The Nature of the Association between Anxiety Sensitivity and Pain-Related Anxiety: Evidence from Correlational and Intervention Studies

High anxiety sensitivity (AS) has been associated with elevated pain-related anxiety in anxiety and pain samples. The present study investigated (a) the associations among the lower order dimensions of AS and pain-related anxiety, using a robust measure of AS, and (b) the pain-related anxiety outcomes of a telephone-delivered cognitive behavioural treatment (CBT) designed to reduce high AS. Participants were 80 anxiety treatment-seeking participants with high AS (M age = 36 years; 79% women). After providing baseline data on AS and pain-related anxiety, participants were randomly assigned to an eight-week telephone CBT or a waiting list control. At baseline, bivariate correlations showed AS physical and cognitive, but not social, concerns were significantly associated with pain-related fear and arousal but not escape/avoidance behaviours. Multiple regression revealed that after accounting for emotional distress symptoms, AS physical, but not cognitive or social, concerns uniquely predicted pain-related anxiety. Multilevel modelling showed that the AS-targeted CBT reduced pain-related anxiety and treatment-related changes in global AS and AS physical concerns mediated changes in pain-related anxiety. Results suggest that an AS-targeted intervention may have implications for reducing pain-related anxiety. Further research is needed in a chronic pain sample.     

Naturalistic Partial Sleep Deprivation Leads to Greater Next-Day Anxiety: The Moderating Role of Baseline Anxiety and Depression

The detrimental effects of insufficient sleep on emotional functioning have been well established. Total sleep deprivation usually leads to increased anxiety and depressive symptoms the following day. However, no study has yet examined the relationships between unmanipulated partial sleep deprivation and next-day symptoms of anxiety and depression in everyday life, which this study sought to characterize. Participants (N = 94) completed daily diary surveys twice per day for 2 weeks without instructions to alter their sleep in any way. Nights of spontaneous, naturally occurring partial sleep deprivation were followed by increased levels of self-reported symptoms of anxious arousal the next day, but were unrelated to next-day symptoms of anhedonic depression or general distress. The relationship between partial sleep deprivation and next-day anxious arousal was found to be moderated by both baseline depressive symptoms and anxiety such that individuals reporting higher levels of depression or anxiety at baseline showed relatively greater increases in symptoms of anxiety following partial sleep deprivation. These results suggest that partial sleep deprivation occurring in everyday life can lead to higher next-day levels of anxious arousal, a relationship that is particularly deleterious for individuals with higher overall levels of anxiety or depressive symptoms.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

The Differential Role of Anxiety Sensitivity and its Components in the Relation between Emotional Nonacceptance and Anxiety and Depressive Symptoms and Disorders among Latinos in Primary Care

The present investigation examined anxiety sensitivity (AS) in the relation between emotional nonacceptance (unwillingness to experience unwanted emotions) and mood and anxiety symptoms among Latinos seeking health services at a primary healthcare facility. Participants included 267 adult Latinos (85.4% female; Mage = 38.8 years, SD = 10.7, and 95.9% used Spanish as their first language). Results indicated that emotional nonacceptance was indirectly related to number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through AS. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Using a multiple mediation model revealed that the AS cognitive, physical, and social concerns demonstrated unique incremental explanatory effects (above and beyond the other two AS sub-scales) for depressive, anxious arousal, and social anxiety symptoms, respectively. Thus, specific sub-scales of AS were uniquely related with the expression of particular affective symptom domains. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between nonacceptance and AS in regard to better understanding and intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.     

Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease.     

Anxiety and Depression Symptoms in Children with Asperger Syndrome Compared with Attention-Deficit/Hyperactivity Disorder and Depressive Disorder

The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and depression symptoms of children and their parents. The emotional and behavioral problems of 56 children with AS (48 boys, 8 girls, mean age, 9.39 ± 2.01 years) were compared with 56 ADHD children and 56 depressive disorder children, matched for age and sex. Their parents’ anxiety and depression symptoms were also compared. Trait-anxiety and internalizing problems in AS children were higher than those in ADHD children and as high as those in depressive disorder children (F = 8.83, p < 0.001 and F = 8.21, p < 0.001). Parents’ anxiety and depression symptoms did not differ among the three groups, but correlations between maternal anxiety and depression and children’s emotional and behavioral problems were most prominent in the AS group. We suggest that the assessment and treatment of children with AS should involve detailed assessment, possible concomitant treatment for comorbid anxiety and depression, and parental education about the effect of parental emotional states on children.     

Mothers' affect dysregulation,depressive symptoms,and emotional availability during mother–infant interaction

Maternal affect dysregulation and maternal depressive symptoms were examined as predictors of maternal emotional availability (EA) during mother–infant interaction in a nonclinical sample. In particular, we investigated if affect dysregulation predicts EA and is more important than are depressive symptoms in predicting EA. Questionnaire measures and 30 min of free play were obtained from 46 mothers of 4‐ to 5‐month‐old infants. Mothers' self‐reported affect dysregulation was inversely related to EA, but mothers' depressive symptoms were not related to EA. More specifically, mothers' tendency to use unhealthy externalizing behaviors to reduce tension and distress predicted less EA. These results suggested that even in relatively low‐risk samples, mothers' self‐reported affect dysregulation, particularly the tendency to act out inappropriately in response to tension and distress, may be a more proximal predictor of EA than are depressive symptoms.     

