The Contribution of Anxiety Sensitivity to Obsessive–Compulsive and Anxiety Symptoms in a Naturalistic Treatment Setting

Original Article

Abstract

Anxiety sensitivity (AS), a fear of arousal-related sensations, is prevalent in a number of disorders. We examined the relationship between internalizing symptoms and the anxiety sensitivity components of physical, social, and cognitive concerns in a sample of 165 patients seeking treatment in a clinic specializing in cognitive behavioral therapy for anxiety-related disorders. Social anxiety symptoms were associated with greater social concerns. Cognitive concerns were characteristic of both depression and generalized anxiety symptoms, suggesting these two classes of symptoms may share AS symptomatology. Physical concerns were specifically related to panic symptoms. Although obsessive–compulsive symptoms were related to cognitive concerns using univariate regression, these symptoms were not strongly related to any of the anxiety sensitivity components when the correlation between disorders was taken into account. Thus, within the internalizing symptoms studied here, the anxiety sensitivity domains were most relevant to panic, social anxiety, generalized anxiety, and depressive symptoms and less related to obsessive–compulsive symptoms.

Keywords

Anxiety sensitivity Internalizing symptoms Anxiety disorders Obsessive–compulsive disorder Depression 

Notes

Acknowledgements

The authors would like to acknowledge the creators of REDCap (Harris et al. 2009), the data acquisition program used to collect the data analyzed in the present study. This software reduced burden on patients by allowing them to provide responses at home, and facilitated easier and more accurate access of such treatment outcome data than traditional paper and pencil formats. The authors would also like to express their sincerest appreciation to Kathy Benhamou and Jody Zhong, the research assistants who assisted heavily on the creation and maintenance of the REDCap database, as well as coordinated data collection and patient reminders. In addition, we would like to thank the Director of the Center for the Treatment and Study of Anxiety (CTSA), Dr. Edna Foa, who allowed us to collect this important data from patients seeking treatment at the CTSA. We would also like to thank all the patients seeking treatment at our center who were willing for us to analyze their de-identified data in order to better understand the construct of anxiety sensitivity.

Compliance with Ethical Standards

Conflict of Interest

Dr. Antonia N. Kaczkurkin, Ms. Hayley Fitzgerald, Dr. Jeremy Tyler, and Dr. Anu Asnaani declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study was approved by the University of Pennsylvania Institutional Review Board. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

