The Illness/Injury Sensitivity Index: Validation of a German Version of the ISI-R

Three fundamental fears—anxiety sensitivity, fear of negative evaluation, and illness/injury sensitivity—are considered integral components of anxiety-related psychopathology and also bear connections with chronic pain. Scales measuring the first two fears, the Anxiety Sensitivity Index and the Fear of Negative Evaluation Scale, have been translated into German; however, the nine-item Illness/Injury Sensitivity Index-Revised (ISI-R) that measures fears of injury and illness has not been available in German language yet. The aim of this study therefore was a translation of the ISI-R into German language and an initial validation of the translated scale in two different samples. The German ISI-R was translated by both professionals and laypersons, and a final version was decided on by consensus. In Study 1, participants included 96 undergraduate students (85% women) who completed the German version of the ISI as part of a larger study. An exploratory factor analysis with oblique rotation was conducted and suggested a two-factor-solution with one factor representing fears of illness and the other fears of injury. This factor structure was confirmed via a confirmatory factor analysis (CFA) in Study 2. Participants included 117 community members (79% women). Convergent validity was supported using a visual analogue scale for fear of illness in both samples and the German translation of the Whiteley Index in Study. Overall, the results supported the German translation of the ISI-R. Comprehensive results, limitations, and directions for future research are discussed.     

The Illness/Injury Sensitivity Index: Validation of a German Version of the ISI-R

Three fundamental fears-anxiety sensitivity, fear of negative evaluation, and illness/injury sensitivity-are considered integral components of anxiety-related psychopathology and also bear connections with chronic pain. Scales measuring the first two fears, the Anxiety Sensitivity Index and the Fear of Negative Evaluation Scale, have been translated into German; however, the nine-item Illness/Injury Sensitivity Index-Revised (ISI-R) that measures fears of injury and illness has not been available in German language yet. The aim of this study therefore was a translation of the ISI-R into German language and an initial validation of the translated scale in two different samples. The German ISI-R was translated by both professionals and laypersons, and a final version was decided on by consensus. In Study 1, participants included 96 undergraduate students (85% women) who completed the German version of the ISI as part of a larger study. An exploratory factor analysis with oblique rotation was conducted and suggested a two-factor-solution with one factor representing fears of illness and the other fears of injury. This factor structure was confirmed via a confirmatory factor analysis (CFA) in Study 2. Participants included 117 community members (79% women). Convergent validity was supported using a visual analogue scale for fear of illness in both samples and the German translation of the Whiteley Index in Study. Overall, the results supported the German translation of the ISI-R. Comprehensive results, limitations, and directions for future research are discussed.     

Do socially anxious individuals fear embarrassment by close others? Development of the Fear of Embarrassment by Others Scale

Social anxiety disorder is characterized by an intense fear of social or performance situations, and a fear of acting in a way that will be humiliating or embarrassing. However, the extent to which socially anxious individuals fear embarrassment due to the behavior of close others remains unknown. The Fear of Embarrassment by Others Scale (FEOS) was developed to assess the extent to which individuals with social anxiety fear being embarrassed by others. To assess the psychometric properties of this measure, 162 undergraduate students low or high in social anxiety completed the FEOS, along with additional questionnaires. An exploratory factor analysis suggested a single factor. The measure demonstrates high internal consistency, and is correlated with measures of social anxiety, fear of negative evaluation, and anxiety sensitivity. Fear of embarrassment by others was not found to be a significant predictor of social anxiety, as compared to anxiety sensitivity and fear of negative evaluation. The FEOS discriminated among participants high and low in social anxiety, as those high in social anxiety scored significantly higher on the measure than did participants low in social anxiety. The utility of this scale for research and clinical practice is discussed.     

Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity?

