The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment

Jasper Smits, Michael Otto, Mark Powers, Scarlett Baird, Jasper A.J. Smits

• Publisher: Academic Press
• Year: 2018
• Print ISBN: 9780128134955
• eBook ISBN: 9780128134962
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment provides evidence-based strategies for clinicians looking to treat, assess and better understand anxiety sensitivity in their patients. The book delivers detailed guidance on the theoretical background and empirical support for anxiety sensitivity treatment methods, assessment strategies, and how clinicians can best prepare for sessions with their clients. Bolstered by case studies throughout, it highlights anxiety sensitivity as a transdiagnostic risk factor while also looking at the importance of lower-order sensitivity factors (physical, social, cognitive) in treatment planning, implementation and evaluation.- Examines anxiety sensitivity as a transdiagnostic risk factor- Provides an overview of clinical assessment strategies, such as self-report and behavioral- Highlights the importance of lower-order anxiety sensitivity factors for treatment- Outlines strategies for effective implementation of exposure therapy- Looks at computerized treatment methods- Includes a companion website that features scripts and worksheets for clinical use

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Anxiety sensitivity as a transdiagnostic treatment target

Jasper A.J. Smits*; Michael W. Otto^†; Mark B. Powers^‡; Scarlett O. Baird* ^⁎ The University of Texas at Austin, Austin, TX, United States
^† Boston University, Boston, MA, United States
^‡ Baylor University Medical Center, Dallas, TX, United States

Abstract

This chapter provides a brief review of the literature on anxiety sensitivity and describes the construct as a transdiagnostic factor. We summarize a model that highlights the role anxiety sensitivity plays as an amplification factor and thus a target for intervention. The chapter finishes by introducing the chapters in this volume.

Keywords

Anxiety sensitivity; Treatment target; Interoceptive exposure; Transdiagnostic factor

As illustrated by the 1979 film, When a Stranger Calls, a classic horror-story meme involves repeated, threatening calls at night to an isolated babysitter. The babysitter notifies the police, and is subsequently informed, “we’ve traced the call, it's coming from inside the house.” Threats arising from within the secure walls of a home are terrifying. Likewise, threat arising from stimuli within one's own body can be both terrifying and disabling. This is the type of fear captured by the concept of anxiety sensitivity, which has been defined as the fear of anxiety and related sensations (Reiss, Peterson, Gursky, & McNally, 1986).

Why a book about anxiety sensitivity? We have four specific answers. The first is that anxiety sensitivity is a strong predictor of both psychopathology and negative health behaviors. Anxiety sensitivity is elevated in individuals with anxiety and depressive disorders, and particularly in panic disorder and posttraumatic stress disorder (Naragon-Gainey, 2010; Olatunji & Wolitzky-Taylor, 2009). Individuals who report disordered eating also evidence heightened anxiety sensitivity (Anestis, Holm-Denoma, Gordon, Schmidt, & Joiner, 2008), which predicts overeating in response to negative emotions (Deboer et al., 2012; Hearon, Quatromoni, Mascoop, & Otto, 2014). Anxiety sensitivity also is related to a striking breadth of negative health behaviors and related medical conditions Otto et al., 2016). In a recent review of this area of study, Horenstein and colleagues (Horenstein, Potter, & Heimberg, 2018) identified 160 studies on the association between anxiety sensitivity and chronic illness, disability, and negative health behaviors. Horenstein and colleagues provided convincing evidence that anxiety sensitivity is linked to fear of pain, fear of cardiac symptoms, fear of respiratory symptoms, and fear of gastrointestinal symptoms relevant to the disability in a wide range of chronic medical conditions. Similarly, anxiety sensitivity predicts the avoidance of health behaviors, including exercise (Farris et al., 2016, 2017; Moshier et al., 2013; Moshier, Szuhany, Hearon, Smits, & Otto, 2016; Smits, Tart, Presnell, Rosenfield, & Otto, 2010), and also certain preventive procedures, like dental treatment (Horenstein et al., 2018). Indeed, the association between anxiety sensitivity and both exercise avoidance and mood-induced eating (Hearon et al., 2014) provides a particularly concerning “1:2 punch” to health. These negative health effects are further strengthened by the association between anxiety sensitivity and coping motives for drug use (Lejuez, Paulson, Daughters, Bornovalova, & Zvolensky, 2006; Leventhal & Zvolensky, 2015; Stewart & Kushner, 2001), including greater difficulties discontinuing smoking (Leventhal & Zvolensky, 2015). In sum, anxiety sensitivity serves as a highly useful, transdiagnostic predictor of distress and disability across a wide spectrum of mental health and physical health disorders (Otto et al., 2016; Otto & Smits, 2018).

