Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks

We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.     

The Role of Anxiety Sensitivity Components in Mediating the Relationship Between Childhood Exposure to Parental Dyscontrol and Adult Anxiety Symptoms

This retrospective study investigated the relationship between childhood exposure to parental dyscontrol (i.e., loss of control behaviors) and levels of anxiety sensitivity (AS) components in early adulthood. Four-hundred-and-sixty-five undergraduate students completed self-report measures including the Dyscontrol Experiences Questionnaire. Specificity emerged between AS components and particular dyscontrol experiences. Although exposure to parental dyscontrol related to negative emotional states was significantly positively correlated with all AS dimensions, exposure to parental dyscontrol related to drinking was significantly positively correlated with psychological concerns only. Mediator regression analyses showed AS psychological concerns to play a significant mediating role between parental dyscontrol related to anger and drinking and both general and panic-related anxiety symptoms in the adult offspring. Results suggest that specific parental behaviors may be etiologic in the development of AS, and acquired AS may help explain relations between childhood learning experiences and the development of psychopathological symptoms in young adulthood.     

Early Learning Experience and Adolescent Anxiety: A Cross-Cultural Comparison Between Japan and England

The main aim of this study was to compare the frequency of anxiety symptoms among adolescents in Japan and England, and to examine the association between early learning experiences and anxiety symptoms. A total of 299 adolescents (147 from England and 152 from Japan), aged 12 to 17 years were investigated. Results showed that adolescents in England reported significantly higher levels of anxiety symptoms than adolescents in Japan. For early learning experiences, no significant differences emerged between the two countries for parent punishment and reinforcement of anxious behavior. However, for non-anxiety physical symptoms (i.e. cold), adolescents in England scored significantly higher in parent punishment and the Japanese sample scored higher in parent reinforcement. Parent verbal transmission about the danger of anxiety and cold symptoms was more common in Japan than in England. The impact of learning experience on adolescent’s anxiety seemed to differ across cultures, which underscore the importance of cultural factors on adolescent’s anxiety.     

Cognitive factors associated with depression and anxiety in adolescents: A two-year longitudinal study

Background/Objective: To examine the roles of anxiety sensitivity and attentional bias in the development of anxiety and depression symptoms among adolescents. Method: 214 grade 7 to grade 10 Hong Kong Chinese students completed a package of psychometric inventories to measure levels of anxiety sensitivity, selective attentional processing, and anxiety and depressive symptoms in 2016 and then again in 2017. Results: Girls, when compared with boys, exhibited more anxiety symptoms and anxiety sensitivity in 2016. They also reported a significant increase in mean depression level from 2016 to 2017. Regression analyses revealed that the physical-concerns dimension of anxiety sensitivity, positive attentional bias, and to a lesser extent negative attentional bias were related to the development of both anxiety and depression symptoms one year later. Fear of mental incapacity could predict depression one year later but not anxiety symptoms. Conclusions: Intervention through anxiety sensitivity training to reduce somatic concerns and attentional bias modification to increase habitual attention to positive stimuli and to disengage from negative stimuli can reduce anxiety and depression symptoms among high school students.     

Menstrual Reactivity: The Role of Gender-Specificity,Anxiety Sensitivity,and Somatic Concerns in Self-Reported Menstrual Distress

To determine the impact of gender roles, anxiety sensitivity, and somatic concerns on self-reported menstrual distress, two studies were conducted. In the first study using 278 primarily Caucasian college females, anxiety-sensitivity level, not current menstrual cycle phase, influenced reports of menstrual symptom severity and depression. Regardless of cycle phase at the time of self-report, women high in anxiety sensitivity reported significantly more depressed mood, trait anxiety, and retrospective menstrual symptoms. In the second study of 158 primarily Caucasian college females varying in anxiety sensitivity levels, adherence to sex role stereotypes, feminist beliefs, and illness attitudes were examined. Participants also completed measures of general premenstrual, most-recent premenstrual, and current menstrual symptoms. Women high in anxiety sensitivity reported the highest levels of sex-specificity, feminist embeddedness, and illness attitudes, with sex-specificity accounting for significant variance in current menstrual symptoms. Results are discussed within the context of the menstrual reactivity hypothesis, which proposes that beliefs surrounding the menstrual cycle and body sensations expectancies contribute to self-reports of greater menstrual distress. Women high in anxiety sensitivity appear to represent one subgroup vulnerable to menstrual reactivity.     

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

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

The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective

Within the triple vulnerabilities model of anxiety disorders, a genetic contribution to the development of anxiety and negative affect (i.e., generalized biological vulnerability), a diminished sense of perceived control over aversive events and emotional experiences (i.e., generalized psychological vulnerability), and elevated levels of anxiety sensitivity (i.e., specific psychological vulnerability) are posited to increase the risk of developing and maintaining panic disorder (Barlow American Psychologist 55(11):1247–1263, 2000). The purpose of the present study was to investigate the direct and interactive effects of perceived control and anxiety sensitivity on panic disorder symptom severity. Structural equation models (SEM) were conducted in data derived from a sample of 379 adults with panic disorder participating in a multi-site randomized controlled trial. Findings indicated that both perceived control and anxiety sensitivity uniquely predicted panic disorder symptoms. A moderation model examining the interactive effects of perceived control and anxiety sensitivity on panic symptoms indicated that the effect of anxiety sensitivity on panic symptoms increased with greater deficits in perceived control. The present findings suggest that deficits in perceived control and elevated levels of anxiety sensitivity exert unique and shared effects on panic disorder symptoms, thereby illustrating the relationship between putative vulnerability factors and panic disorder symptoms as predicted by the triple vulnerabilities model.     