References

  1. Allan, N. P., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014). Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. Journal of Anxiety Disorders, 28, 266–275.  https://doi.org/10.1016/j.janxdis.2013.12.004.CrossRefPubMedGoogle Scholar
  2. Allan, N. P., Norr, A. M., Capron, D. W., Raines, A. M., Zvolensky, M. J., & Schmidt, N. B. (2015). Specific associations between anxiety sensitivity dimensions and fear and distress dimensions of emotional distress disorders. Journal of Psychopathology and Behavior Assessment, 37, 67–78.  https://doi.org/10.1007/s10862-014-9437-y.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  4. Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55, 1247–1263.  https://doi.org/10.1037/0003-066X.55.11.1247.CrossRefPubMedGoogle Scholar
  5. Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283, 2529–2536.  https://doi.org/10.1001/jama.283.19.2529.CrossRefPubMedGoogle Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
  7. Benítez, C. I., Shea, M. T., Raffa, S., Rende, R., Dyck, I. R., Ramsawh, H. J., … Keller, M. B. (2009). Anxiety sensitivity as a predictor of the clinical course of panic disorder: A 1 year follow up study. Depression and Anxiety, 26, 335–342.  https://doi.org/10.1002/da.20423.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, 57, 289–300.  https://doi.org/10.2307/2346101.Google Scholar
  9. Brown, H., Waszczuk, M., Zavos, H., Trzaskowski, M., Gregory, A., & Eley, T. (2014). Cognitive content specificity in anxiety and depressive disorder symptoms: A twin study of cross-sectional associations with anxiety sensitivity dimensions across development. Psychological Medicine, 44, 3469–3480.  https://doi.org/10.1017/S0033291714000828.CrossRefPubMedGoogle Scholar
  10. Brown, M., Smits, J. A., Powers, M. B., & Telch, M. J. (2003). Differential sensitivity of the three ASI factors in predicting panic disorder patients’ subjective and behavioral response to hyperventilation challenge. Journal of Anxiety Disorders, 17, 583–591.  https://doi.org/10.1016/S0887-6185(02)00231-1.CrossRefPubMedGoogle Scholar
  11. Calamari, J. E., Rector, N. A., Woodard, J. L., Cohen, R. J., & Chik, H. M. (2008). Anxiety sensitivity and obsessive-compulsive disorder. Assessment, 15, 351–363.  https://doi.org/10.1177/1073191107312611.CrossRefPubMedGoogle Scholar
  12. Calkins, A. W., Otto, M. W., Cohen, L. S., Soares, C. N., Vitonis, A. F., Hearon, B. A., & Harlow, B. L. (2009). Psychosocial predictors of the onset of anxiety disorders in women: Results from a prospective 3-year longitudinal study. Journal of Anxiety Disorders, 23, 1165–1169.  https://doi.org/10.1016/j.janxdis.2009.07.022.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Carleton, R. N., Collimore, K. C., & Asmundson, G. J. (2010). “It’s not just the judgements—It’s that I don’t know”: Intolerance of uncertainty as a predictor of social anxiety. Journal of Anxiety Disorders, 24, 189–195.  https://doi.org/10.1016/j.janxdis.2009.10.007.CrossRefPubMedGoogle Scholar
  14. Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.  https://doi.org/10.1016/0005-7967(86)90011-2.CrossRefPubMedGoogle Scholar
  15. Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176, 379–386.  https://doi.org/10.1192/bjp.176.4.379.CrossRefPubMedGoogle Scholar
  16. Cox, B. J., Enns, M. W., Freeman, P., & Walker, J. R. (2001). Anxiety sensitivity and major depression: Examination of affective state dependence. Behaviour Research and Therapy, 39, 1349–1356.  https://doi.org/10.1016/S0005-7967(00)00106-6.CrossRefPubMedGoogle Scholar
  17. Craske, M. G., Sanderson, W. C., & Barlow, D. H. (1987). The relationships among panic, fear, and avoidance. Journal of Anxiety Disorders, 1, 153–160.  https://doi.org/10.1016/0887-6185(87)90005-3.CrossRefGoogle Scholar
  18. Deacon, B. J., & Abramowitz, J. S. (2006). Anxiety sensitivity and its dimensions across the anxiety disorders. Journal of Anxiety Disorders, 20, 837–857.  https://doi.org/10.1016/j.janxdis.2006.01.003.CrossRefPubMedGoogle Scholar
  19. Dozois, D. J., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory–II. Psychological Assessment, 10, 83–89.  https://doi.org/10.1037/1040-3590.10.2.83.CrossRefGoogle Scholar
