Anxiety Sensitivity and Negative Interpretation Biases: Their Shared and Unique Associations with Anxiety Symptoms

Anxiety sensitivity (AS) is a psychological risk factor for anxiety disorders. Negative interpretation biases are a maladaptive form of information-processing also associated with anxiety disorders. The present study explored whether AS and negative interpretation biases make independent contributions to variance in panic and generalized anxiety symptoms and whether particular interpretation bias domains (e.g., of ambiguous arousal sensations) have specific associations with panic and/or generalized anxiety symptoms. Eighty-nine female undergraduates (44 low AS; 45 high AS) completed measures of AS, interpretation biases, and panic and generalized anxiety symptoms. Findings showed that AS and negative interpretation biases both significantly added to the prediction of anxiety symptoms. Negative interpretations of ambiguous arousal sensations were uniquely associated with panic symptoms, while negative interpretations of ambiguous general and social events were uniquely associated with generalized anxiety symptoms. Findings support the conceptual validity of AS and negative interpretation biases and their unique and shared contributions to anxiety symptoms.     

Incremental Validity of Perceived Control Dimensions in the Differential Prediction of Interpretive Biases for Threat

This study evaluated whether a diminished perception of control over environmental and interoceptive events differentially predicted interpretive biases for threat for ambiguous scenarios. The sample had 95 participants without a history of psychopathology. Results indicated that the internal dimension of the Anxiety Control Questionnaire (ACQ; R. M. Rapee, M. G. Craske, T. A. Brown, & D. H. Barlow, 1996) was predictive of interpretive biases for internal scenarios above and beyond demographic variables, subclinical panic attack history, and state anxiety; the external control subscale of the ACQ also was predictive of internal rank-ordered responses. The ACQ external dimension was predictive of interpretive responses for external scenarios beyond the effects accounted for by the other predictor variables, including perceived control for internal events. These findings provide initial correlational evidence consistent with cognitive–behavioral accounts of panic disorder that posit a perceived lack of control over aversive events may exacerbate an interpretive bias for threat.     

Specificity of interoceptive fear to panic disorders

It has been argued that fear of interoceptive sensations is a maintaining factor in panic disorders. This study investigated whether interoceptive fears are specific to panic disorders or whether they are a feature of neurosis in general. Twenty-nine panic patients, 28 nonpanicking neurotic controls, and 29 normal controls were compared for their scores on a 14-item questionnaire intended to measure interoceptive fears. Indeed it was found that panic patients scored considerably higher than both control groups, whereas no significant differences emerged between the two control groups. It is concluded that interoceptive fear is diagnostically specific to panic disorders.This study was partly supported by the Dutch Organization for Fundamental Research (ZWO/Psychon., 560-268-001) and was carried out at the unit for clinical behavior therapy at Vijverdal Mental Hospital, Maastricht, The Netherlands.     

A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms

Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression—interpretation bias and attribution style—in adults with varying levels of anxiety and depressive symptoms. Participants (18–26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.     

Do anxious parents interpretive biases towards threat extend into their child's environment?

Anxiety disorders are known to run in families [Turner, S. M., Beidel, D. C., & Costello, A. (1987). Psychopathology in the offspring of anxiety disorder patients. Journal of Consulting and Clinical Psychology, 55(2), 229–235] and environmental factors may largely account for the concordance between parental and child anxieties. Cognitive psychology models emphasise the importance of interpretive biases towards threat in the maintenance of anxiety and it is well established that anxious adults and children display similar interpretive biases and that these biases in anxious parents and their children are correlated. This raises the question of whether anxious cognitions/cognitive style may be transmitted from parent to child. We propose that this is more likely if anxious parents demonstrate interpretive biases not only about potential threats in their own environment but also about potential threats in their child's environment. Forty parents completed a recognition memory measure of interpretation bias adapted from Eysenck, Mogg, May, Richards, and Mathews (1991) [Bias in interpretation of ambiguous sentences related to threat in anxiety. Journal of Abnormal Psychology, 100(2), 144–150] to measure biases in response to potentially threat provoking situations involving themselves and their child. The interpretive biases demonstrated by parents were similar across situations involving themselves and their children. As expected, parental interpretive biases were further modified by anxiety with higher levels of parental anxiety associated with more negative interpretive biases about situations in their own and their child's environment, although this association was significantly stronger for potentially threat provoking situations in their own environment. These results are consistent with parent's interpretive biases extending beyond their own environment into their child's environment, although future research should continue to consider the mechanisms by which anxious parents may transmit fear cognitions to their children.     

Modifying Threat-related Interpretive Bias in Adolescents

Socially anxious feelings sharply increase during adolescence and such feelings have been associated with interpretive biases. Studies in adults have shown that interpretive biases can be modified using Cognitive Bias Modification procedures (CBM-I) and subsequent effects on anxiety have been observed. The current study was designed to examine whether the CBM-I procedure has similar effects in adolescents. Unselected adolescents were randomly allocated to either a positive interpretation training (n = 88) or a placebo-control condition (n = 82). Results revealed that the training was successful in modifying interpretations and effects generalized to a new task. The interpretive bias effects were most pronounced in individuals with a threat-related interpretive bias at pre-test. No effects on state anxiety were observed. The current findings are promising with regard to applying bias modification procedures to adolescents, while further research is warranted regarding emotional effects.     