Rather than viewing anxiety among chronic pain patients as simply a component of negative affectivity, investigators have developed a model of "pain anxiety" in which patients develop fear and avoidance of activity linked to pain. We examined whether pain anxiety can be conceptualized as a specific phobia, or whether evidence supported the notion that pain anxiety is better understood as a manifestation of anxiety sensitivity in the context of chronic pain. Chronic musculoskeletal pain patients (N=70) underwent cold pressor and mental arithmetic tasks while cardiovascular, self-report, and behavior indexes were recorded. They completed measures of pain anxiety, anxiety sensitivity, fear of negative evaluation, depression and trait anxiety. Correlation analyses showed pain anxiety was related to pain-relevant responses during cold pressor, but it was also related to evaluation-relevant responses during cold pressor, and to pain- and evaluation-relevant responses (including subtraction accuracy) during mental arithmetic. Regression analyses showed that almost all effects of pain anxiety on task responses were accounted for by anxiety sensitivity. Fear of negative evaluation, in contrast, correlated only with evaluation-relevant responses, and mostly during mental arithmetic. These effects remained significant when depression, trait anxiety, or anxiety sensitivity were statistically controlled. Pain anxiety may be an expression of anxiety sensitivity rather than a circumscribed phobia; a distinction that could profitably guide treatment strategies.     

The structure of negative emotions in adolescents

This study examined the structure of negative emotions in a sample of nonclinical adolescents, using an approach that exclusively relied on child self-report. A large sample of adolescents (N = 968) completed self-report questionnaires measuring symptoms of fear, anxiety, and depression. Confirmatory factor analysis provided support for the notion that fear, anxiety, and depression are distinct yet correlated components of negative emotions. This result is in agreement with recent empirical findings and current theoretical notions on the structure of negative emotions in children and should be taken as an encouragement for researchers to develop more specific measures for assessing fear, anxiety, and depression in children.     

Evaluating anxiety sensitivity and other fundamental sensitivities predicting anxiety symptoms and fearful responding to a biological challenge

Fear of arousal symptoms, often referred to as anxiety sensitivity (AS), appears to be associated with risk for anxiety pathology and other Axis I conditions. However, AS is only one of three fundamental components of Reiss' Expectancy Model proposed to account for the development of anxiety problems. Very little research has focused on the other two components of this model (Fear of Negative Evaluation, Illness/Injury Sensitivity) and the specificity of AS, relative to these other two components, has rarely been evaluated. This study evaluated general and unique associations among all three so-called fundamental sensitivities to fearful responding to a biological challenge in a nonclinical sample (N=404). Participants were administered a 20-s inhalation of 20% CO2/balance O2. Consistent with hypothesis, only AS uniquely contributed to increased subjective fear responding to the challenge. These findings are consistent with Expectancy Theory in suggesting that the AS component of the model is specific to amplification of fears to arousal cues.     

A bifactor model of negative affectivity: fear and distress components among younger and older youth

The Positive and Negative Affect Schedule for Children (PANAS-C) is a 27-item youth-report measure of positive affectivity and negative affectivity. Using 2 large school-age youth samples (clinic-referred sample: N = 662; school-based sample: N = 911), in the present study, we thoroughly examined the structure of the PANAS-C NA and PA scales and fit a bifactor model to the PANAS-C NA items. Our exploratory factor analytic results demonstrated that negative affectivity is comprised of 2 main components-NA: Fear and NA: Distress-specifically among older youth. A bifactor model also evidenced the best model fit relative to a unidimensional and second-order factor structure of the PANAS-C NA items. The NA: Fear group factor evidenced significant correspondence with external criterion measures of anxiety. However, the original PANAS-C NA scale evidenced equal (and in some cases greater) correspondence with criterion measures of anxiety. We thus recommend continued usage and interpretation of the full PANAS-C NA scale despite the identification of the fear and distress group factors underlying general negative affectivity. The identification of these fear and distress group factors nonetheless suggest that negative affectivity may be comprised largely of a fear and distress component among older youth. The implications of these findings are discussed in relation to better understanding the structure of psychopathology across childhood development and informing the development of future treatments of negative emotions.     

Does the social concerns component of the anxiety sensitivity index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity?

The present study utilized an exploratory factor-analytic approach (i.e. principal-components analysis; PCA) to investigate whether the Social Concerns component of the Anxiety Sensitivity Index (ASI [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.]) is best conceptualized as belonging to the domain of anxiety sensitivity (AS) and/or the domain of negative evaluation sensitivity (NES). A sample of university students (N = 216) was administered measures of both NES (i.e. Brief Fear of Negative Evaluation scale; Leary, 1983) and AS (i.e. ASI). Participants' responses to the items comprising these measures were subjected to a PCA with oblique rotation. Factors representing the NES construct and the three lower-order AS constructs (i.e. AS Physical, Psychological and Social Concerns) were obtained. Subscales derived from these four factors were positively and significantly correlated with one another and loaded on a single higher-order factor labeled Threat Sensitivity. Thus, the present findings suggest that the AS Social Concerns factor is distinct from NES and the other lower-order components of AS. However, correlational analyses and higher-order PCA indicated that the AS Social Concerns factor taps a blend of AS and NES as well as something unique and distinct from both global AS and NES.     