Trajectory of change in anxiety sensitivity in relation to anxiety,depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy

ABSTRACT

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.     

Stigma and Psychological Distress in People With HIV/AIDS

Using a community sample of 197 people living with HIV/AIDS, we examined how awareness of societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) are related to psychological well-being. Both felt stigma and self-stigma were significantly correlated with symptoms of depression and anxiety, but controlling for felt stigma reduced self-stigma's association with depressive symptoms to nonsignificance. Global self-esteem and social avoidance fully mediated the associations between self-stigma and distress but only partially mediated the associations between felt stigma and distress. Felt stigma mediated the relationship between distress and HIV-related changes in physical appearance.     

Emotion Appraisal and Anxiety Symptomatology in a University Sample

Current conceptualizations for anxiety disorders focus heavily on cognitive and behavioral aspects of anxiety and address other emotions to a far lesser extent. Studies have demonstrated that negative appraisals of anxiety and fear (e.g., anxiety sensitivity) are elevated in each of the anxiety disorders and depressive disorders. Much less is known about how the appraisal of other emotions is related to anxiety disorder symptom presentation. The current study examines the appraisal of specific aversive emotions in relation to anxiety symptomatology. Undergraduate university students (N = 530) completed measures of specific anxiety and depressive symptoms, as well as a measure of emotional appraisal. A maximum likelihood estimated multivariate regression model was used to examine the unique relationships between emotional appraisal and anxiety and depressive symptoms. Results indicated that anxiety symptoms varied in their relationships with emotional appraisal. Each symptom group was highly related to fear of appraisals of anxiety; however, some anxiety symptoms were also related to fear of other emotional states, including guilt, sadness, disgust, lust, and embarrassment. Understanding the full range of appraisals of emotional experiences in anxiety conditions may help inform conceptualizations, and potentially treatments, by guiding the focus to the feared emotional states of the individual. The present study helps to clarify some of the relationships between emotion appraisal and anxiety symptoms.     

Distress Tolerance and Anxiety Sensitivity Cognitive Concerns: Testing the Incremental Contributions of Affect Dysregulation Constructs on Suicidal Ideation and Suicide Attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N = 192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.     

An Open Trial Investigation of a Transdiagnostic Group Treatment for Children With Anxiety and Depressive Symptoms

The current study investigates the feasibility and preliminary outcomes associated with a transdiagnostic emotion-focused group protocol for the treatment of anxiety disorders and depressive symptoms in youth. Twenty-two children (ages 7 to 12; M = 9.79) with a principal anxiety disorder and varying levels of comorbid depressive symptoms were enrolled in an open trial of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Bilek, 2009), an intervention adapted from existent unified protocols for the treatment of emotional disorders among adults and adolescents. Results indicate that participants experienced significant improvements in clinician-rated severity of principal anxiety disorder diagnoses (d = 1.38), the sum of all anxiety and depressive disorder severity ratings (d = 1.07), and child-reported anxiety (d = 0.47) and parent-reported depressive symptoms (d = 0.54) at the posttreatment assessment. EDTP had good retention rates and reports of high satisfaction. Thus, preliminary evidence suggests that EDTP is a feasible and potentially efficacious treatment of youth anxiety disorders and co-occurring depressive symptoms. Children experiencing a range of internalizing symptoms may benefit from this more generalized, emotion-focused treatment modality, as it offers flexibility to families and the mental health clinician, while maintaining a concurrent focus on the provision of cognitive-behavioral treatment skills vital to the amelioration of anxiety and depressive disorder symptoms in youth.     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。     

Examining the Role of Perfectionism and Intolerance of Uncertainty in Postevent Processing in Social Anxiety Disorder

Postevent processing (PEP) is proposed to be a key maintenance factor of social anxiety disorder (SAD; e.g., Clark and Wells 1995). The goal of the current study was to examine the independent roles of two transdiagnostic variables, namely perfectionism and intolerance of uncertainty (IU), as unique predictors of PEP in SAD above and beyond social anxiety and depressive symptoms. Fifty-six adults with SAD and high levels of speech anxiety completed measures of perfectionism, IU, social anxiety, and depression. They gave an impromptu speech to induce PEP, and completed measures assessing degree of PEP and its associated distress. Significant positive correlations were found between perfectionism and negative PEP degree and distress, as well as between IU and negative PEP distress. The perfectionism subscales of parental expectations and parental criticism significantly predicted negative PEP degree and distress over and above social anxiety and depressive symptoms. Perfectionism, as well as IU, were significantly and positively correlated with positive PEP distress, and significantly predicted positive PEP distress above and beyond social anxiety and depressive symptoms. The study design was cross-sectional; hence, experimental and longitudinal studies are needed to further understand the roles of perfectionism and IU as they relate to PEP. Individuals with SAD who are high in perfectionism or IU appear to be more prone to engaging in, or experiencing distress associated with, negative PEP. Specific strategies for decreasing negative PEP in this vulnerable population, especially for those high in perfectionism, may be necessary for optimal treatment outcome.     