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

Treating anxiety comorbid with heart disease is challenging due to (a) diagnostic overlap between anxiety and heart disease, (b) the high risk associated with ignoring chest pain symptoms and delaying seeking medical attention, (c) that cognitive-behavioral therapy based on catastrophic misinterpretation of bodily symptoms requires adaption to incorporate the element of risk, and (d) that certain interoceptive symptom induction experiments may be harmful and are therefore fraught with liability. We describe Panic Attack Treatment in Comorbid Heart Diseases (PATCHD) that is based on enhancing coping skills, performing safe interoceptive exposures and supervised exercise, and countering avoidance to reduce panic attack frequency. Pre- and posttreatment data from 18 patients shows a significant reduction in cardiovascular hospital admissions and length of stay, panic attacks, general anxiety, and depression (all p < .05). Because of the complex nature of panic disorder comorbid with heart disease, health professionals should familiarize themselves with several necessary CBT adaptions.     

A Psychometric Analysis of the Revised Child Anxiety and Depression Scales—Parent Version in a School Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a parent-report questionnaire of youth anxiety and depression with scales corresponding to the DSM diagnoses of separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. The RCADS-P was recently developed and has previously demonstrated strong psychometric properties in a clinic-referred sample (Ebesutani et al., Journal of Abnormal Child Psychology 38, 249–260, 2010b). The present study examined the psychometric properties of the RCADS-P in a school-based population. As completed by parents of 967 children and adolescents, the RCADS-P demonstrated high internal consistency, test-retest reliability, and good convergent/divergent validity, supporting the RCADS-P as a measure of internalizing problems specific to depression and five anxiety disorders in school samples. Normative data are also reported to allow for the derivation of T-scores to enhance clinicians’ ability to make classification decisions using RCADS-P subscale scores.     

Biases in affective forecasting and recall in individuals with depression and anxiety symptoms

The authors used experience sampling to investigate biases in affective forecasting and recall in individuals with varying levels of depression and anxiety symptoms. Participants who were higher in depression symptoms demonstrated stronger (more pessimistic) negative mood prediction biases, marginally stronger negative mood recall biases, and weaker (less optimistic) positive mood prediction and recall biases. Participants who were higher in anxiety symptoms demonstrated stronger negative mood prediction biases, but positive mood prediction biases that were on par with those who were lower in anxiety. Anxiety symptoms were not associated with mood recall biases. Neither depression symptoms nor anxiety symptoms were associated with bias in event prediction. Their findings fit well with the tripartite model of depression and anxiety. Results are also consistent with the conceptualization of anxiety as a "forward-looking" disorder, and with theories that emphasize the importance of pessimism and general negative information processing in depressive functioning.     

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders.

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.     

Translating Empirically Supported Strategies Into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder

Many patients suffering from panic disorder do not receive adequate care. Advances in the conceptualization and treatment of panic disorder encourage innovative strategies for targeting core fears (fears of anxiety sensations) that underlie this disorder. In this article, we discuss the use of exercise as a potential strategy for therapeutic exposure to these feared sensations, and the role that exercise may play as an acceptable intervention to aid the dissemination of exposure-based approaches to the treatment of panic disorder. Evidence for the efficacy of exercise for the treatment of anxiety and panic is presented; along with strategies to enhance the role exercise can play as an interoceptive (internal sensation) exposure procedure. Finally, issues of comorbidity and exercise acceptability are discussed. Our conclusion is that exercise-based interventions are promising strategies for improving the utilization of exposure-based interventions for panic disorder. Clinical guidelines and future research directions are discussed.     

Does anxiety sensitivity predict symptoms of panic, depression, and social anxiety?

This study examined whether the lower-order factors of the Anxiety Sensitivity Index (ASI) exhibited specificity in predicting symptoms of panic, depression, and social anxiety prospectively. This question was addressed using a sample of undergraduates stratified to represent low, medium, and high levels of anxiety sensitivity (AS). It was hypothesized that the physical concerns, mental concerns, and social concerns subscales of the ASI would predict increases in panic, depression, and social anxiety symptoms, respectively, one year later. Results found that the physical concerns subscale predicted increases in both panic and depressive symptoms. Neither the mental concerns nor the social concerns subscales predicted significant variance in any of the Time 2 symptoms. Theoretical implications of these data for AS are discussed.     

Face Emotion Processing in Depressed Children and Adolescents with and without Comorbid Conduct Disorder

Studies of adults with depression point to characteristic neurocognitive deficits, including differences in processing facial expressions. Few studies have examined face processing in juvenile depression, or taken account of other comorbid disorders. Three groups were compared: depressed children and adolescents with conduct disorder (n = 23), depressed children and adolescents without conduct disorder (n = 29) and children and adolescents without disorder (n = 37). A novel face emotion processing experiment presented faces with ‘happy’, ‘sad’, ‘angry’, or ‘fearful’ expressions of varying emotional intensity using morphed stimuli. Those with depression showed no overall or specific deficits in facial expression recognition accuracy. Instead, they showed biases affecting processing of low-intensity expressions, more often perceiving these as sad. In contrast, non-depressed controls more often misperceived low intensity negative emotions as happy. There were no differences between depressed children and adolescents with and without conduct disorder, or between children with comorbid depression/conduct disorder and controls. Face emotion processing biases rather than deficits appear to distinguish depressed from non-depressed children and adolescents.     

