Reliability and convergent validity of the Childhood Anxiety Sensitivity Index in children and adolescents

OBJECTIVE: The purpose of this study was to examine the reliability and the convergent validity of the Children Anxiety Sensitivity Index (CASI) with DSM-IV anxiety disorder symptoms, by comparison with the Screen for Child Anxiety Related Emotional Disorders (SCARED), in a community sample of Brazilian children and adolescents. METHODS: Children and adolescents from five schools were selected from a larger study that aimed to assess different aspects of childhood anxiety disorders. All participants completed the CASI and the SCARED. RESULTS: This study supported the reliability of the CASI total score. Girls reported higher total anxiety sensitivity scores than boys and there were no differences in total anxiety sensitivity scores between children and adolescents. This study showed moderate to high correlations between the CASI scores with SCARED scores, all correlations coefficients being positive and significant. CONCLUSIONS: Our findings demonstrate an appropriate reliability and evidence of convergent validity in the CASI in a sample of Brazilian children and adolescents.

Emotional reasoning and anxiety sensitivity: associations with social anxiety disorder in childhood

Background Two specific cognitive constructs that have been implicated in the development and maintenance of anxiety symptoms are anxiety sensitivity and emotional reasoning, both of which relate to the experience and meaning of physical symptoms of arousal or anxiety. The interpretation of physical symptoms has been particularly implicated in theories of social anxiety disorder, where internal physical symptoms are hypothesized to influence the individual's appraisals of the self as a social object. Method The current study compared 75 children on measures of anxiety sensitivity and emotional reasoning: 25 with social anxiety disorder, 25 with other anxiety disorders, and 25 nonanxious children (aged 7–12 years). Results Children with social anxiety disorder reported higher levels of anxiety sensitivity and were more likely than both other groups to view ambiguous situations as anxiety provoking, whether physical information was present or not. There were no group differences in the extent to which physical information altered children's interpretation of hypothetical scenarios. Limitations This study is the first to investigate emotional reasoning in clinically anxious children and therefore replication is needed. In addition, those in both anxious groups commonly had comorbid conditions and, consequently, specific conclusions about social anxiety disorder need to be treated with caution. Conclusion The findings highlight cognitive characteristics that may be particularly pertinent in the context of social anxiety disorder in childhood and which may be potential targets for treatment. Furthermore, the findings suggest that strategies to modify these particular cognitive constructs may not be necessary in treatments of some other childhood anxiety disorders.

Confirmatory factor analysis and psychometric properties of the Anxiety Sensitivity Index-Revised in clinical and normative populations

The present investigation aimed to critically examine the factor structure and psychometric properties of the Anxiety Sensitivity Index - Revised (ASI-R). Confirmatory factor analysis using a clinical sample of adults (N = 248) revealed that the ASI-R could be improved substantially through the removal of 15 problematic items in order to account for the most robust dimensions of anxiety sensitivity. This modified scale was renamed the 21-item Anxiety Sensitivity Index (21-item ASI) and reanalyzed with a large sample of normative adults (N = 435), revealing configural and metric invariance across groups. Further comparisons with other alternative models, using multi-sample analysis, indicated the 21-item ASI to be the best fitting model for both groups. There was also evidence of internal consistency, test-retest reliability, and construct validity for both samples suggesting that the 21-item ASI is a useful assessment device for investigating the construct of anxiety sensitivity in both clinical and normative populations.

Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns. ^

Anxiety sensitivity in children and the development of panic and anxiety in adolescents: A prospective study

Research with adult samples has identified a cognitive risk factor for the development of panic and other anxiety disorders in the concept of anxiety sensitivity. The research to date on anxiety sensitivity in children, using the Childhood Anxiety Sensitivity Index (CASI), suggests that the CASI may help to garner knowledge regarding the development of anxiety sensitivity and also help to understand the development of panic attacks, panic disorder and other anxiety disorders in youth. To examine the development of anxiety sensitivity and its relation to panic in youth, data were collected on 44 children in 1998 who were administered the CASI in 1991. Results indicated that children whose CASI scores increased from Time 1 to Time 2 were significantly more likely to report experiencing panic attacks than children whose CASI scores decreased from Time 1 to Time 2. Specifically, 64% (9/14) of children whose CASI scores increased from Time 1 to Time 2 reported having one or more panic attacks versus 36% (5/14) reported having none. Moreover, 72% (21/29) of children whose CASI scores decreased from Time 1 to Time 2 reported no panic attacks. These results suggest that childhood may be the time when anxiety sensitivity as a risk factor for panic and panic disorder is developing. Results are discussed in terms of their relevance for understanding the development of panic and the need for further research to determine the generalizability of these findings in larger samples of children followed over different time spans. ^

Anxiety sensitivity's facets in relation to anxious and depressive symptoms in youth

