Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology

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Abstract

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N = 404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy 1986; 24: 1–8.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.

Section snippets

Overview of study design

These data are derived from a primary prevention study that included both an experimental and a prospective design. “At risk” participants (i.e., those with high AS) with no current or recent psychiatric illness were randomly assigned to a risk reduction or control condition and followed for approximately 24 months. The experimental manipulation was modeled after educational and behavioral procedures commonly used with patients with anxiety disorders (Schmidt and Woolaway-Bickel, 2000). This

Sample characteristics and preliminary analyses

The final sample included an initial assessment of 404 participants. Of those, approximately 73% completed at least one follow-up evaluation (n = 295). The primary outcomes of interest were any diagnoses endorsed during either of the follow-up interviews. The total n for various analyses varies to some degree depending on missing data. Participants dropping out of the study did not differ from completers in terms of baseline demographics, trait anxiety, AS, or experimental condition (ps > .10).

Diagnostic history and psychopathology at baseline

The

Discussion

Expectancy theory proposes that AS may serve as a premorbid risk factor for the development of anxiety pathology (Reiss, 1991). Empirical evidence for AS as a risk factor for Axis I diagnoses is scant, with the exception being Maller and Reiss’s (1992) three-year follow-up study. The present study provided a more definitive prospective test of whether AS acts as a dispositional risk factor for clinical syndromes. For example, the current study used a substantially larger sample, controlled for

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    This project was supported by the Ohio Department of Mental Health research grant (737111) and by a National Institute Mental Health Grant (MH62056) to Dr. Schmidt. It also was supported by National Institute on Drug Abuse research Grants (1 R21 DA016227-01 and 1 R01 DA018734-01A1) awarded to Dr. Zvolensky and a National Institute of Mental Health Grant (MH72848) to Dr. Maner.

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