Examining Temporal Associations between Perceived Maternal Psychological Control and Early Adolescent Internalizing Problems

The present study examined a) the associations between adolescent-reported maternal psychological control and self-reported internalizing problems one year later, while simultaneously examining the opposite direction of effects and b) the equivalence of these associations across gender. Participants were 479 10-to-14-year old adolescents (55% female) participating in two waves of a study. Results from multi-group, cross-lagged panel analyses indicated that although early adolescents’ depressive symptoms and social anxiety predicted change in perceived maternal psychological control one year later, perceived maternal psychological control did not predict change in early adolescents’ internalizing problems. Elevated levels of depressive symptoms were associated with increased levels of perceived maternal psychological control one year later, whereas elevated levels of social anxiety were associated with decreased levels. Aforementioned findings were consistent across boys’ and girls’ data. Study findings extend limited research on adolescent effects, demonstrating that early adolescents’ internalizing problems play a role in perceived maternal psychological control.     

Dynamic Associations between Maternal Depressive Symptoms and Adolescents’ Depressive and Externalizing Symptoms

The current prospective study investigated transactional relations between maternal depressive symptoms and children’s depressive and externalizing symptoms. Participants included 240 children (M age = 11.86 years, SD = 0.56; 53.9% female) and their mothers who were part of a 6-year longitudinal study. Measures of maternal depression (Beck Depression Inventory), child depression (Children’s Depression Inventory), and children’s externalizing symptoms (Youth Self-Report Form) were assessed annually. Data analyses using dynamic latent difference score structural equation models indicated that the observed relations between mothers’ and adolescents’ symptoms were stable across the 6 years. Higher levels of maternal depressive symptoms predicted subsequent elevations in children’s depressive symptoms and in their externalizing problems over time. Among mothers with high initial levels of depression, children’s depressive symptoms predicted subsequent declines in mothers’ depressive symptoms. Children’s externalizing problems were not related to subsequent change in maternal symptoms.     

Maternal Depression,Maternal Expressed Emotion,and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.     

Anxiety Symptoms in African American Children: Relations with Ethnic Pride,Anxiety Sensitivity,and Parenting

This cross-sectional study examined the relations among children’s ethnic pride, perceived parenting behavior (i.e., parental control, parental acceptance), anxiety sensitivity, and child anxiety symptoms (i.e., physical symptoms, social anxiety symptoms, separation anxiety symptoms, and harm avoidance symptoms) in 266 African American school children (M = 9.98 years old; 55% girls). Structural equation modeling results indicated that high ethnic pride was associated with high parental acceptance. High perceived parental acceptance, in turn, was related to children reporting low levels of social anxiety symptoms and high levels of harm avoidance. In addition, high parental control was related to high anxiety sensitivity. Anxiety sensitivity partially mediated the relation between parental control and separation anxiety symptoms, such that parental control was both directly and indirectly related to separation anxiety symptoms. Parental control was indirectly related to physical symptoms, social anxiety symptoms, and harm avoidance symptoms through its direct link to anxiety sensitivity. The study’s results increment knowledge about factors influencing specific dimensions of anxiety in African American children.     

Cascading effects: the influence of attention bias to threat on the interpretation of ambiguous information

Both attention bias to threat and negative interpretive bias have been implicated in the emergence and maintenance of anxiety disorders. However, relations between attention and interpretive biases remain poorly understood. The current study experimentally manipulated attention bias to threat and examined the effects of attention training on the way ambiguous information was interpreted. Results suggest that the preferential allocation of attention towards threat affects the manner in which ambiguous information is interpreted. Individuals trained to attend to threat were more likely than individuals in a placebo training group to interpret ambiguous information in a threat-related manner. These data suggest that perturbations in the initial stages of information processing associated with anxiety may lead to a cascade of subsequent processing biases.     

Attention bias in youth: Associations with youth and mother's depressive symptoms moderated by emotion regulation and affective dynamics during family interactions

Recent research has highlighted the potential role of attention bias for emotional stimuli as a possible cognitive risk factor for depression in youth. However, differences in youth emotion regulation or maternal affect may moderate the association between maternal and youth depression and youth attention biases. The current study investigated the relationship between maternal and youth depressive symptoms and youth (aged 11–17 years) attention bias for sad and happy faces in 59 mother–youth dyads, examining whether positive and negative maternal affect observed during structured interaction tasks or youth emotion regulation tendencies moderated associations between maternal and youth depression and attention biases. Youth suppression interacted with maternal and youth depression to predict sad attentional biases in youth, while maternal positive affect interacted with maternal depression to predict happy attention biases in youth.