  20. Ebesutani, C., McLeish, A. C., Luberto, C. M., Young, J., & Maack, D. J. (2014). A bifactor model of anxiety sensitivity: Analysis of the Anxiety Sensitivity Index-3. Journal of Psychopathology and Behavioral Assessment, 36, 452–464.  https://doi.org/10.1007/s10862-013-9400-3.CrossRefGoogle Scholar
  21. Floyd, M., Garfield, A., & LaSota, M. T. (2005). Anxiety sensitivity and worry. Personality and Individual Differences, 38, 1223–1229.  https://doi.org/10.1016/j.paid.2004.08.005.CrossRefGoogle Scholar
  22. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496.  https://doi.org/10.1037/1040-3590.14.4.485.CrossRefPubMedGoogle Scholar
  23. Hajcak, G., Huppert, J. D., Simons, R. F., & Foa, E. B. (2004). Psychometric properties of the OCI-R in a college sample. Behaviour Research and Therapy, 42, 115–123.  https://doi.org/10.1016/j.brat.2003.08.002.CrossRefPubMedGoogle Scholar
  24. Hallion, L. S., & Ruscio, A. M. (2013). Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity. Journal of Abnormal Psychology, 122, 369–375.  https://doi.org/10.1037/a0031731.CrossRefPubMedGoogle Scholar
  25. Hallion, L. S., Tolin, D. F., Assaf, M., Goethe, J., & Diefenbach, G. J. (2017). Cognitive control in Generalized Anxiety Disorder: Relation of inhibition impairments to worry and anxiety severity. Cognitive Therapy and Research, 41, 610–618.  https://doi.org/10.1007/s10608-017-9832-2.CrossRefGoogle Scholar
  26. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42, 377–381.  https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMedGoogle Scholar
  27. Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive-behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: Clinical, developmental, and social perspectives (pp. 395–422). Boston, MA: Elsevier.CrossRefGoogle Scholar
  28. Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A. J., Stein, M. B., … Craske, M. G. (2014). Social anxiety disorder in DSM-5. Depression and Anxiety, 31, 472–479.  https://doi.org/10.1002/da.22231.CrossRefPubMedGoogle Scholar
  29. Hirsch, C. R., Mathews, A., Lequertier, B., Perman, G., & Hayes, S. (2013). Characteristics of worry in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44, 388–395.  https://doi.org/10.1016/j.jbtep.2013.03.004.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 193–209.  https://doi.org/10.1080/16506070701421313.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Huppert, J. D., Walther, M. R., Hajcak, G., Yadin, E., Foa, E. B., Simpson, H. B., & Liebowitz, M. R. (2007). The OCI-R: Validation of the subscales in a clinical sample. Journal of Anxiety Disorders, 21, 394–406.  https://doi.org/10.1016/j.janxdis.2006.05.006.CrossRefPubMedGoogle Scholar
  32. Kemper, C. J., Lutz, J., Bähr, T., Rüddel, H., & Hock, M. (2012). Construct validity of the anxiety sensitivity index–3 in clinical samples. Assessment, 19, 89–100.  https://doi.org/10.1177/1073191111429389.CrossRefPubMedGoogle Scholar
  33. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.  https://doi.org/10.1001/archpsyc.62.6.617.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.  https://doi.org/10.1001/archpsyc.56.10.921.CrossRefPubMedGoogle Scholar
  35. Lahey, B. B., Applegate, B., Hakes, J. K., Zald, D. H., Hariri, A. R., & Rathouz, P. J. (2012). Is there a general factor of prevalent psychopathology during adulthood? Journal of Abnormal Psychology, 121, 971–977.  https://doi.org/10.1037/a0028355.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Lee, H. J., & Kwon, S. M. (2003). Two different types of obsession: autogenous obsessions and reactive obsessions. Behaviour Research & Therapy, 41, 11–29.  https://doi.org/10.1016/S0005-7967(01)00101-2.CrossRefGoogle Scholar
  37. McNally, R. J. (1999). Anxiety sensitivity and information-processing biases for threat. In S. Taylor (Ed.), Anxiety sensitivity (pp. 183–197). Mahwah, NJ: Erlbaum.Google Scholar
  38. McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52, 938–946.  https://doi.org/10.1016/S0006-3223(02)01475-0.CrossRefPubMedGoogle Scholar
  39. Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136, 128–150.  https://doi.org/10.1037/a0018055.CrossRefPubMedGoogle Scholar
  40. Nowakowski, M. E., Rowa, K., Antony, M. M., & McCabe, R. (2016). Changes in anxiety sensitivity following group cognitive-behavior therapy for social anxiety disorder and panic disorder. Cognitive Therapy and Research, 40, 468–478.  https://doi.org/10.1007/s10608-015-9750-0.CrossRefGoogle Scholar