Testing the Bivalent Fear of Evaluation Model of Social Anxiety: The Relationship between Fear of Positive Evaluation,Social Anxiety,and Perfectionism

The Bivalent Fear of Evaluation (BFOE) model of social anxiety proposes that fear of negative evaluation (FNE) and fear of positive evaluation (FPE) play distinct roles in social anxiety. Research is however lacking in terms of how FPE is related to perfectionism and how these constructs interact to predict social anxiety. Participants were 382 individuals from the general community and included an oversampling of individuals with social anxiety. Measures of FPE, FNE, perfectionism, and social anxiety were administered. Results were mostly consistent with the predictions made by the BFOE model and showed that accounting for confounding variables, FPE correlated negatively with high standards but positively with maladaptive perfectionism. FNE was also positively correlated with maladaptive perfectionism, but there was no significant relationship between FNE and high standards. Also consistent with BFOE model, both FNE and FPE significantly moderated the relationship between maladaptive perfectionism and social anxiety with the relationship strengthened at high levels of FPE and FNE. These findings provide additional support for the BFOE model and implications are discussed.     

人格特质对考试焦虑的影响:多重中介效应分析

目的:探讨自尊、惧怕负面评价及无法忍受不确定性在人格特质和考试焦虑间的中介作用。方法:采用人格问卷简式量表EPQ-RSC、Rosenberg自尊问卷、惧怕负面评价量表简表、无法忍受不确定性量表和考试焦虑量表测量410名在校高中生和大学生。结果:(1)相关分析表明,神经质、惧怕负面评价、无法忍受不确定性及考试焦虑之间彼此正相关显著;外向性与自尊正相关显著,与惧怕负面评价、无法忍受不确定性及考试焦虑等负相关显著;精神质与自尊、惧怕负面评价及考试焦虑等负相关显著;自尊与神经质、惧怕负面评价、无法忍受不确定性及考试焦虑负相关显著。(2)回归分析表明,人格特质中的神经质和精神质能显著预测考试焦虑,无法忍受不确定性在人格特质和考试焦虑之间起部分中介作用;结构方程模型分析结果显示,人格特质中神经质和精神质对考试焦虑的直接效应显著,经由自尊、惧怕负面评价和无法忍受不确定性对考试焦虑的间接效应也极为显著。结论:自尊、惧怕负面评价和无法忍受不确定性在人格特质与考试焦虑间起着中介作用。     

大学生社会排斥对社交焦虑的影响：负面评价恐惧与人际信任的作用

为探讨大学生社会排斥对社交焦虑的影响以及负面评价恐惧和人际信任在二者之间的作用机制,研究采用大学生社会排斥问卷（SEQU）、社交焦虑量表（SASSCS）、负面评价恐惧量表（BFNES）及人际信任量表（ITS）对450名大学生进行测试。结果表明：（1）大学生社会排斥不仅对个体的社交焦虑水平产生影响,还会通过负面评价恐惧的中介作用对社交焦虑产生影响;（2）人际信任能够调节大学生社会排斥对社交焦虑的直接作用,具体而言,与高人际信任的大学生相比较,较低人际信任的大学生的社会排斥对社交焦虑的预测作用更加显著。     

大学生社会排斥对社交焦虑的影响：负面评价恐惧与人际信任的作用

为探讨大学生社会排斥对社交焦虑的影响以及负面评价恐惧和人际信任在二者之间的作用机制,研究采用大学生社会排斥问卷（SEQU）、社交焦虑量表（SASSCS）、负面评价恐惧量表（BFNES）及人际信任量表（ITS）对450名大学生进行测试。结果表明：（1）大学生社会排斥不仅对个体的社交焦虑水平产生影响,还会通过负面评价恐惧的中介作用对社交焦虑产生影响;（2）人际信任能够调节大学生社会排斥对社交焦虑的直接作用,具体而言,与高人际信任的大学生相比较,较低人际信任的大学生的社会排斥对社交焦虑的预测作用更加显著。     