The second reason is that the Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992) has proven its mettle relative to alternative measures of distress tolerance. In the last decade, distress tolerance has emerged as an increasingly studied construct for understanding the development and maintenance of psychopathology (Leyro, Zvolensky, & Bernstein, 2010). Distress tolerance is defined both by (1) the perceived capacity to withstand negative emotional or somatic states, and (2) the behavioral act of withstanding these internal states, as elicited by particular stressors. Distress tolerance is presumed to have both general factors as well as domain specificity, and accordingly measures have been developed to try to measure distress tolerance within specific domains such as the intolerance of uncertainty, the intolerance of frustration, the intolerance of emotion, as well as intolerance to pain or other induced physical states (Zvolensky, Bernstein, & Vujanovic, 2011). The original ASI is the most widely used instrument of the construct. This self-report measure, which has sound psychometric properties both for use in clinical and nonclinical samples (Peterson & Reiss, 1992), lists 16 statements reflecting either distress about anxiety symptoms (e.g., “It scares me when I feel shaky”) or concern about negative consequences of anxiety symptoms (e.g., “When I am nervous, I worry that I might be mentally ill”), and asks respondents to indicate the degree to which they agree with each statement (0 = “very little”; 4 = “very much”). The total score can range between 0 and 64. A revised version of the ASI, the ASI-3 (Taylor et al., 2007), has been developed in addition to a modification of the instrument for assessing anxiety sensitivity in children (CASI; Silverman, Fleisig, Rabian, & Peterson, 1991). Chapter 2 provides an overview of these measures and discusses how to best use them in practice.

Not only is there an impressively large literature regarding the ASI relative to other measures of distress intolerance (Horenstein et al., 2018), the ASI has done well in one-to-one comparisons with other measures of distress tolerance. For example, McHugh and Otto showed that the assessment of distress tolerance does indeed appear to rely on both general and domain-specific components, and that anxiety sensitivity, as measured by the ASI, has value in showing linkages across both self-report and behavioral persistence indices of distress tolerance (McHugh et al., 2011; McHugh & Otto, 2011). Why might anxiety sensitivity be so valuable as a broad-based predictor? We believe that it is not because of the domain specificity of the ASI (to anxiety-related physical, social, and cognitive symptoms), but because measures of anxiety sensitivity evaluate the fearful and anxious responses to these symptoms (e.g., all items of the 16-item Anxiety Sensitivity Index start with the phrase, “It scares me when…”). As illustrated in Fig. 1, we believe that it is this anxious response to symptoms of anxiety that underlies the value of anxiety sensitivity for assessing the amplification of anxiety and motivation to escape/avoid these target sensations (Otto et al., 2016). In short, anxiety sensitivity amplifies the aversiveness of a wide range of somatic experiences, and thereby motivates avoidance and escape, including the use of maladaptive strategies for avoidance such as drug use, stressful events, mood disturbances, or other physical provocations such as substance withdrawal, which all produce anxiety-like sensations. The role of anxiety sensitivity is to amplify the aversiveness of these sensations and drive maladaptive avoidance responses. We believe it is this essential pattern that underlies the value of anxiety sensitivity as both a predictor of maladaptive behavioral patterns and as a potential treatment target for ameliorating these maladaptive behaviors (Otto et al., 2016).

Fig. 1 Anxiety sensitivity in the maintenance of psychopathology and negative health behaviors. Reprinted by permission from Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., … Doan, S. N. (2016). Anxiety sensitivity and working memory capacity: risk factors and targets for health behavior promotion. Clinical Psychology Review, 49, 67–78. https://doi.org/10.1016/j.cpr.2016.07.003.

The value of anxiety sensitivity as a treatment target is the third reason for this book. Anxiety sensitivity is a malleable risk and maintaining factor. Indeed, meta-analytic review of 24 studies (1851 participants) showed that cognitive-behavior therapy results in very large reductions in anxiety sensitivity relative to a control condition (Hedges’ g = 1.40; Smits, Berry, Tart, & Powers, 2008). Interoceptive exposure procedures provide a particularly focused intervention for fears of emotions and associated bodily sensations—providing stepwise exposure to these sensations as induced by a range of physical procedures provides patients an opportunity to (re)establish a sense of safety around anxiety and related sensations (Boswell et al., 2013; Otto et al., 2012). Similarly, aerobic exercise has been shown to be efficacious in rapidly reducing anxiety sensitivity (Broman-Fulks, Berman, Rabian, & Webster, 2004; Smits et al., 2008), presumably following the same me...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• 1: Anxiety sensitivity as a transdiagnostic treatment target
• 2: Assessing anxiety sensitivity
• 3: Integrating patients’ anxiety sensitivity profile into one's case formulation and treatment planning
• 4: Treating anxiety sensitivity in adults with anxiety and related disorders
• 5: Optimizing outcomes for pain conditions by treating anxiety sensitivity
• 6: Integrative treatment program for anxiety sensitivity and smoking cessation
• 7: Anxiety sensitivity treatment for children and adolescents
• 8: Targeting anxiety sensitivity as a prevention strategy
• 9: Anxiety sensitivity and your clinical practice
• Index