  41. Olatunji, B. O., Feldman, G., Smits, J. A., Christian, K. M., Zalta, A. K., Pollack, M. H., & Simon, N. M. (2008). Examination of the decline in symptoms of anxiety and depression in generalized anxiety disorder: Impact of anxiety sensitivity on response to pharmacotherapy. Depression and Anxiety, 25, 167–171.  https://doi.org/10.1002/da.20283.CrossRefPubMedGoogle Scholar
  42. Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135, 974–999.  https://doi.org/10.1037/a0017428.CrossRefPubMedGoogle Scholar
  43. Olthuis, J. V., Watt, M. C., & Stewart, S. H. (2014). Anxiety sensitivity index (ASI-3) subscales predict unique variance in anxiety and depressive symptoms. Journal of Anxiety Disorders, 28, 115–124.  https://doi.org/10.1016/j.janxdis.2013.04.009.CrossRefPubMedGoogle Scholar
  44. Otowa, T., Roberson-Nay, R., Bekhbat, M., Neigh, G. N., & Hettema, J. M. (2017). Genetics of anxiety disorders. In D. S. Charney, E. J. Nestler, P. Sklar & J. D. Buxbaum (Eds.), Neurobiology of mental illness (pp. 419–433). New York, NY: Oxford University Press.Google Scholar
  45. Pilecki, B., Arentoft, A., & McKay, D. (2011). An evidence-based causal model of panic disorder. Journal of Anxiety Disorders, 25, 381–388.  https://doi.org/10.1016/j.janxdis.2010.10.013.CrossRefPubMedGoogle Scholar
  46. Poli, A., Melli, G., Ghisi, M., Bottesi, G., & Sica, C. (2017). Anxiety sensitivity and obsessive-compulsive symptom dimensions: Further evidence of specific relationships in a clinical sample. Personality and Individual Differences, 109, 130–136.  https://doi.org/10.1016/j.paid.2017.01.002.CrossRefGoogle Scholar
  47. Pollack, M. H., Otto, M. W., Worthington, J. J., Manfro, G. G., & Wolkow, R. (1998). Sertraline in the treatment of panic disorder: A flexible-dose multicenter trial. Archives of General Psychiatry, 55, 1010–1016.  https://doi.org/10.1001/archpsyc.55.11.1010.CrossRefPubMedGoogle Scholar
  48. Raines, A. M., Oglesby, M. E., Capron, D. W., & Schmidt, N. B. (2014). Obsessive compulsive disorder and anxiety sensitivity: Identification of specific relations among symptom dimensions. Journal of Obsessive-Compulsive and Related Disorders, 3, 71–76.  https://doi.org/10.1016/j.jocrd.2014.01.001.CrossRefGoogle Scholar
  49. Reardon, J. M., & Williams, N. L. (2007). The specificity of cognitive vulnerabilities to emotional disorders: Anxiety sensitivity, looming vulnerability, and explanatory style. Journal of Anxiety Disorders, 21, 625–643.  https://doi.org/10.1016/j.janxdis.2006.09.013.CrossRefPubMedGoogle Scholar
  50. Rector, N. A., Szacun-Shimizu, K., & Leybman, M. (2007). Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behaviour Research and Therapy, 45, 1967–1975.  https://doi.org/10.1016/j.brat.2006.09.017.CrossRefPubMedGoogle Scholar
  51. Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153.  https://doi.org/10.1016/0272-7358(91)90092-9.CrossRefGoogle Scholar
  52. Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). New York, NY: Academic Press.Google Scholar
  53. Robinson, L. J., & Freeston, M. H. (2014). Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clinical Psychology Review, 34, 256–271.  https://doi.org/10.1016/j.cpr.2014.03.003.CrossRefPubMedGoogle Scholar
  54. Rodriguez, B. F., Bruce, S. E., Pagano, M. E., Spencer, M. A., & Keller, M. B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy, 42, 79–91.  https://doi.org/10.1016/S0005-7967(03)00074-3.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Sandin, B., Sánchez-Arribas, C., Chorot, P., & Valiente, R. M. (2015). Anxiety sensitivity, catastrophic misinterpretations and panic self-efficacy in the prediction of panic disorder severity: Towards a tripartite cognitive model of panic disorder. Behaviour Research and Therapy, 67, 30–40.  https://doi.org/10.1016/j.brat.2015.01.005.CrossRefPubMedGoogle Scholar
  56. Schmidt, N. B., Zvolensky, M. J., & Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40, 691–699.  https://doi.org/10.1016/j.jpsychires.2006.07.009.CrossRefPubMedGoogle Scholar
  57. Shear, K. M., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154, 1571–1575.  https://doi.org/10.1176/ajp.154.11.1571.CrossRefPubMedGoogle Scholar