Relationships between psychoevolutionary fear of evaluation,cognitive distortions,and social anxiety symptoms: A preliminary structural equation model

Social anxiety disorder is a mental health condition that affects 4.7% of Australians each year. The complex interplay between psychoevolutionary and cognitive models has become the focus of research in recent years, particularly with the development of the bivalent fear of evaluation model (i.e., negative and positive evaluation fears). The present study aimed to test a model of social anxiety symptoms using structural equation modelling, integrating previously fragmented evidence. A sample of 255 participants (75.3% female; M_age = 31.9, SD = 10.3) undertook an online survey, including Social Phobia Scale, Brief Fear of Negative Evaluation—Straightforward, Fear of Positive Evaluation, Concerns of Social Reprisal, and Disqualifications of Positive Social Outcomes measures. The hypothesised model for social anxiety symptoms described the data reasonably well (χ²(1) = 4.917, p = .027, CFI = .995, GFI = .992, SRMR = .017), explaining 57.1% of social anxiety variance. Study hypotheses were supported with bivalent fear of evaluation accounting for unique variance in cognitive distortions, which in turn accounted for unique variation in social anxiety symptoms. Effect sizes indicate bivalent fears of evaluation and disqualification of positive social outcomes as important predictors of social anxiety symptoms. Although replication in a clinical cohort and experimental confirmation are needed, the findings suggest a focus on disqualification of positive social outcomes to alleviate social anxiety symptoms.     

The longitudinal relationship between fear of positive evaluation and fear of negative evaluation

Available research suggests that fear of negative evaluation and fear of positive evaluation are related but distinct constructs that each contribute to social anxiety, implying a need to focus on these fears in treatment. Yet, this research is almost entirely based on cross-sectional data. We examined the longitudinal relationship between fears of positive and negative evaluation over three time points in a sample of undergraduate students. We tested competing models consistent with two basic positions regarding these fears: (1) that fear of positive evaluation only appears to affect social anxiety because it arises from the same, single underlying trait as fear of negative evaluation, and (2) fears of positive and negative evaluation are correlated, but clearly distinct, constructs. The best-fitting model was an autoregressive latent-trajectory model in which each type of fear had a separate trait-like component. The correlation between these trait-like components appeared to fully account for the relationships between these constructs over time. This investigation adds to the evidence in support of the second position described above: fear of positive evaluation is best interpreted as a separate construct from fear of negative evaluation.     

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.     

Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder

The Brief Fear of Negative Evaluation Scale (BFNE; M. R. Leary, 1983a) is often used to assess fear of negative evaluation, the core feature of social anxiety disorder. However, few studies have examined its psychometric properties in large samples of socially anxious patients. Although the BFNE yields a single total score, confirmatory factor analysis indicated a 2-factor solution to be more appropriate, with the 1st factor consisting of all straightforwardly worded items (BFNE-S) and the 2nd of all reverse-scored items (BFNE-R). Support was obtained for the convergent and discriminant validity of the BFNE and BFNE-S, but not the BFNE-R. These results suggest that standard scoring of the BFNE may not be optimal for patients with social anxiety disorder.     

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.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

Comparison of group and individual cognitive-behavioral therapy in reducing fear of negative evaluation

Previous studies have established the efficacy of group and individual formats of cognitive-behavioral therapy in reducing fear of negative evaluation in social anxiety disorder, but the effectiveness of the group and individual therapies has not been widely assessed. This study was conducted to compare the effectiveness of cognitive-behavior group therapy to individual cognitive-behavioral therapy in social anxiety disorder. 28 patients were randomly allocated to two groups of 14. Each group participated in 12 weekly sessions. The final sample was 22 participants after drop-out. Pretest and posttest data were collected using the Brief Fear of Negative Evaluation Scale and the Beck Depression Inventory-II. Controlling for pretest fear of negative evaluation and depression, cognitive-behavioral group therapy was more effective than individual cognitive-behavioral therapy in reducing fear of negative evaluation, but the clinical significance and improvement rates of the two treatment formats were equivalent.     

Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co-occurring trauma-related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma-related stress and social anxiety symptom scores (TRS/SAS), only high trauma-related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co-occurring trauma-related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.