Cognitive vulnerability to comorbidity: looming cognitive style and depressive cognitive style as synergistic predictors of anxiety and depression symptoms

Background and objectives

Because anxiety and depression are highly comorbid, it is likely that individuals with co-occurring cognitive vulnerabilities to depression and anxiety will experience more severe symptoms of anxiety and depression. However, no study to date has examined the effects of co-occurring (simultaneous) cognitive vulnerabilities to depression and anxiety on the severity of symptoms.

Method

The present study examines the co-occurring effects of Alloy and Abramson’s (1999) Negative Cognitive Style, a vulnerability to depression, and Riskind’s (2000) looming cognitive style, a vulnerability to anxiety.

Results

Results indicated that those with co-occurring vulnerabilities experience a more severe level of anxiety and depression symptoms.

Limitations

The present study used a measure of symptoms rather than actual clinical diagnoses.

Conclusion

These findings address the previously ignored area of cognitive vulnerability to comorbidity. Co-occurring cognitive vulnerabilities to anxiety and depression synergistically confer risk for more severe anxiety and depression symptoms than the individual or additive effects of either vulnerability do alone.     

Influence of anxiety,depression and looming cognitive style on auditory looming perception

Previous studies show that individuals with an anticipatory auditory looming bias over-estimate the closeness of a sound source that approaches them. Our present study bridges cognitive clinical and perception research, and provides evidence that anxiety symptoms and a particular putative cognitive style that creates vulnerability for anxiety (looming cognitive style, or LCS) are related to how people perceive this ecologically fundamental auditory warning signal. The effects of anxiety symptoms on the anticipatory auditory looming effect synergistically depend on the dimension of perceived personal danger assessed by the LCS (physical or social threat). Depression symptoms, in contrast to anxiety symptoms, predict a diminution of the auditory looming bias. Findings broaden our understanding of the links between cognitive-affective states and auditory perception processes and lend further support to past studies providing evidence that the looming cognitive style is related to bias in threat processing.     

The looming maladaptive style predicts shared variance in anxiety disorder symptoms: further support for a cognitive model of vulnerability to anxiety

Looming vulnerability pertains to a distinct cognitive phenomenology characterized by mental representations of dynamically intensifying danger and rapidly rising risk as one projects the self into an anticipated future [J. Pers. Soc. Psychol. 79 (2000) 837]. While looming appraisals can be experienced as state elicitation, some individuals are hypothesized to develop an enduring cognitive pattern of cross-situational looming appraisals, the looming maladaptive style (LMS), which functions as a cognitive vulnerability to anxiety. In the present study, we examined the extent to which the LMS predicts common variance in numerous anxiety disorder symptoms, independent of the potentially confounding effects of current depressive symptoms. Specifically, we hypothesized that controlling for depressive symptoms, LMS would predict shared variance in a latent factor comprised of indicators of five anxiety disorder symptoms: obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, social phobia, and specific phobic fears. Measures of these anxiety disorder symptoms, depressive symptoms, and looming vulnerability were administered to unselected college student population. Structural equations modeling analyses provided support for our hypothesis that LMS predicts shared variance in anxiety disorder symptoms and suggest that this cognitive style may be an overarching dimension of vulnerability to anxiety.     

Examination of the convergent validity of looming vulnerability in the anxiety disorders

The looming vulnerability model proposes that individuals with anxiety generate dynamic mental scenarios of threats as intensifying and approaching faster than they can cope or respond. In addition to the looming cognitive style posing a general cognitive vulnerability for anxiety, the looming vulnerability model posits that different anxiety disorders can be distinguished based on the specific content of their looming vulnerability themes. The current study examined whether different anxiety disorders have distinct looming vulnerability content along the lines of disorder-specific themes. A treatment-seeking sample of individuals with DSM-IV anxiety disorders (N = 172) completed measures of looming vulnerability prior to treatment initiation. Consistent with the looming vulnerability model, the results indicated that individuals with social phobia, obsessive compulsive disorder, and panic disorder reported significantly greater disorder-specific looming content compared to non-disorder specific looming content. Individuals with generalized anxiety disorder reported the same level of looming social threat as those with social phobia. The results suggest that different anxiety disorders can be distinguished by the specific content of looming vulnerability themes and provide empirical support for the convergent validity of the Looming Vulnerability Scale.     

