Anxiety sensitivity and its impact on pain experiences and conditions: A state of the art

This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets – basic laboratory‐based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive‐behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.     

Anxiety sensitivity and fear of pain in children

Associations among scores on scales of anxiety sensitivity and trait anxiety and a fear of pain questionnaire were examined for 118 children. Analysis showed that anxiety sensitivity was positively and substantially related to fear of pain in the children. Furthermore, the data suggested anxiety sensitivity to be a better predictor of fear of pain than trait anxiety.     

Anxiety sensitivity, body vigilance and fear of pain

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed.     

Anxiety sensitivity and major depression: examination of affective state dependence.

An emerging body of research suggests that anxiety sensitivity (AS), and particularly a facet of AS labelled fear of cognitive dyscontrol, is elevated in depressed individuals and is associated with severity of depressed mood. The current prospective study extended previous work by investigating the extent of affective state dependency in the AS-depression relationship in 51 patients who had major depressive episode (MDE) at baseline assessment (Time 1) and did not have MDE 1 year later at follow-up (Time 2). Despite considerable reduction in severity of depressed mood, scores on the Anxiety Sensitivity Index (M=27) remained elevated. Hierarchical regression analysis indicated that, after controlling for both Time 1 and Time 2 depression severity, Time 1 AS continued to predict residual Time 2 AS and increased prediction of variance from approximately 25% to 50%. Time 1 fear of cognitive dyscontrol AS continued to significantly predict Time 2 fear of cognitive dyscontrol AS when Time 2 fear of physical symptoms AS was statistically controlled. A subsample of recovered patients who displayed only minimal depression symptoms was compared to a matched sample of community controls. While the two groups did not significantly differ on level of depressed mood, the formerly depressed patients had significantly higher levels of AS. Implications for a proposed "depression sensitivity" are discussed.     

Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population

The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67-73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.     

Anxiety sensitivity and fear of pain in patients with recurring headaches.

Anxiety sensitivity (AS) plays an important role in the cognitive, affective and behavioral profiles of patients with chronic pain related to musculoskeletal injury. However, investigators have not considered whether these findings extend to patients with other classes of chronic pain. The primary purpose of this investigation was to address this issue in 72 patients with recurring headaches who completed a self-report questionnaire inventory during a treatment visit to an outpatient neurology clinic. The mean ASI score for the group (mean = 24; SD = 11) was relatively high. When patients were classified on the basis of ASI scores, 20 (28%) met criteria for high, 41 (57%) for medium and 11 (15%) for low AS. Multivariate analysis of variance confirmed that these groups differed on specific aspects of their cognitive, affective, and behavioral profiles. High AS patients reported greater depression, trait anxiety, pain-related escape/avoidance behavior and fearful appraisals of pain than did patients with medium or low AS. High AS patients also indicated greater cognitive disruption in response to pain than did patients with low AS. Groups did not differ in headache severity, physiological reactivity, change in lifestyle, anger, nor did they differ in use of over-the-counter or prescribed analgesics. Multiple regression analysis identified AS, pain-related cognitive disruption, and sensory pain experience as significant predictors of fear of pain. Lifestyle changes attributed to headache were, on the other hand, predicted by headache severity, physiological and cognitive anxiety and escape/avoidance behavior. These results provide further evidence of the important association between AS and fear responses of patients with chronic pain syndromes. Implications and future directions are discussed.     

Anxiety sensitivity index: normative data and its differentiation from trait anxiety

In the present study we report: (1) normative data on the Spanish version of the Anxiety Sensitivity Index (ASI); and (2) empirical evidence related to differentiation between the constructs of anxiety sensitivity and trait anxiety. A sample of 390 university students (ranging in age from 18 to 34 years) completed the ASI and Spielberger's Trait Anxiety Scale (STAI-T). The means and standard deviations for the Spanish version of the ASI are similar to the ones reported by Peterson and Reiss (Anxiety Sensitivity Index Manual, 2nd edition. Worthington, OH: International Diagnostic Systems, 1992) for the English version. Factor analysis of the joint ASI and STAI-T items yielded two different factors; the STAI-T items load onto one factor (i.e., the trait anxiety factor) and the ASI items load onto the other factor (i.e., the anxiety sensitivity factor). Findings provide empirical support for validation of the Spanish ASI and are consistent with a construct distinction between anxiety sensitivity and trait anxiety.     

Objects and attention: the state of the art

What are the units of attention? In addition to standard models holding that attention can select spatial regions and visual features, recent work suggests that in some cases attention can directly select discrete objects. This paper reviews the state of the art with regard to such 'object-based' attention, and explores how objects of attention relate to locations, reference frames, perceptual groups, surfaces, parts, and features. Also discussed are the dynamic aspects of objecthood, including the question of how attended objects are individuated in time, and the possibility of attending to simple dynamic motions and events. The final sections of this review generalize these issues beyond vision science, to other modalities and fields such as auditory objects of attention and the infant's 'object concept'.     

Meaning and relational well-being: a reflection on the state of the art and a way forward

This paper provides a brief overview of facets of meaning and relational well-being highlighting the foci of current research on meaning, relationships as sources of meaning, contextual relevance and meta-theoretical assumptions. Lacunae in knowledge are indicated and a model proposed as framework for further research on meaning and relational well-being which was the focused topic of this special issue.     

