly washing concerns). The relevance of these findings for future research investigating the role of disgust in specific anxiety disorders is discussed.     

Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity

Research focused on psychological risk factors for anxiety psychopathology has led to better conceptualization of these conditions as well as pointed toward preventative interventions. Anxiety sensitivity (AS) has been well-established as an anxiety risk factor, while distress tolerance (DT) is a related construct that has received little empirical exploration within the anxiety psychopathology literature. The current investigation sought to extend the existing literature by examining both DT and the relationship between DT and AS across a number of anxiety symptom dimensions, including panic, generalized anxiety, social anxiety, and obsessive-compulsive anxiety. Participants (N = 418) completed a number of measures that assessed DT, AS, anxiety symptomatology, and negative affect. Findings indicated that DT was uniquely associated with panic, obsessive compulsive, general worry, and social anxiety symptoms, but that DT and AS were not synergistically associated with each of these symptom dimensions. These findings indicate that an inability to tolerate emotional distress is associated with an increased vulnerability to experience certain anxiety symptoms.     

Disgust sensitivity, trait anxiety and anxiety disorders symptoms in normal children.

There is evidence to suggest that disgust sensitivity plays a role in the development of small animal fears and phobias. Recently, Phillips, Senior, Fahy, and David (1998) [Phillips, M. L., Senior, C., Fahy, T., & David, A. S. (1998). Disgust: the forgotten emotion of psychiatry. British Journal of Psychiatry, 172, 373-375.] suggested that disgust sensitivity is also involved in various other anxiety-based symptoms (e.g. obsessive-compulsive complaints, social phobia). The present study sought to test this suggestion in a large sample of normal school children (N = 189). Children completed a measure of disgust sensitivity, the trait anxiety version of the Spielberger State-Trait Anxiety Inventory for Children and the Screen for Child Anxiety Related Emotional Disorders, an instrument that measures DSM-defined anxiety disorders symptoms. Disgust sensitivity was indeed found to be correlated with a broad range of anxiety disorders symptoms. However, results also indicated that these correlations were predominantly carried by trait anxiety. That is, when controlling for levels of trait anxiety, only specific phobia symptoms (including animal phobia, blood-injection-injury phobia and situational-environmental phobia) and separation anxiety disorder symptoms were significantly related to disgust sensitivity, although correlations were rather modest. Taken together, these findings cast doubts on the claim that disgust sensitivity is an unique and independent factor that contributes to a broad range of anxiety disorders.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Social Anxiety Scale for Adolescents: normative data and further evidence of construct validity

Replicates and extends prior work with the Social Anxiety Scale for Adolescents (SAS-A) by providing psychometric data, further evidence of construct validity, and large-sample based normative data. Participants were 2,937 students (1,431 boys and 1,506 girls) in Grades 6, 7, 8, 9, and 11. Students completed the SAS-A, the Revised Children's Manifest Anxiety Scale (RCMAS), and the Children's Depression Inventory (CDI). Results replicated a three-factor structure for the SAS-A, with good internal consistencies for its subscales. Normative data were subdivided by sex and grade group. Construct validity included replication of prior relations with general anxiety (RCMAS) and depressive symptomatology (CDI). Implications of these results for further use and norming of the SAS-A are discussed.     

The facets of anxiety sensitivity represented in the childhood anxiety sensitivity index: confirmatory analyses of factor models from past studies

Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents.     

Multidimensionality of state and trait anxiety: factor structure of the Endler Multidimensional Anxiety Scales

The Endler Multidimensional Anxiety Scales (EMAS) are derived from an interactional model of personality that proposes that anxiety is a function of the interaction of person and situation variables. The EMAS distinguish between state and trait anxiety and assume that both are multidimensional constructs. The EMAS were administered to 2,009 students in a neutral situation. Three factor analyses were performed to clarify the empirical relation between state and trait anxiety and the variables within the 2 domains. Results support the distinction between state and trait anxiety. Factor analysis of the state items provided support for the separate dimensions of cognitive and autonomic state anxiety. Factor analysis of the trait items provided support for trait anxiety multidimensionality. Four congruent factors were associated with increases in state anxiety in 4 general situations: Social Evaluation, Physical Danger, Ambiguous, and Daily Routines.     

The anxiety sensitivity index: item analysis and suggestions for refinement.

Anxiety sensitivity is the fear of anxiety-related sensations, and is measured by the 16-item Anxiety Sensitivity Index (ASI). Despite the popularity and utility of the ASI in research, a number of studies have provided evidence for the inadequacy of several items, and item-to-scale correlations for the ASI have not been published. In this study, a converging set of analyses to evaluate the item adequacy and factor structure of the ASI was used. The results of these multiple analyses converged nicely suggesting that Items 1, 5, 7, 8, and 13 should be considered for removal from the instrument. The impact of removing these problematic items from the scale was explored through the reanalysis of data from 3 previously published studies that compared the original ASI with the new 11-item version (the ASI minus the 5 problematic items). The results of these analyses suggest that the 2 scales function comparably in many respects but that the new version may be a more precise measure of anxiety sensitivity. The 11-item ASI appears to tap 2 primary aspects of anxiety sensitivity: fears of somatic sensations of anxiety and fears of loss of mental control. Suggestions for further development of the ASI are offered.     

