Subjective symptoms and cardiac reactivity to brief hyperventilation in individuals with high anxiety sensitivity

doi:10.1016/0005-7967(94)90117-1

Behaviour Research and Therapy

Volume 32, Issue 2, February 1994, Pages 237-241

https://doi.org/10.1016/0005-7967(94)90117-1 Get rights and content

Abstract

Cognitive models maintain that panic attacks may be initiated by fear resulting from the interpretation of somatic sensations as personally threatening or harmful. Similarly, several researchers have proposed that the enhanced response of panickers to biological challenge may result from the fear of induced anxiety sensations rather than from direct stimulation of aberrant biochemical systems. The present study examined the effects of both panic history and fear of anxiety sensations on subjective and cardiac responses to biological challenge. Eighty nonclinical subjects were chosen on the basis of level of anxiety sensitivity and history of previous panic attacks. High and low anxiety-sensitive panickers and nonpanickers (four groups of 20 subjects) were subjected to a 90 sec period of voluntary hyperventilation, during which heart rate was assessed. Regardless of panic history, total symptom scores did not differ between high and low anxiety-sensitive subjects at baseline or pre-hyperventilation, but did differ at post-hyperventilation. There were, however, no significant differences in post-hyperventilation measures of heart rate. The apparent mismatch of subjective and physiological responsivity to the challenge in high anxiety-sensitive individuals (i.e. more severe symptom self-reports in the absence of increased cardiac activation) provides support for the hypothesis that high anxiety sensitivity is associated with an enhanced tendency to panic in response to biological challenge.

