Anxiety sensitivity – fear of anxiety-related sensations due to perceived consequences of physical, mental, or social harm – is considered an imperative factor in the maintenance and development of anxiety disorders (Reiss and McNally, 1985). This construct is much more specific than the previously proposed anxiety-related construct of trait anxiety. There is much variability in how prone people are to experience anxiety. Some individuals experience anxiety when minimally provoked, and others require much more stressful circumstances.
Individual differences in how prone one is to experience anxiety is considered trait anxiety (Taylor, 1999). The tendency to see the world as dangerous or threatening or the tendency to become anxious across situations sums up the broad definition of trait anxiety (Beck and Emery, 1985). A more sophisticated conceptualization was offered in a hierarchical model of trait anxiety (Lilienfeld, Turner, and Jacob, 1993). In this model, anxiety consists of one higher-order factor, the general concept of trait anxiety, and three lower-order factors: anxiety sensitivity, fear of negative evaluation, and fear of illness or injury sensitivity. This model later received empirical support (Taylor, 1995). Anxiety sensitivity is conceptually different from trait anxiety in that anxiety sensitivity represents the tendency to fear or respond anxiously to arousal symptoms whereas trait anxiety refers to the tendency to have an anxious response to any stressor or stressors in general (Holloway and McNally, 1987). In sum, the development and severity of a variety of anxiety conditions is determined by three fundamental fears: negative evaluation, fear of injury or death, and anxiety sensitivity (Reiss and McNally, 1985; Reiss, 1991). According to the sensitivity theory of motivation, anxiety sensitivity is a genetically based aversion to anxiety that is combined with beliefs about the negative consequences of anxiety (Reiss and Havercamp, 1996).
Anxiety Sensitivity Index
The Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, and McNally, 1986; Peterson and Reiss, 1992) was developed to measure and test the theory of anxiety sensitivity. The ASI consists of 16-items asking about the degree to which an individual finds anxiety sensations fearful or catastrophic in outcome (Peterson and Reiss, 1992). Individuals respond to each question on a five-point Likert scale ranging from 0 (“very little”) to 4 (“very much”). A recent psychometric analysis of the ASI was conducted by Zinbarg, Barlow, and
Brown (1997). They found that the ASI is made up of a hierarchy of subscales. The lowest first-order factors assess three areas: physical concerns, mental incapacitation concerns, and social concerns. Most of the items on the ASI address the fear of physical harm resulting from anxious sensations, as reflected in the first factor. Examples of items targeting an individual’s beliefs about mental incapacitation include “When I cannot keep my mind on a task, I worry that I might be going crazy” and “When I am nervous, I worry that I am mentally ill.” Finally, items measuring the feared social consequences of anxiety sensations include “Other people notice when I feel shaky” and “It is important to me not to appear nervous.”
Anxiety Sensitivity and Panic Disorder
Anxiety sensitivity appears to predispose individuals to panic disorder. Lilienfeld (1997) found that anxiety sensitivity predicts a history of panic attacks above and beyond indicators of more general trait anxiety or negative affect. Anxiety sensitivity measures differentiated individuals who experience panic attacks but do not have panic disorder from those who have never had a panic attack (Norton, Cox, and Malan, 1992). Individuals high in anxiety sensitivity are considered to be at greater risk to experience panic attacks and develop panic disorder than individuals with low levels of anxiety sensitivity.
Anxiety sensitivity may develop from direct experience with aversive events such as serious illness or injury. Alternatively, exposure to the serious illness or death of a family member or the influence of an overprotective parent may also contribute to an individual’s vulnerability to anxiety sensitivity (Craske, 1999). Anxiety sensitivity is associated with a heightened level of attention paid to internal physical cues. Individuals who experience panic appear to have an elevated awareness or an increased ability to identify and detect bodily
sensations associated with arousal. This increased ability to detect physical cues may predispose an individual for the development of panic disorder (Craske, 1999).