Coping skills: role of trait sport confidence and trait anxiety

The current research assesses relationships among coping skills, trait sport confidence, and trait anxiety. Two samples (n=47 and n=77) of international competitors from surf life saving (M=23.7 yr.) and touch rugby (M=26.2 yr.) completed the Athletic Coping Skills Inventory, Trait Sport Confidence Inventory, and Sport Anxiety Scale. Analysis yielded significant correlations amongst trait anxiety, sport confidence, and coping. Specifically confidence scores were positively associated with coping with adversity scores and anxiety scores were negatively associated. These findings support the inclusion of the personality characteristics of confidence and anxiety within the coping model presented by Hardy, Jones, and Gould, Researchers should be aware that confidence and anxiety may influence the coping processes of athletes.     

Factor structure of the childhood anxiety sensitivity index.

We developed various factor models of the Childhood Anxiety Sensitivity Index [Silverman, W. K., Fleisig, W., Rabian, B. & Peterson, R. A. (1991). Childhood anxiety sensitivity index. Journal of Clinical Child Psychology, 20, 162-168] and tested the goodness of fit of the models in an independent sample. Of primary interest was to examine the question that characterized the factor analytic studies conducted on the adult version of the anxiety sensitivity index, i.e. the ASI [Reiss, S., Peterson, R. A., Gursky, D. M. & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8]: is anxiety sensitivity in children a unidimensional construct, an orthogonal multidimensional construct, or a hierarchical construct? Two independent samples (a clinic sample and a nonclinical sample) were used for development and replication of the factor models. The clinic sample consisted of 258 children (105 girls and 153 boys) who presented to a child anxiety disorders specialty clinic. The unselected, nonclinic sample consisted of 249 children (122 girls and 127 boys) enrolled in an elementary school. The results provided strong empirical support for a hierarchical multidimensional model with either three or four first-order factors. The two factors that emerged that appeared to be robust were Physical Concerns and Mental Incapacitation Concerns. What remains unresolved is whether Control of anxiety symptoms and Social Concerns are to be differentiated (as in the hierarchical model with four first-order factors) or not (as in the hierarchical model with three first-order factors). In addition to discussing this issue, the convergence of the present study's findings with past findings obtained with the ASI is discussed.     

Childhood anxiety sensitivity index factors predict unique variance in DSM-IV anxiety disorder symptoms

Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower-order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower-order factors. We examined the concurrent and incremental validity of the CASI and its lower-order factors in a non-clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM-IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State-Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.     

Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety

Anxiety sensitivity (AS) reflects the fear of arousal-related sensations and intolerance of uncertainty (IU) represents the dispositional fear of the unknown. Within cognitive–behavioral models, AS and IU are individual difference variables considered central to the phenomenology of health anxiety. However, prior studies have cast doubt on whether both variables incrementally contribute to our understanding of health anxiety. Addressing limitations of these prior studies, the present study examined the incremental specificity of AS and IU as these two variables relate to health anxiety in a large medically healthy sample of community adults (N = 474). Both AS and IU incrementally contributed to the concurrent prediction of health anxiety beyond both negative affect and one another. However, within these analyses, the physical dimension of AS and the inhibitory dimension of IU were the only AS and IU dimensions to evidence incremental specificity in relation to health anxiety.     

Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.     

Detecting state and trait anxiety from auditory and visual cues: a meta-analysis

Observers' ability to detect state anxiety and trait anxiety in others was evaluated in a meta-analysis that also included a critical moderator variable, communication channel. The overall effect size (r) for accuracy was .39 for the 46 state anxiety studies and .26 for the 34 trait anxiety studies. However, the effect of communication channel was very substantial in magnitude and highly significant; it also interacted with the type of anxiety. State anxiety was correctly identified more often from audio-only stimuli (M r = .49) compared with video-only cues (r = .24), whereas the opposite was true for trait anxiety, where video-only cues resulted in greater accuracy (r = .31) compared with audio-only stimuli (r = .05). Results indicated that the moment-to-moment change in emotion (state anxiety) may be better communicated with vocal/verbal stimuli, whereas more stable features of personality (trait anxiety) may be more apparent from body and facial cues.     

An expanded childhood anxiety sensitivity index: its factor structure, reliability, and validity in a non-clinical adolescent sample

Anxiety sensitivity refers to the fear of anxiety-related bodily sensations that are interpreted as having potentially harmful somatic, psychological, or social consequences. The current study examined the factor analytic structure of anxiety sensitivity in a large sample of normal adolescents (N=518) using the revised childhood anxiety sensitivity index (CASI-R). Confirmatory factor analysis indicated that anxiety sensitivity as measured by the CASI-R can best be conceptualised as a hierarchical construct with four lower-order factors loading on a single higher-order factor. The lower-order factors were 'fear of cardiovascular symptoms', 'fear of publicly observable anxiety reactions', 'fear of cognitive dyscontrol', and 'fear of respiratory symptoms'. An additional aim of the present study was to investigate the psychometric properties of the CASI-R. Results showed the CASI-R to be a reliable scale in terms of internal consistency. Furthermore, CASI-R scores were substantially related to levels of anxiety sensitivity as measured by the original index, trait anxiety, symptoms of anxiety disorders, in particular 'panic disorder and agoraphobia', and depression. Finally, some evidence was found for the validity of the CASI-R factor scores. That is, all factors convincingly loaded on symptoms of 'panic disorder and agoraphobia', whereas the factor 'fear of publicly observable anxiety reactions' was also strongly associated with symptoms of 'social phobia'.     

The validity of the mu index for differentiation of state and trait scales

For 443 men and women of the general population and mean age of 45.8 yr. state and trait measures were obtained on two occasions, 6 mo. apart. Internal consistencies at each time were similar (.84-.95). Test-retest coefficients were lower for measures of state concepts than for trait concepts. Howarth's mu indices were higher for state concepts than for trait concepts.