Early Maladaptive Schemas as Moderators of the Impact of Stressful Events on Anxiety and Depression in University Students

The aim of this study was to test the effects of early maladaptive schemas (EMS) derived from the Schema Therapy model (Young 1999) according to the diathesis-stress paradigm. We expected that EMS would make students more vulnerable to symptoms of depression and anxiety in the presence of stressful events and that the effects of these schemas would be different for each symptom. In particular, it was hypothesised that abandonment, emotional deprivation, defectiveness, and failure schemas would interact with stressful events to predict depressive symptoms, whereas abandonment, vulnerability to harm, and dependence schemas were expected to moderate anxiety symptoms. Due to gender differences in EMS and depressive and anxiety symptoms, we also expected that sex would act as a moderator of the relationships between EMS and symptoms. A two-wave prospective study showed that the presence of EMS constitutes a vulnerability factor for both, depressive and anxiety symptoms, and this effect was also moderated by sex. Moreover, the EMS’s content specificity revealed which schemas were more relevant to each symptom, providing valuable information for prevention and intervention programmes.     

Combined Emotional Socialization Training and Family Accommodation Modification: Impact on Emotional Regulation and Anxiety Symptoms in Anxious Children

Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (M_age = 6.7, SD = 0.1) and their mothers. Mothers were randomly assigned to an EST (n = 17), FAM (n = 16), Combined (n = 17), or a waitlist control (WLC) (n = 16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children’s Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

Internalizing Symptoms in Female Adolescents: Associations with Emotional Awareness and Emotion Regulation

The transition into adolescence involves a number of changes that for many adolescents result in increased negative affect and internalizing symptoms, especially for females. In the current study we examined the direct and indirect effects of emotional awareness on internalizing symptoms by exploring the extent to which certain emotion regulation strategies influence this relationship. Participants were 123 female adolescents aged 13–16 years (M = 14.51 years) who completed measures of emotional awareness, emotion regulation (emotional reappraisal and expressive suppression), and symptoms of depression and social anxiety. Two multiple indirect effect models were conducted including both reappraisal and suppression (one for each of the dependent variables, depression and social anxiety) via the bootstrapping method. Results found that reappraisal accounted for the effect of emotional awareness on depressive symptoms but suppression accounted for the effect of emotional awareness on social anxiety symptoms. Results suggest that emotion regulation strategies play an important role in determining depressive and social anxiety symptoms and are associated with an adolescent’s level of emotional awareness.     

Psychometric properties of the Death Anxiety Scale (DAS) among HIV/AIDS patients

AIDS patients and HIV carriers who are aware of their condition are under multiple kinds of stress with adverse effects on their emotional state and personal and social activity. This paper reports the psychometric properties of the DAS (Death Anxiety Scale) using the Spanish version in the clinical setting. The sample is made up of 148 HIV/AIDS patients (109 men and 39 women). The internal consistency of the scale was .72 and its test-retest reliability was .70. Principal components analysis extracted five factors that jointly accounted for 56.5% of the total variance. As, on the whole, these results are very similar to those reported by other authors, it is concluded that the Spanish DAS is a valid instrument for the assessment of death anxiety in Spanish HIV/AIDS patients.     

Emotion dysregulation and adolescent psychopathology: a prospective study

Background

Emotion regulation deficits have been consistently linked to psychopathology in cross-sectional studies. However, the direction of the relationship between emotion regulation and psychopathology is unclear. This study examined the longitudinal and reciprocal relationships between emotion regulation deficits and psychopathology in adolescents.

Methods

Emotion dysregulation and symptomatology (depression, anxiety, aggressive behavior, and eating pathology) were assessed in a large, diverse sample of adolescents (N = 1065) at two time points separated by seven months. Structural equation modeling was used to examine the longitudinal and reciprocal relationships between emotion dysregulation and symptoms of psychopathology.

Results

The three distinct emotion processes examined here (emotional understanding, dysregulated expression of sadness and anger, and ruminative responses to distress) formed a unitary latent emotion dysregulation factor. Emotion dysregulation predicted increases in anxiety symptoms, aggressive behavior, and eating pathology after controlling for baseline symptoms but did not predict depressive symptoms. In contrast, none of the four types of psychopathology predicted increases in emotion dysregulation after controlling for baseline emotion dysregulation.

Conclusions

Emotion dysregulation appears to be an important transdiagnostic factor that increases risk for a wide range of psychopathology outcomes in adolescence. These results suggest targets for preventive interventions during this developmental period of risk.