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Anxiety sensitivity (AS) is a well-studied transdiagnostic risk construct that is believed to amplify responses to many forms of stress. The COVID-19 pandemic is a broad stressor with significant physical and social threats. In the current study, we were interested in ascertaining the degree to which AS would relate to distress and disability in the context of COVID-19. We hypothesized that AS would be associated with increased distress and disability. Moreover, we hypothesized that AS would be uniquely predictive while controlling for other relevant risk factors such as age, race, and perceived local COVID-19 infection rates.
Participants (N = 249) were U.S. adults assessed using online data resourcing and re-assessed one month later.
At the first time point, during the beginning phases of the COVID-19 pandemic, AS was significantly related to COVID-19 distress and disability with a moderate effect size. AS was longitudinally associated with higher COVID-19 worry and depression.
Our findings are limited by the use of a relatively small online sample. Additionally, assessment of pre-pandemic and post-pandemic symptoms and functioning would be beneficial for future research.
Taken together, the current study provided evidence consistent with AS as a causal risk factor for the development of distress and depression during the COVID-19 pandemic.
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Previous research has documented the inhibitory effects of worry on cardiovascular reactivity to subsequently presented fear-relevant stimuli. Although theoretical assertions point to the verbal-linguistic (as opposed to imagery-based) nature of worry as the cause of these inhibitory effects, extant research investigating the effects of worrisome thinking on subsequent anxiety-eliciting tasks has not isolated the verbal-linguistic nature of worry as the active ingredient in its suppressive effects on arousal. Furthermore, prior research has not examined the potential effects of worry on maintenance of panic symptoms. In this study, participants high in anxiety sensitivity were asked to engage in verbal worry, imaginal worry, or relaxation prior to each of three repeated presentations of an interoceptive exposure task. Relaxation was associated with lower initial subjective fear that remained low across repeated exposures, and related stable sympathetic arousal (and decreased heart rate) over time. Imagery-based worry was associated with moderate initial subjective fear that was sustained across repeated exposures, and sympathetic arousal (and heart rate) that was likewise stable over time. However, verbal worry was associated with high initial subjective fear that was sustained over time, but sympathetic arousal (and heart rate) that decreased across repeated exposures. Thus, verbal worry was uniquely associated with a lack of synchronous response systems and maintenance of anxious meaning over time. Theoretical and clinical implications are discussed.
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We tested whether mindfulness de-couples the expected anxiogenic effects of distress intolerance on psychological and physiological reactivity to and recovery from an anxiogenic stressor among participants experimentally sensitized to experience distress.
N = 104 daily smokers underwent 18-hours of biochemically-verified smoking deprivation. Participants were then randomized to a 7-min analogue mindfulness intervention (present moment attention and awareness training; PMAA) or a cope-as-usual control condition; and subsequently exposed to a 2.5-min paced over breathing (hyperventilation) stressor designed to elicit acute anxious arousal. Psychological and physiological indices of anxious arousal (Skin Conductance Levels; SCL) as well as emotion (dys)regulation (Respiratory Sinus Arrhythmia; RSA) were measured before, during and following the stressor.
We found that PMAA reduced psycho-physiological dysregulation in response to an anxiogenic stressor, as well as moderated the anxiogenic effect of distress intolerance on psychological but not physiological responding to the stressor among smokers pre-disposed to experience distress via deprivation.
The present study findings have a number of theoretical and clinical implications for work on mindfulness mechanisms, distress tolerance, emotion regulation, and smoking cessation interventions.
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Recent evidence suggests an association between cognitive anxiety sensitivity and suicidal ideation. Cognitive anxiety sensitivity has also been implicated as a precursor to various forms of overarousal. These manifestations of overarousal (i.e., agitation, insomnia, nightmares, and anger) may account for the association between cognitive anxiety sensitivity and suicidal ideation.
In Study 1, undergraduate students selectively sampled for recent suicidal ideation completed all measures online. In Study 2, clinical outpatients completed all measures prior to their initial intake appointments at a psychology clinic.
Study 1 demonstrated that agitation and insomnia individually and jointly accounted for the association between cognitive anxiety sensitivity and suicidal ideation, controlling for general anxiety and demographic variables. Study 2 replicated and extended these findings, such that, controlling for demographics, general anxiety, and physical and social anxiety sensitivity, agitation and anger each independently and together accounted for the association between cognitive anxiety sensitivity and suicidal ideation, whereas insomnia and nightmares did not.
This study utilized a cross-sectional design and self-report measures in both samples as well as a sample of undergraduate students in Study 1.
Together, these findings suggest that agitation and anger may explain the previously established relationship between cognitive anxiety sensitivity and suicidal ideation. Targeting cognitive anxiety sensitivity in treatment may in turn reduce these forms of overarousal and thereby suicide risk.
Experiential, autonomic, and respiratory correlates of CO<inf>2</inf> reactivity in individuals with high and low anxiety sensitivity
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Psychometric studies indicate that anxiety sensitivity (AS) is a risk factor for anxiety disorders such as panic disorder (PD). To better understand the psychophysiological basis of AS and its relation to clinical anxiety, we examined whether high-AS individuals show similarly elevated reactivity to inhalations of carbon dioxide (CO₂) as previously reported for PD and social phobia in this task. Healthy individuals with high and low AS were exposed to eight standardized inhalations of 20% CO₂-enriched air, preceded and followed by inhalations of room air. Anxiety and dyspnea, in addition to autonomic and respiratory responses were measured every 15 s. Throughout the task, high AS participants showed a respiratory pattern of faster, shallower breathing and reduced inhalation of CO₂ indicative of anticipatory or contextual anxiety. In addition, they showed elevated dyspnea responses to the second set of air inhalations accompanied by elevated heart rate, which could be due to sensitization or conditioning. Respiratory abnormalities seem to be common to high AS individuals and PD patients when considering previous findings with this task. Similarly, sensitization or conditioning of anxious and dyspneic symptoms might be common to high AS and clinical anxiety. Respiratory conditionability deserves greater attention in anxiety disorder research.
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Citation Excerpt :
As with trait social anxiety, some research suggests that anxiety sensitivity is associated with exaggerated objective arousal (Conrod, 2006), whereas others research suggests that it is not (Asmundson, Norton, Wilson, & Sandler, 1994; Leen-Feldner, Feldner, Bernstein, McCormick, & Zvolensky, 2005; Stewart, Buffett-Jerrott, & Kokaram, 2001). Notwithstanding, similar to those with greater trait social anxiety, individuals with greater anxiety sensitivity have been consistently found to have exaggerated perceptions of arousal (Asmundson et al., 1994; Carter, Sbrocco, & Ayati, 2009; Leen-Feldner et al., 2005; Stewart et al., 2001). Anxiety sensitivity has been empirically associated with trait social anxiety in clinical and non-clinical samples (Anderson & Hope, 2009; Carleton, Abrams, Asmundson, Antony, & McCabe, 2009; Moore, Chung, Peterson, Katzman, & Vermani, 2009), and both constructs have been associated with heightened perceptions of arousal.
Physiological arousal serves to maintain social anxiety disorder by skewing self-perception. Anxiety sensitivity is associated with the disorder and exaggerated perceptions of arousal, but has not been tested as explaining exaggerated perceived arousal in social contexts. The aim of this investigation was to address this issue.
A total of 42 individuals participated in three tasks associated with potential social threat (i.e., a speech, typing task, hyperventilation) and completed measures of trait social anxiety and anxiety sensitivity. State anxiety, perceived arousal, and objective arousal were assessed during each task.
Trait social anxiety and anxiety sensitivity were correlated with state anxiety and perceived arousal, but not objective arousal, during the tasks. Anxiety sensitivity mediated the relationships between trait social anxiety and perceived arousal and between trait social anxiety and state anxiety for the typing and hyperventilation tasks.
Although the sample likely included a number of individuals with social anxiety disorder, the sample was mostly comprised of individuals without a diagnosis. The current results can be extended to clinical presentations to some extent, but future research is needed to further explore the demonstrated relationships in samples of individuals with social anxiety disorder.
Anxiety sensitivity may play a crucial role in perceptions of arousal and state anxiety in the context of potential social threats, warranting attention from researchers and clinicians focussing on social anxiety disorder.

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Subjective symptoms and cardiac reactivity to brief hyperventilation in individuals with high anxiety sensitivity

Abstract

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behaviour Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Anxiety and its disorders