Personal identity and bioethics: the state of the art

In this introduction to the special issue of Theoretical Medicine and Bioethics on the topic of personal identity and bioethics, I provide a background for the topic and then discuss the contributions in the special issue by Eric Olson, Marya Schechtman, Tim Campbell and Jeff McMahan, James Delaney and David Hershenov, and David DeGrazia.     

Research utilization: The state of the art

As a field of study, “research utilization” is at a turning point. Despite an accumulation of replicable findings, robust constructs, even a “soft technology” for bridging the gap between theory and practice, we are still largely in the situation of the distance between social problems of, let us say, conflict or inequality and the ability of social science to provide credible, reliable and usable solutions. At the same time, the initial paradigms, suffering from hyperrationalism, have given way to more transactional ones, and have been shaken by the tenets of postmodernism. Shaken, but not undone, as “middle-level” constructs emerge, ones that appear to link the research community with a variety of professional communities in more meaningful and durable ways. Michael Huberman has been Visiting Professor of Education at Harvard University since 1991, where he teaches research methodologies and conducts research on knowledge dissemination. He is also Senior Research Associate at the Network, Inc.     

Masculinity and femininity scales: current state of the art

A theoretical and empirical review of masculinity and femininity scales was carried out after 30 years of their existence. Hypotheses to be tested were: (a) muldimensionality versus bidimensionality; (b) inadequate percentage of variance accounted for (less than 50%); (c) inconsistency between factor structure and the dualistic model. 618, 200 and 287 students took part in each of the three studies that were carried out. Factorial analyses (PAF) were performed. Results support multidimensionality, unsatisfactory percentage of variance accounted for, and lack of congruence between obtained factors and the dualistic model. All these data were analysed within the context of the twofold sex and gender reality model.     

Anxiety sensitivity and panic attacks in a nonclinical population

In the present study, we administered the Anxiety Sensitivity Index (ASI) and a modified version of the Panic Attack Questionnaire (PAQ) to 425 college students to determine whether high anxiety sensitivity ('fear of fear') occurs in the absence of a history of unpredictable ('spontaneous') panic attacks, or whether such attacks are a necessary precursor to high anxiety sensitivity. Based on their ASI scores, subjects were assigned to either the high, medium, or low anxiety sensitivity groups. High anxiety sensitivity subjects more frequently reported both a personal and family history of panic than did subjects in the other groups. Nevertheless, two-thirds of the high anxiety sensitivity subjects had never experienced an unpredictable panic attack. This suggests that the fear of anxiety can be acquired in ways other than through personal experience with panic.     

The impact of a religious opera on a secular audience: the existential and religious importance of art

Abstract

Although there is a voluminous literature on the use of traditional healers by ethnic minorities, their use by psychiatric patients has been little studied. This study looks at the use of traditional healers by Asian psychiatric patients. Five of the sample of 14 patients had consulted a traditional healer at some time during their psychiatric illness. Three case histories are presented.     

Color display systems: The state of the art

This paper presents the basic dimensions and characteristics of the nine currently marketed self-contained color display systems that could conceivably be employed by psychologists for instruction and research in psychology. The systems all cost less than $10,000, with the least expensive systems costing less than $2,000. The systems are compared on several significant variables to aid in the process of selection. The uses of this type of color display system for research and instruction in psychology are described.     

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.     

Anxiety sensitivity and panic symptomatology: the mediator role of hypochondriacal concerns

The present study tests the mediating role of hypochondriasis to explain the relation between anxiety sensitivity and panic symptomatology. Fifty-seven outpatients with clinically significant levels of panic symptomatology were selected to participate in the study. Measures of anxiety sensitivity, hypochondriasis, and panic symptomatology were obtained from standardized, self-administered questionnaires: the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the Whiteley Index of Hypochondriasis (WI; Pilowsky, 1967), and the Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001). Regression analyses were performed to test for the mediation models. The results show that the effect of anxiety sensitivity on panic symptomatology is not significant when controlling the hypochondriacal concerns, whereas the latter predicted panic symptoms. This result holds for the overall ASI as well as for the Physical Concerns and the Mental Incapacitation Concerns dimensions of the ASI scale. No evidence of a direct relation between the Social Concerns dimension and panic symptoms was found. The findings suggest that hypochondriacal concerns might represent the mechanism through which anxiety sensitivity is able to influence panic symptoms.     

Creating the conditions for psychological safety and its impact on quality coach-athlete relationships

In this study, we investigated the notion that giving voice to athletes is an important aspect to creating a psychologically safe environment which can then feed into maintaining good quality coach-athlete relationships where every athlete feels heard, valued, and connected. 379 athletes completed a multi-section questionnaire that assessed their (a) capacity to be open and manage conflict with their coaches, (b) perceptions of psychological safety within their team or group, and (c) perceptions of the coach-athlete relationship quality. Structural equation modelling revealed that openness and conflict management positively predicted psychological safety which, in turn, positively predicted coach-athlete relationship quality. Psychological safety was found to explain the association between athletes’ communication (i.e., capacity to be open, honest and transparent as well as manage interpersonal conflict effectively) and coach-athlete relationship quality regardless of athletes’ gender. These findings highlighted that if athletes have the capacity to have candid discussions and can navigate conflict with their coaches, then it is possible to feel psychologically safe and thus able to engage in risky interpersonal interactions (e.g., raise concerns, admit mistakes) within their group context without fear of intimidation and humiliation. Furthermore, it was revealed that such a psychologically safe group environment fostered athletes’ trust and respect, as well as commitment and cooperation with their coach. The discussion provides links to theory, research and practice.