The structure of emotional and cognitive anxiety symptoms

A sample of 327 patients with primary panic disorder or social phobia completed a questionnaire comprising 77 emotional and cognitive anxiety symptoms from which 12 index scales were constructed. Explorative factor analysis yielded two factors, but confirmatory factor analysis indicated that the factor solution was not invariant across diagnoses. Nevertheless, the two-factor structures fitting data from patients with panic disorder and social phobia, respectively, had similarities in content. The first factor, emotions and cognitive-social concerns, comprised emotional expressions (sadness, fear, and anger), cognitions about cognitive dysfunction (difficulty concentrating, confusion, and loss of control) and social phobic cognitions. It was positively correlated with severity of bodily anxiety symptoms and with the neuroticism personality trait. The second factor, fear of physical sensations, was positively correlated with a cardio-respiratory dimension of bodily anxiety symptoms in panic disorder, lending support to the hypothesis of specific threat-relevant links between bodily symptoms and catastrophic cognitions.     

Anxiety sensitivity, trait anxiety, and the anxiety disorders

The recent debates and commentaries about the construct validity of the Anxiety Sensitivity Index (ASI) suggest several issues that remain to be resolved. First, the factor structure of the ASI remains to be clarified. Second, the distinction between this instrument and measures of trait anxiety has yet to be elucidated. A third issue concerns the extent to which the ASI and the trait version of the State-Trait Anxiety Inventory (STAI-T) can discriminate between panic disorder and other anxiety disorders. These issues were investigated by administering the ASI and the STAI-T to 142 spider-phobic college students and 93 psychiatric outpatients. In both samples, the ASI was found to be unifactorial. When the pool of ASI and STAI-T items was subjected to a factor analysis with oblique rotation, both samples yielded a two-factor solution. The STAI-T items were responsible for almost all the salient loadings on the first factor, and the ASI items were responsible for almost all the salient loadings on the second factor. In both samples the correlation between the factors was .39. These results suggest that the ASI is not simply a measure of trait anxiety. Items that are particularly important in defining the ASI concern the fear of bodily sensations. Fear of the social consequences of anxiety played a minor role in this factor. Panic-disordered patients were differentiated from patients with other anxiety disorders by ASI items pertaining to fear and catastrophic misinterpretation of bodily sensations. The full-scale score and item responses of the STAI-T were unable to differentiate between the anxiety groups. The findings support the construct validity of the ASI and the recent cognitive models of panic disorder. The results also suggest that a three-item version of the ASI may be used for the diagnosis of panic disorder.     

Childhood adversity and vulnerability to mood and anxiety disorders

Based upon epidemiological surveys, adverse childhood events are proposed to be risk factors for adult depressive and anxiety disorders. However, the extent to which these events are seen in clinical patient populations is less clear. We examined the prevalence of a number of proposed risk factors for depression in 650 patients with mood and anxiety disorders at the time of presentation for treatment in an outpatient subspecialty clinic. Emotional abuse, physical abuse, or sexual abuse (childhood adversity) was found in approximately 35% of patients with major depression and panic disorder, was more common in women than men, and was associated with an earlier onset of symptoms. Childhood adversity was also strongly associated with marital discord/divorce, and psychopathology in a parent, suggesting family discord predisposes to childhood abuse. Furthermore, the association of childhood abuse with parental mental illness suggests that genetic and environmental factors are difficult to separate as etiological factors in vulnerability. Depression and Anxiety 5:66–72, 1997. © 1997 Wiley-Liss, Inc     

The psychobiology of resilience and vulnerability to anxiety disorders: implications for prevention and treatment

Much of the research on the neurobiology of human anxiety disorders has focused on psychopaihological abnormalities in patients with anxiety disorders. While this line of research is obviously important, more investigation is needed to elucidate the psychobiology of resilience to extreme stress. Study of the psychobiology of resilience has the potential to identify neurochemical, neuropeptide, and hormonal mediators of vulnerability and resilience to severe stress. In addition, the relevance of neural mechanisms of reward and motivation, fear responsiveness, and social behavior to character traits associated with risk and resistance to anxiety disorders may be clarified. These areas of investigation should lead to improved methods of diagnosis, novel approaches to prevention, and new targets for antianxiety drug discovery.     

The relationship of anxiety disorders, anxiety sensitivity and pulmonary dysfunction with dyspnea-related distress and avoidance

Little is known about factors that mediate the relationship between anxiety and respiratory-related distress and disability. We hypothesized that elevations in anxiety sensitivity would be associated with greater severity of dyspnea, greater dyspnea-related avoidance, and poorer subjective assessment of health in patients with dyspnea referred for pulmonary function testing, regardless of objective evidence of pulmonary dysfunction. A total of 182 consecutive patients receiving pulmonary function tests to evaluate dyspnea were screened with a patient-rated Primary Care Evaluation of Mental Disorders and completed the Anxiety Sensitivity Index and questionnaires assessing symptom severity and avoidance. Anxiety Sensitivity Index score predicted more severe subjective dyspnea and greater dyspnea-related avoidance, even after adjustment for anxiety disorders and pulmonary dysfunction. Despite some limitations, these data provide preliminary support that strategies to identify, measure, and address high levels of anxiety sensitivity should be examined to reduce subjective distress and improve functioning for patients with dyspnea.     