Differential relationships of somatic and cognitive anxiety with measures of processing speed in older adults

Research suggests a reciprocal relationship between late-life anxiety and cognition, particularly attention and executive functions. Whereas evidence supports a conceptual distinction between cognitive and somatic dimensions of anxiety, their differential relationship with cognitive outcomes has not been examined, particularly on tests of attention/executive functions that rely on processing speed. Study goals were threefold: (a) to describe levels of overall, cognitive, and somatic anxiety in a sample of older adults without dementia, (b) to determine if overall anxiety is associated with performance on select measures of attention/executive functions that rely on processing speed, and (c) to determine if a differential relationship exists between cognitive and somatic anxiety and cognitive performance. Participants were 368 community-dwelling older adults. Results showed that elevated levels of somatic, but not cognitive anxiety were associated with poorer performance across measures. Findings suggest that the nature of anxiety symptoms may have important implications for cognitive performance in older adults.     

Parenting-related childhood learning history and panic vulnerability: a test using a laboratory-based biological challenge procedure

A small but growing literature highlights specific parenting behaviors in increasing panic vulnerability among offspring. The current study examined the association between parenting-related instrumental and observational learning of sick-role behavior during childhood and reactivity to a panic-relevant biological challenge procedure that has evidenced predictive validity in terms of panic onset. Participants were 93 physically and psychologically healthy young adults (39 females; M_age = 23.41 years). As expected, results indicated that instrumental learning experiences involving (panic-relevant) arousal-reactive symptoms predicted increased post-challenge anxiety, arousal, and negative affective valence, even after accounting for variability associated with other theoretically relevant variables (e.g., anxiety sensitivity). Consistent with prior work, this learning history effect was specific to arousal-reactive, as opposed to arousal non-reactive, symptoms. Unexpectedly, observational learning was not related to challenge responding. Findings are discussed in terms of the potential role of parenting in etiologic models of panic development.     

Somatic complaints in anxious children

Although stomachaches and headaches are considered characteristic of children with anxiety disorders, there is converging evidence that a broader range of somatic symptoms may be associated with children's expressions of anxiety. The purpose of this study was to determine the prevalence of somatic complaints in anxious children. The results indicated that children with anxiety disorders endorsed the presence of many different somatic complaints, and that contrary to clinical intuition, stomaches and headaches were not among the most commonly reported symptoms. In addition, the anxious children endorsed significantly more somatic complaints when compared to normal controls. Furthermore, the symptom pattern reported by anxious children indicated the presence of both the somatic and cognitive components usually associated with panic attacks, although none of the children met diagnostic criteria for panic disorder. The results are discussed in terms of the contribution of somatic symptoms to the understanding of anxiety disorders in children.     

Children's narratives and well-being

Research with adults indicates that writing causal-explanatory and emotionally disclosing narratives of stressful experiences is related to psychological well-being. Limited research with children has shown mixed results, but developmental theory suggests that simple extrapolation from adult findings might be problematic. In this study, 9- to 13-year-old children engaged in three days of writing under emotional and non-emotional instructions, and completed measures of depression, anxiety, strengths and difficulties, and somatic symptoms both at baseline and 2 months following intervention. Narratives were coded using a developmentally appropriate, exhaustive coding system. Children in the emotional writing group wrote more about negative evaluations, problems, emotions, explanations and coping than children in the non-emotional writing group. However, those children who wrote more about negative evaluations, problems and explanations subsequently showed higher levels of anxiety, depression and difficulties. Due to limited narrative and emotional regulation skills, expressive writing may not benefit, and may even be detrimental for, some children.     

Developmental Trajectories of Anxiety Symptoms in Early Adolescence: The Influence of Anxiety Sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M _age?=?11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.     

Cardiophobia: a paradigmatic behavioural model of heart-focused anxiety and non-anginal chest pain.

Cardiophobia is defined as an anxiety disorder of persons characterized by repeated complaints of chest pain, heart palpitations, and other somatic sensations accompanied by fears of having a heart attack and of dying. Persons with cardiophobia focus attention on their heart when experiencing stress and arousal, perceive its function in a phobic manner, and continue to believe that they suffer from an organic heart problem despite repeated negative medical tests. In order to reduce anxiety, they seek continuous reassurance, make excessive use of medical facilities, and avoid activities believed to elicit symptoms. The relationship of cardiophobia to illness phobia, health anxiety, and panic disorder is discussed. An integrative psychobiological model of cardiophobia is presented which includes previous learning conditions relating to experiences of separation and cardiac disease; deficient and inappropriate behavioural repertoires which constitute a psychological vulnerability for cardiophobic problems; negative life events, stressors, and conflicts in the person's present situation that trigger and contribute to the symptoms; current affective, cognitive, and behavioural symptoms and their stimulus properties; and genetic and acquired biological vulnerability factors. Finally, recommendations for the treatment of cardiophobia are derived from the model and areas of future research are outlined.     

