by Michael D. Anestis, M.S.
Yesterday, I discussed the diathesis-stress model of mental illness. In this discussion, I reviewed a study by Joiner and colleagues (1999) demonstrating that the interaction of a vulnerability (dysfunctional attitudes) and environmental stress (poor midterm outcome in a college course) predicted increases in symptoms of depression. In other words, rather than a simple bad-grade-leads-to-depression relationship, the authors found that individuals with what Aaron Beck terms "dysfunctional attitudes," who experienced a sufficiently stressful event, were the most likely to experience increased symptoms of depression. Building off this discussion, I would like to turn my attention to an article just published in the current issue of the Journal of Abnormal Psychology by Katie McLaughlin and Mark Hatzenbuehler (2009) of Yale University. In this study, the authors sought to provide an understanding of how stressful life events might contribute to the development of anxiety disorder symptoms in adolescents. Here again, rather than simply stating that stress causes problems, the authors wanted to understand how stress has such effects for certain people. Understanding this can help us design better treatments and, perhaps even more importantly, identify risk early in the process, thereby allowing for effective interventions prior to the onset of an actual anxiety disorder.
McLaughlin and Hatzenbuehler (2009) were particularly interested in the role of anxiety sensitivity, which as you might remember from a prior PBB article on the topic, is defined as a fear of the symptoms of anxiety - particularly physiological symptoms - and the belief that such symptoms will result in aversive social, psychological, and physical consequences (Reiss & McNally, 1985). Individuals with high levels of anxiety sensitivity frequently misinterpret normative physiological experiences (e.g., increased heart rate after physical exertion) as catostrophic (e.g., "I'm having a heart attack"). This causes the individual to become anxious, which causes an increase in those same physiological symptoms, which causes increased anxiety, and so on until quite often, the individual experiences a panic attack.
The authors of this paper view anxiety sensitivity as a concept similar to rumination, which we have discussed at length on PBB. Just as some individuals ruminate - focusing on the nature and causes of their negative emotions - in response to negative life events (Nolen-Hoeksema & Morrow, 1991), McLaughlin and Hatzenbuehler (2009) argue that some individuals might become increasingly focused on symptoms of anxiety, particularly those physiological in nature, in response to stressful experiences. In this sense, they believe that stressful events might cause certain individuals to develop high levels of anxiety sensitivity, which in turn would increase the likelihood that such individuals would develop anxiety disorder symptoms. In other words, the stressful event does not cause increased anxiety. Instead, the impact of the stressful event on anxiety sensitivity sets off a chain reaction that ultimately leads to increased anxiety disorder symptoms. As we have discussed on this site before, research that answers the question "why" two variables are related is particularly useful, so this study has great value in that it attempts to help us understand how stressful events contribute to the development of anxiety disorders for particular individuals.
To test their hypotheses, the authors conducted a study in which 1,065 adolescents between the ages of 11 and 14 were assessed three times over the course of seven months. Their findings were highly impressive. First, they found that stressful life events reported at Time 1 predicted anxiety sensitivity at Time 2, even when controlling for Time 1 anxiety sensitivity. In other words, the more stress an individual reported experiencing at the beginning of the experiment, the higher their level of anxiety sensitivity was at the second assessment point, regardless of how high their anxiety sensitivity levels were at the beginning of the study. Additionally, the authors found that health related stressful events and stressful events related to family discord were particularly important in predicting higher levels of anxiety sensitivity. This means that not every type of stressful event has the same consequences.
The second set of analyses examined the hypothesis I mentioned earlier: that anxiety sensitivity would explain the link between stressful events and increased symptoms of anxiety. As anticipated, they found that anxiety sensitivity mediated this relationship, meaning that stressful events lead to increased symptoms of anxiety in part because they increase individuals' levels of anxiety sensitivity.
In their final set of analyses, the authors examined whether this situation is unique to anxiety or whether anxiety sensitivity would have an equivalent impact on depression symptoms. The results indicated that anxiety sensitivity was specifically related to anxiety and did not explain increases in depression symptoms once anxiety symptoms and initial levels of depression were covaried.
So, what is the take home message from this study? First of all, it provides further evidence that anxiety sensitivity is a strong contributor to anxiety disorders and, as such, an important target for psychological interventions. Fortunately, empirically supported treatments such as interoceptive exposure are capable of accomplishing this feat. Secondly, it helps clarify the relationship between stressful events and anxiety by providing another link in the chain rather than simply assuming stressful events has some unknown impact on anxiety. Finally, the findings provided support for the specificity of anxiety sensitivity's contribution to anxiety disorder symptoms by demonstrating that it did not have an equivalent impact on depression symptoms.
If you would like to learn more about anxiety sensitivity or empirically supported treatments for anxiety, we recommend the following resources, all of which are available through our online store:
- Overcoming the Fear of Fear: How to Reduce Anxiety Sensitivity
by Margo Watt & Sherry Stewart
- Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach Client Workbook
by Debra Hope, Richard Heimberg, Harlan Juster, & Cynthia Turk
- Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual, Third Edition
by Philip Kendall
- Stop Obsessing!: How to Overcome Your Obsessions and Compulsions
by Edna Foa & Reid Wilson
- Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences Therapist Guide
by Edna Foa, Elizabeth Hembree, & Barbara Rothbaum
- Mastery of Your Anxiety and Panic: Workbook
by David Barlow & Michelle Craske
- The Worry Cure: Seven Steps to Stop Worry from Stopping You
by Robert Leahy
-
Anxiety Free: Unravel Your Fears Before They Unravel You
by Robert Leahy
- Treatment Plans and Interventions for Depression and Anxiety Disorders
by Robert Leahy & Stephen Holland
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University.
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