  58. Shear, K. M., Frank, E., Rucci, P., Williams, J., Grochocinski, V. J., Vander Bilt, J., Houck, P. R., & Wang, T. (2001). Reliability and validity of the panic disorder severity scale: Replication and extension. Journal of Psychiatric Research, 35, 293–296.  https://doi.org/10.1016/S0022-3956(01)00028-0.CrossRefPubMedGoogle Scholar
  59. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.  https://doi.org/10.4088/JCP.09m05305whi.PubMedGoogle Scholar
  60. Sherry, A., & Henson, R. K. (2005). Conducting and interpreting canonical correlation analysis in personality research: A user-friendly primer. Journal of Personality Assessment, 84, 37–48.  https://doi.org/10.1207/s15327752jpa8401_09.CrossRefPubMedGoogle Scholar
  61. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.  https://doi.org/10.1001/archinte.166.10.1092.CrossRefPubMedGoogle Scholar
  62. Stein, M. B., Jang, K. L., & Livesley, W. J. (1999). Heritability of anxiety sensitivity: A twin study. American Journal of Psychiatry, 156, 246–251.  https://doi.org/10.1176/ajp.156.2.246.PubMedGoogle Scholar
  63. Taylor, S., Koch, W. J., Woody, S., & McLean, P. (1996). Anxiety sensitivity and depression: How are they related? Journal of Abnormal Psychology, 105, 474–479.  https://doi.org/10.1037/0021-843X.105.3.474.CrossRefPubMedGoogle Scholar
  64. Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Coles, M. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188.  https://doi.org/10.1037/1040-3590.19.2.176.CrossRefPubMedGoogle Scholar
  65. Teachman, B. A., Marker, C. D., & Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder. Journal of Consulting and Clinical Psychology, 78, 964–973.  https://doi.org/10.1037/a0021067.CrossRefPubMedPubMedCentralGoogle Scholar
  66. Timpano, K. R., Raines, A. M., Shaw, A. M., Keough, M. E., & Schmidt, N. B. (2016). Effects of a brief anxiety sensitivity reduction intervention on obsessive compulsive spectrum symptoms in a young adult sample. Journal of Psychiatric Research, 83, 8–15.  https://doi.org/10.1016/j.jpsychires.2016.07.022.CrossRefPubMedGoogle Scholar
  67. Vacha-Haase, T., & Thompson, B. (2004). How to estimate and interpret various effect sizes. Journal of Counseling Psychology, 51, 473–481.  https://doi.org/10.1037/0022-0167.51.4.473.CrossRefGoogle Scholar
  68. van Beek, N., & Griez, E. (2003). Anxiety sensitivity in first-degree relatives of patients with panic disorder. Behaviour Research and Therapy, 41, 949–957.  https://doi.org/10.1016/S0005-7967(02)00129-8.CrossRefPubMedGoogle Scholar
  69. Wheaton, M. G., Deacon, B. J., McGrath, P. B., Berman, N. C., & Abramowitz, J. S. (2012). Dimensions of anxiety sensitivity in the anxiety disorders: Evaluation of the ASI-3. Journal of Anxiety disorders, 26, 401–408.  https://doi.org/10.1016/j.janxdis.2012.01.002.CrossRefPubMedGoogle Scholar
  70. White, K. S., Brown, T. A., Somers, T. J., & Barlow, D. H. (2006). Avoidance behavior in panic disorder: The moderating influence of perceived control. Behaviour Research and Therapy, 44, 147–157.  https://doi.org/10.1016/j.brat.2005.07.009.CrossRefPubMedGoogle Scholar
  71. Zinbarg, R. E., Barlow, D. H., & Brown, T. A. (1997). Hierarchical structure and general factor saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277–284.  https://doi.org/10.1037/1040-3590.9.3.277.CrossRefGoogle Scholar
  72. Zinbarg, R. E., Brown, T. A., Barlow, D. H., & Rapee, R. M. (2001). Anxiety sensitivity, panic, and depressed mood: A reanalysis teasing apart the contributions of the two levels in the hierarchical structure of the Anxiety Sensitivity Index. Journal of Abnormal Psychology, 110, 372–377.  https://doi.org/10.1037/0021-843X.110.3.372.CrossRefPubMedGoogle Scholar
  73. Zvolensky, M. J., Feldner, M. T., Eifert, G. H., & Stewart, S. H. (2001). Evaluating differential predictions of emotional reactivity during repeated 20% carbon dioxide-enriched air challenge. Cognition & Emotion, 15, 767–786.  https://doi.org/10.1080/02699930143000284.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of PsychiatryCenter for the Treatment and Study of AnxietyPhiladelphiaUSA
  2. 2.Department of Psychological and Brain SciencesBoston UniversityBostonUSA

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