Emotion Regulation and the Specific Associations with Health Anxiety

This study investigated two primary research aims surrounding health anxiety: (a) to examine what differences exist in emotion regulation strategies of health anxious and non-health anxious populations and (b) to investigate what emotion regulation strategies predict health anxiety, before and after controlling for trait cognitive and somatic anxiety. A total of 95 participants of the general population completed a series of online questionnaires. A single factor between groups MANOVA revealed that a health anxious group scored significantly higher in several emotion regulation strategies: distraction, external attribution, emotion expression and acting out; anxiety-related variables: trait cognitive and somatic anxiety; and beliefs about the negative consequences of becoming ill. Hierarchical regressions showed that several emotion regulation strategies were significantly associated with higher levels of health anxiety, before: distraction, external attribution, capitalising, positive reappraisal and emotional expression; and after: external attribution and capitalising, the control of trait anxiety. Overall, the results demonstrated that (a) emotional intelligence and behavioural attempts to understand emotional experiences may be associated with specific health anxiety symptomology, while a lack of effective cognitive strategies and worry may be responsible for the associated trait anxiety dimensions.     

Heart-beat perception, panic/somatic symptoms and anxiety sensitivity in children

There is considerable evidence implicating heart-beat perception (HBP) accuracy and anxiety sensitivity (AS) in the development of panic in adults. However, to date there have been no studies exploring the association between HBP, AS and childhood panic/somatic symptoms. Seventy-nine children aged 8 to 11 years completed a mental tracking paradigm (Psychophysiology 18 (1981) 483) to assess HBP, the Children's Anxiety Sensitivity Index (J Clin Chil Psychol 20 (1991) 162) and the Screen for Childhood Anxiety Related Emotional Disorders (J Am Acad Child Adoles Psych 38 (1999) 1230). Those with good HBP (n = 7, 9%) had significantly higher panic/somatic symptoms (t = -1.71, P < 0.05), and AS (t = -2.16, P < 0.02) than those with poor HBP. There were no effects of age, sex or BMI on HBP. Those with high levels of panic/somatic symptoms were seven times more likely to have good HBP and had AS scores 1 S.D. higher than the remainder of the sample. Multivariate analyses revealed that these two phenotypes had independent associations with high panic/somatic symptoms. These results extend the literature on HBP and panic and suggest that in children, as in adults, increased panic/somatic symptoms are associated with enhanced ability to perceive internal physiological cues, and fear of such sensations.     

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.     

A preliminary study of the moderating role of church-based social support in the relationship between racist experiences and general anxiety symptoms

The current study explores the potential buffering effect of church-based social support on the effect of racism on anxiety symptomology in a Black sample. Fifty participants completed a questionnaire packet containing measures of anxious arousal and stress (general anxiety) symptoms, church-based social support, and experience of racist events. Results indicated that church-based social support moderated the relationship between racist experiences and general anxiety symptoms such that at low levels of church-based social support the experiences of racism and stress (general anxiety) symptoms were significantly positively associated. The clinical implications of these findings and future research directions are discussed.     

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.     

Effects of dispositional self-focus,appraisal and attention instructions on responses to a threatening stimulus

Abstract

Two studies are reported which explored the relationship between self-focused attention and anxiety. The first study tested the hypotheses that self-focused attention is associated with anxiety in threatening situations and that the relationship is mediated by negative appraisal processes. Study 1 showed no significant interaction between self-focus and negative appraisal on state-anxiety. However, self-focus was associated with increments in state-anxiety, high levels of worry and somatic symptom reports in a threatening situation. The relationship between self-focus and state-anxiety was mediated by somatic symptoms. Study 2 used cognitive and somatic self-attention instructions and external focus instructions to verify the hypothesis that self-focus on somatic arousal is associated with anxiety. It is concluded that specific self-focusing tendencies are associated with the elicitation and exacerbation of anxiety.     

The role of disgust and fear in blood and injection-related fainting symptoms: A structural equation model

Structural equation models were used to examine the relationship of blood, injection, and injury (BII) fears, disgust sensitivity, and trait anxiety to having experienced fainting-related symptoms in 722 university students. The latent variable representing BII fears was highly positively related to faint symptoms whereas that relating to disgust experiences was inversely related to fainting. A second disgust sensitivity variable was not directly related to fainting. Trait anxiety added nothing directly to the model, although it was related to BII latent variable. Additional analyses included a gender-related cross-validation which showed that models developed on one gender group did not fit well when applied to the other gender group. Blood drawings were the most common faint eliciting situations and were found to be reportedly more likely to elicit faint symptoms than were injections.