The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders

The objective of this study was to examine the relationship between anger management style, depression, anxiety and somatic symptoms in anxiety disorder and somatoform disorder patients. The subjects comprised 71 patients with anxiety disorders and 47 with somatoform disorders. The level of anger expression or anger suppression was assessed by the Anger Expression Scale, the severity of anxiety and depression by the Symptom Checklist-90-Revised (SCL-90-R) anxiety and depression subscales, and the severity of somatic symptoms by the Somatization Rating Scale and the SCL-90-R somatization subscale. The results of path analyses showed that anger suppression had only an indirect effect on somatic symptoms through depression and anxiety in each of the disorders. In addition, only anxiety had a direct effect on somatic symptoms in anxiety disorder patients, whereas both anxiety and depression had direct effects on somatic symptoms in somatoform disorder patients. However, the anxiety disorder group showed a significant negative correlation between anger expression and anger suppression in the path from anger-out to anger-in to depression to anxiety to somatic symptoms, unlike the somatoform disorder group. The results suggest that anger suppression, but not anger expression, is associated with mood, i.e. depression and anxiety, and somatic symptoms characterize anxiety disorder and somatoform disorder patients. Anxiety is likely to be an important source of somatic symptoms in anxiety disorders, whereas both anxiety and depression are likely to be important sources of somatic symptoms in somatoform disorders. In addition, anger suppression preceded by inhibited anger expression is associated with anxiety and somatic symptoms in anxiety disorders.     

儿童焦虑性情绪障碍筛查量表的临床应用

目的研究儿童焦虑性情绪障碍筛查量表SCARED在儿童及青少年情绪障碍中的应用。方法随机抽取上海市精神卫生中心儿童心理门诊符合CCMD-3诊断标准的焦虑症患儿35例,多动障碍患儿31例,随机抽取上海市某中小学45例健康儿童为对照组。研究组患儿及父母均填写SCARED量表,对照组填写SCARED量表并在一周后重测,多动症组评估SCARED量表。结果研究组SCARED量表总分及各因子分均分别显著高于对照组、多动症组。患儿自评与父母评定的相关系数在0．618至0．839之间。重测信度在0．451～0．872之间,各因子分与总分相关系数在0．331～0．852之间,Cronbach‘s a系数在0．2331至0．8032之间。SCARED量表总分与焦虑自评量表总分相关系数为0．661。结论SCARED量表信、效度良好,可作为临床辅助诊断及科研的筛查工具。     

焦虑障碍患者焦虑敏感与特质焦虑的相关研究

目的:探讨焦虑障碍患者焦虑敏感与特质焦虑、临床特征的相关性。方法:68例焦虑障碍患者(焦虑组)根据汉密尔顿焦虑量表(HAMA)评分≥7分为分界值,分为焦虑未缓解组43例和缓解组25例,进行焦虑敏感测定量表(ASI-R)及状态-特质焦虑问卷中特质焦虑量表部份(T-AI)的评定;ASI-R评分结果与70名正常对照(正常对照组)进行比较,分析ASI-R评分与T-AI总分及临床特征的相关性。结果:焦虑组ASI-R总分、对躯体感觉的焦虑因子分、对躯体感觉的恐惧因子分、对认知失控焦虑恐惧因子分、对社会后果焦虑恐惧因子分均高于正常对照组(t分别=8.51,9.00,8.15,8.74,3.24;P均<0.01)。焦虑缓解组ASI-R总分、及对躯体感觉的焦虑因子分、对躯体感觉的恐惧因子分、对认知失控焦虑恐惧因子分均高于正常对照组(t分别=4.41,3.37,4.24,3.76;P均<0.01);未缓解组ASI-R总分及各因子分高于缓解组(t分别=3.30,3.41,2.61,2.78,2.14;P<0.05或P<0.01)。经相关分析,ASI-R总分、及躯体感觉的焦虑因子分、对认知失控的焦虑恐惧因子分与T-AI总分显著相关(r分别=0.33,0.28,0.40;P<0.05或P<0.01);ASI-R总分、对认知失控焦虑恐惧因子分、对社会后果焦虑恐惧因子分与病程显著相关(r分别=0.27,0.26,0.31;P均<0.05)。结论:焦虑障碍患者的焦虑敏感程度高于正常人群;焦虑敏感水平部分与焦虑特质有关。     