Anxiety sensitivity is a multifaceted cognitive risk factor currently being examined in relation to anxiety and depression. The paucity of research on the relative contribution of the facets of anxiety sensitivity to anxiety and depression, coupled with variations in existing findings, indicate that the relations remain inadequately understood. In the present study, the relations between the facets of anxiety sensitivity, anxiety, and depression were examined in 730 Hispanic-Latino and European-American youth referred to an anxiety specialty clinic. Youth completed the Childhood Anxiety Sensitivity Index, the Revised Children’s Manifest Anxiety Scale, and the Children’s Depression Inventory. The factor structure of the Childhood Anxiety Sensitivity Index was examined using ordered-categorical confirmatory factor analytic techniques. Goodness-of-fit criteria indicated that a two-factor model fit the data best. The identified facets of anxiety sensitivity included Physical/Mental Concerns and Social Concerns. Support was also found for cross-ethnic equivalence of the two-factor model across Hispanic-Latino and European-American youth. Structural equation modeling was used to examine models involving anxiety sensitivity, anxiety, and depression. Results indicated that an overall measure of anxiety sensitivity was positively associated with both anxiety and depression, while the facets of anxiety sensitivity showed differential relations to anxiety and depression symptoms. Both facets of anxiety sensitivity were related to overall anxiety and its symptom dimensions, with the exception being that Social Concerns was not related to physiological anxiety symptoms. Physical/Mental Concerns were strongly associated with overall depression and with all depression symptom dimensions. Social Concerns was not significantly associated with depression or its symptom dimensions. These findings highlight that anxiety sensitivity’s relations to youth psychiatric symptoms are complex. Results suggest that focusing on anxiety sensitivity’s facets is important to fully understand its role in psychopathology. Clinicians may want to target all facets of anxiety sensitivity when treating anxious youth. However, in the context of depression, it might be sufficient for clinicians to target Physical/Mental Incapacitation Concerns.

Children's learning of anxiety sensitivity : a preliminary study using a sample of youths referred for anxiety disorders

The purpose of the present study was to examine the origins of anxiety sensitivity (AS) by assessing youths' learning experiences in relation to their AS symptoms and anxiety symptoms. Participants were 33 youths between 7 to 13 years old (M = 9.39 years, SD = 2.01). Youths were assessed using a structured interview and self-report measures. Chi-square analyses revealed no statistically significant differences in the proportions of boys vs. girls, Hispanic vs. non-Hispanic, and married vs. non-married. Pearson correlation analyses revealed that youths' AS learning experiences were significantly related to youths' AS and to youths' anxiety symptoms scores. Partial correlations between youths' learning experiences associated with AS symptoms in relation to AS scores controlling for anxiety symptoms effects were statistically significant. Findings were consistent with theory and suggest that learning mechanisms may be involved in AS acquisition and maintenance. The findings' implications are discussed regarding possible learning experiences' role in the development of AS.

Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns.

Noninvasive Brain Stimulation With High-Frequency and Low-Intensity Repetitive Transcranial Magnetic Stimulation Treatment for Posttraumatic Stress Disorder

Objective: We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)-associated symptoms. Method: In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV-diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment. Results: Results show that both active conditions-20 Hz rTMS of left and right DLPFC induced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD. Conclusions: These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy. J an Psychiatry 2010;71(8):992-999 (C) Copyright 2009 Physicians Postgraduate Press, Inc.

An??lisis factorial confirmatorio del ??ndice de Sensibilidad a la Ansiedad para Ni??os

Resumen tomado de la publicaci??n

Efectos del consumo de cigarrillo en la presentación y severidad de la dismenorrea

Introducción: La dismenorrea se presenta como una patología cada vez más frecuente en mujeres de 16-30 años. Dentro de los factores asociados a su presentación, el consumo de tabaco ha revelado resultados contradictorios. El objetivo del presente estudio es explorar la asociación entre el consumo de cigarrillo y la presentación de dismenorrea, y determinar si los trastornos del ánimo y la depresión, alteran dicha asociación. Materiales y métodos: Se realizó un estudio de prevalencia analítica en mujeres de la Universidad del Rosario matriculadas en pregrado durante el primer semestre de 2013, para determinar la asociación entre el consumo de tabaco y la presentación de dismenorrea. En el estudio se tuvieron en cuenta variables tradicionalmente relacionadas con dismenorrea, incluyendo las variables ansiedad y depresión como potenciales variables de confusión. Los registros fueron analizados en el programa Estadístico IBM SPSS Statistics Versión 20.0. Resultados: Se realizaron 538 cuestionarios en total. La edad promedio fue 19.92±2.0 años. La prevalencia de dismenorrea se estimó en 89.3%, la prevalencia de tabaquismo 11.7%. No se encontró una asociación entre dismenorrea y tabaquismo (OR 3.197; IC95% 0.694-14.724). Dentro de las variables analizadas, la depresión y la ansiedad constituyen factores de riesgo independientes para la presentación de dismenorrea con una asociación estadísticamente significativa p=0.026 y p=0.024 respectivamente. El análisis multivariado encuentra como factor determinante en la presentación de dismenorrea, la interacción de depresión y ansiedad controlando por las variables tradicionales p<0.0001. Sin embargo, esta asociación se pierde cuando se analiza en la categoría de dismenorrea severa y gana relevancia el uso de métodos de anticoncepción diferentes a los hormonales, mientras que el hecho de haber iniciado la vida sexual presenta una tendencia limítrofe de riesgo. Conclusiones: No se puede demostrar que el tabaco es un factor asociado a la presentación de dismenorrea. Los trastornos del ánimo y la ansiedad constituyen factores determinantes a la presentación de dismenorrea independientemente de la presencia de otros concomitantes. Las variables de asociación se modifican cuando la variable dependiente se categoriza en su estado más severo. Se necesitan estudios más amplios y detallados para establecer dicha asociación.