Initial panic attacks occur in a variety of settings. These locations are often outside of the home (Craske, Miller, Rotunda, and Barlow, 1990), such as while at work or school, while driving, on a plane or bus, in public in general, or in a situation that is socially evaluative (Craske, 1999). Craske and Rowe (1997) proposed that initial panic attacks are most likely to occur in situations where feared physical sensations are perceived as especially threatening because of possible impairment. Examples include driving, fear of being trapped, fear of negative evaluation, or fear of being in an unfamiliar location. Certain situations or contexts are more likely to be linked with negative personal consequences of experiencing anxiety (Craske, 1999).
An intense fear of specific bodily sensations related to panic attacks often develops after an individual experiences the initial panic attack. Following a panic attack, this “fear of fear” is considered a sensitization of the individual’s predisposing trait of anxiety sensitivity. Reiss (1991) described a vicious cycle in which anxiety sensitivity increases the risk of panic attacks and panic attacks increase the levels of anxiety sensitivity. There is considerable evidence demonstrating that panic disordered individuals hold powerful beliefs and fears of
mental or physical harm occurring from bodily sensations associated with panic attacks (Craske, 1999).
Anxiety Sensitivity and Other Anxiety Disorders
The role of anxiety sensitivity has been in examined in other anxiety disorders, particularly social anxiety. However, anxiety sensitivity appears to play a different role in the maintenance of social anxiety disorder than it does in panic. Different anxiety disorders are associated with different patterns of responding on the ASI. For example, Hazen, Walker, and Stein (1995) compared ASI scores of individuals with social phobia to those of individuals with panic disorder. Results suggested a different manner of responding between the two
groups, with the social phobia group having significantly higher scores than the panic disorder group on three items (“Other people notice when I am shaky”, “It is important to me not to appear nervous”, and “It embarrasses me when my stomach growls”), all of which reflect concern for social consequences.
Anxiety Sensitivity and Social Anxiety in College Students
Given that anxiety sensitivity was elevated in individuals with social anxiety (Taylor et al., 1992), researchers have begun to examine anxiety sensitivity and social anxiety in the college student population. Gore, Carter, and Parker (2002) collected self-report measures including the Social Interaction Anxiety Scale and the Social Phobia Scale (SIAS and SPS; Mattick and Clarke, 1998), Anxiety Sensitivity Index-Physical Scale (ASI; Peterson and Reiss, 1992), and the State-Trait Anxiety Inventory (STAI-T; Speilberger, Gorsuch, and
Lushene, 1970) from 37 university students enrolled in psychology courses. All participants were also presented with a laboratory social challenge task instructing them to ask an “aloof” confederate on a date. Gore et al. (2002) found that while trait anxiety significantly predicted anxiety responses to the social challenge task, social anxiety measures were better predictors than either the ASI-physical subscale or the STAI-T. Thus, the SIAS and SPS combined accounted for more variance than either the STAI-T or the ASI-physical scale when predicting all social challenge task-related state measures. In addition, the higher the
individual’s social anxiety measure scores, the greater the state social anxiety as well as physical symptoms reported after interacting in the social challenge. In regards to anxiety sensitivity, individuals with higher ASI-physical scores did report greater fear during the social challenge. A surprising finding noted by Gore et al. was that the ASI-physical scale was nearly as good at predicting anxiety response as the SIAS and SPS combined. The ASIphysical scale significantly predicted all dependent measures, including the Beck Anxiety
Inventory (BAI; Beck, Brown, Epstein, and Steer, 1988), the Fear of Physical Sensations Questionnaire (FPSQ) which is a modified version of the Agoraphobic Cognitions Questionnaire (ACQ; Chambless, Caputo, Bright, and Gallagher, 1984), and Social State (SocS) which is a state measure adapted from a version of the Fear of Negative Evaluation scale (Watson and Friend, 1969).
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