Cognitive vulnerability in fear of flying: the role of anxiety sensitivity

Previous research has indicated that more than 50% of air travel passengers experience hypoxia above clinical threshold. This condition produces a number of aversive somatic sensations such as difficulty breathing, elevated heart rate, dizziness, etc. Because these symptoms closely resemble the somatic symptoms of anxiety, it is interesting to look into a possible relationship between hypoxia-related symptoms and fear of flying. More specifically, the aim of this study is to clarify the role of anxiety sensitivity as a cognitive vulnerability marker in this relationship. Anxiety sensitivity is the specific tendency to interpret bodily sensations as threatening or harmful. Our hypothesis is that anxiety sensitivity moderates the relationship between hypoxia-related symptoms and fear of flying. When people with high anxiety sensitivity fly and experience somatic symptoms, they will make threatening interpretations causing fear and as a possible consequence avoidance behaviour leading to flight anxiety. About 160 participants were asked to complete the Flight Anxiety Situations Questionnaire, the Flight Anxiety Modality Questionnaire and the Anxiety Sensitivity Index. Results of a moderator analysis indicated that the relationship between somatic sensations and in-flight anxiety is stronger for people with high anxiety sensitivity than for people with low anxiety sensitivity. So it seems that anxiety sensitivity does indeed function as a moderator between the experience of somatic sensations while flying and in-flight anxiety. Clinical implications are discussed, as well as suggestions for further research.     

Anxiety sensitivity in African-American adolescents: evidence of symptom specificity of anxiety sensitivity components

OBJECTIVE: To examine the specificity of components of anxiety sensitivity (phrenophobia, fear of cardiovascular sensations, and fear of unsteadiness) to anxiety and depression in a sample of African-American adolescents. METHOD: Participants were 527 African-American adolescents (238 females, mean age 13.8 years) who were originally recruited as first graders in 1993 to 1994 for participation in the second-generation Johns Hopkins Prevention Intervention Research Center trials. Youths completed measures of anxiety sensitivity and anxious and depressive symptoms in the spring of 2001. Associations between anxiety sensitivity and depression and anxiety were examined using hierarchical linear regressions. RESULTS: Anxiety sensitivity as a unitary construct was positively associated with symptoms of anxiety after adjusting for symptoms of depression. Fear of unsteadiness showed specificity to anxiety after adjusting for depression and phrenophobia. Phrenophobia was positively associated with anxiety and depression, after adjusting for the other symptom and fears of physical sensations. CONCLUSIONS: Specificity of anxiety sensitivity to anxiety in a sample of African-American adolescents furthers understanding of the nature of anxiety sensitivity in this group and the potential roles of components of anxiety sensitivity in the development of psychopathology in general.     

Construct validity and vulnerability to anxiety: A cognitive interviewing study of the revised Anxiety Sensitivity Index

The Anxiety Sensitivity Index (ASI; Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8) is probably the most widely used measure of cognitive vulnerability to anxiety. However, there have been periodic doubts expressed about whether it measures beliefs about the negative consequences of anxiety symptoms, as it purports to, or actual anxiety experiences. The present study investigated the construct validity of the revised ASI using a cognitive interviewing approach. Sixteen outpatients with anxiety problems responded to ASI-R items and items from another measure of vulnerability to anxiety, the Anxiety Attitude and Belief Scale, while thinking aloud. The resulting verbal protocols were coded according to the apparent cognitive processes respondents engaged in when answering the items. Responses to the revised ASI-R more often entailed retrieval of past episodes of anxiety, and participants more frequently formulated their responses based on judgments of the occurrence or intensity of feelings rather than on the appraisal of anticipated consequences of what was described in the items. These findings potentially have significant implications for interpretation of results from the large body of literature using the different versions of the ASI.     

Borderline personality features and emotional reactivity: The mediating role of interpersonal vulnerabilities

Background and ObjectivesThe purpose of this study was to examine the mediating role of interpersonal vulnerabilities in the association of borderline personality (BP) features with emotional reactivity to an interpersonal stressor.MethodsFor this study, female university students with high (N = 23), mid (N = 23), and low (N = 22) BP features completed the Inventory of Interpersonal Problems-Personality Disorders-25 (IIP-PD-25). Self-reported emotions, skin conductance responses (SCRs), interbeat intervals, and heart rate variability measured emotional reactivity to a social rejection stressor.ResultsBP features were positively associated with interpersonal dysfunction and predicted greater SCR reactivity and self-reported emotional reactivity. Interpersonal dysfunction mediated the association between BP features and physiological (SCRs), but not self-reported, emotional reactivity. In particular, scores on the interpersonal ambivalence subscale of the IIP-PD-25 mediated the association of BP features with SCR reactivity.LimitationsThis study examined BP features in a non-clinical sample, and relied on a relatively small sample. Furthermore, the design of the present study does not capture the potential transaction between interpersonal vulnerabilities and emotional dysfunction.ConclusionsThe findings of this study illuminate one potential mechanism underlying the heightened reactivity of persons with BP features to rejection, suggesting that interpersonal ambivalence plays a particularly important role in physiological reactivity.