An integrated cognitive model of panic disorder: The role of positive and negative cognitions

One reason for the neglect of the role of positive factors in cognitive-behavioural therapy (CBT) may relate to a failure to develop cognitive models that integrate positive and negative cognitions. Bandura [Psychol. Rev. 84 (1977) 191; Anxiety Res. 1 (1988) 77] proposed that self-efficacy beliefs mediate a range of emotional and behavioural outcomes. However, in panic disorder, cognitively based research to date has largely focused on catastrophic misinterpretation of bodily sensations. Although a number of studies support each of the predictions associated with the account of panic disorder that is based on the role of negative cognitions, a review of the literature indicated that a cognitively based explanation of the disorder may be considerably strengthened by inclusion of positive cognitions that emphasize control or coping. Evidence to support an Integrated Cognitive Model (ICM) of panic disorder was examined and the theoretical implications of this model were discussed in terms of both schema change and compensatory skills accounts of change processes in CBT. (C) 2004 Elsevier Ltd. All rights reserved.

Links between body mass index, total body fat, cholesterol, high-density lipoprotein, and insulin sensitivity in patients with obesity related to depression, anger, and anxiety

OBJECTIVE: Define links between psychosocial parameters and metabolic variables in obese females before and after a low-calorie diet. METHOD: Nine female obese patients (age 36.1 +/- 7.1 years, body mass index [BMI] > 30 kg/m2) were investigated before and after a 6-week low-calorie diet accompanied by behavior therapy. Blood lipids, insulin sensitivity (Bergman protocol), fat distribution (by dual-energy X-ray absorptiometry [DEXA]), as well as psychological parameters such as depression, anger, anxiety, symptom load, and well-being, were assessed before and after the dieting period. RESULTS: The females lost 9.6 +/- 2.8 kg (p < .0001) of body weight, their BMI was reduced by 3.5 +/- 0.3 kg/m2 (p < .0001), and insulin sensitivity increased from 3.0 +/- 1.8 to 4.3 +/- 1.5 mg/kg (p = .05). Their abdominal fat content decreased from 22.3 +/- 5.5 to 18.9 +/- 4.5 kg (p < .0001). In parallel, psychological parameters such as irritability (p < .05) and cognitive control (p < .0001) increased, whereas feelings of hunger (p < .05), externality (p < .05), interpersonal sensitivity (p < .01), paranoid ideation (p < .05), psychoticism (p < .01), and global severity index (p < .01) decreased. Prospectively, differences in body fat (percent) were correlated to nervousness (p < .05). Waist-to-hip ratio (WHR) differences were significantly correlated to sociability (p < .05) and inversely to emotional instability (p < .05), whereas emotional instability was inversely correlated to differences in insulin sensitivity (p < .01). DISCUSSION: Weight reduction may lead to better somatic risk factor control. Women with more nervousness and better sociability at the beginning of a diet period may lose more weight than others.

Relationships between sensory sensitivity, anxiety and selective eating in children

The present study examines whether parental reports of child selective eating are associated with child anxiety and sensitivity to sensory stimuli in their environment. Parents of 95 children aged 5-10 completed questionnaires about child eating behavior, child anxiety and sensory sensitivity. Results indicated that both anxiety and sensory sensitivity were associated with selective eating. In addition, child sensory sensitivity fully mediated the relationship between anxiety and selective eating in children suggesting that it is greater sensitivity to sensory information which explains why more anxious children are more likely to be selective eaters. Further research is necessary to better understand these relationships and indicate whether gradual exposure interventions with children who are sensory sensitive may help to prevent or reduce selective eating. © 2012 Elsevier Ltd.

Brief report:effects of sensory sensitivity and intolerance of uncertainty on anxiety in mothers of children with autism spectrum disorder

This study examined the relations between anxiety and individual characteristics of sensory sensitivity (SS) and intolerance of uncertainty (IU) in mothers of children with ASD. The mothers of 50 children completed the Hospital Anxiety and Depression Scale, the Highly Sensitive Person Scale and the IU Scale. Anxiety was associated with both SS and IU and IU was also associated with SS. Mediation analyses showed direct effects between anxiety and both IU and SS but a significant indirect effect was found only in the model in which IU mediated between SS. This is the first study to characterize the nature of the IU and SS interrelation in predicting levels of anxiety.