Single-Session Anxiety Sensitivity Reduction Program for Trauma-Exposed Adults: A Case Series Documenting Feasibility and Initial Efficacy

doi:10.1016/j.beth.2012.03.005

Behavior Therapy

Volume 43, Issue 3, September 2012, Pages 482-491

https://doi.org/10.1016/j.beth.2012.03.005 Get rights and content

Abstract

The present case series examined a single-session, cognitive-behavioral anxiety sensitivity (AS) reduction program among five trauma-exposed adults. Participants (age range = 19–37 years) reported significantly elevated levels of AS at baseline, a history of posttraumatic stress disorder Criterion A trauma exposure, and no current Axis I psychopathology. The outcomes of the preventive intervention were examined with regard to 3-month postintervention changes in AS, posttraumatic stress, panic attack frequency and severity, negative affect levels, and behavioral functioning and impairment. Results demonstrated decreases in each of the studied outcomes over the examined time period. This preliminary yet uncontrolled data provides empirical evidence of the feasibility and support for the utilization of a brief AS reduction intervention program to target anxiety-related vulnerability among trauma-exposed adults.

Highlights

► This study evaluated a single-session, cognitive-behavioral anxiety sensitivity (AS) reduction program among 5 adults. ► Participants reported trauma exposure, significantly elevated levels of AS, and no current Axis I disorders. ► At 3-month follow-up, participants endorsed decreases in AS, posttraumatic stress, panic attacks, and negative affectivity. ► This work highlights a promising way to utilize a brief interoceptive exposure program among trauma-exposed individuals. ► Future work is needed to test this intervention within a larger-scale, randomized controlled trial.

Section snippets

Participants

Participants (age range = 19–37 years, all Caucasian) were comprised of five consecutively enrolled individuals (three women; two men) who met inclusionary criteria and who provided baseline and 3-month postintervention follow-up session data. All participants were matriculated into the study. Participants were included in the study on the basis of meeting the following inclusion criteria: (a) being between 18 and 45 years of age; (b) reporting exposure to at least three traumatic events, according

Results

See Table 1, Table 2 for sample descriptive data (N = 5) and single-subject descriptive data at preintervention baseline and 3-month postintervention follow-up sessions.

Discussion

The extant literature underscores the clinical relevance of AS as a vulnerability and maintenance factor for anxiety psychopathology, namely PTSD and PD (e.g., Fedoroff et al., 2000, Schmidt et al., 2010). However, the efficacy of brief AS reduction intervention strategies (e.g., IE) aimed at improving the emotional well-being of trauma-exposed populations has been unexplored. This preliminary investigation, without an experimental control condition, evaluated the feasibility and efficacy of a

References (55)

A. Bernstein et al.
Dimensional, categorical, or dimensional-categories: Testing the latent structure of anxiety sensitivity among adults using factor-mixture modeling
Behavior Therapy
(2010)
N. Breslau et al.
A second look at comorbidity in victims of trauma: The posttraumatic stress disorder-major depression connection
Biological Psychiatry
(2000)
L. Elwood et al.
Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis–stress model
Journal of Behavior Therapy and Experimental Psychiatry
(2009)
C.A. Gardenswartz et al.
Prevention of panic disorder
Behavior Therapy
(2001)
G.A. Leskin et al.
Lifetime trauma history and panic disorder: Findings from the National Comorbidity Survey
Journal of Anxiety Disorders
(2002)
R.J. McNally
Anxiety sensitivity and panic disorder
Biological Psychiatry
(2002)
M. Miniati et al.
Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse
Journal of Psychiatric Research
(2010)
N.B. Schmidt et al.
Anxiety sensitivity amelioration training (ASAT): A longitudinal primary prevention program targeting cognitive vulnerability
Journal of Anxiety Disorders
(2007)
N.B. Schmidt et al.
Anxiety sensitivity: Prospective prediction of anxiety among early adolescents
Journal of Anxiety Disorders
(2010)
N.B. Schmidt et al.
Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes
Comprehensive Psychiatry
(2008)

J.I. Sheikh et al.

Childhood abuse history in older women with panic disorder

American Journal of Geriatric Psychiatry

(1994)

J. Wald et al.

Efficacy of interoceptive exposure therapy combined with trauma-related exposure therapy for posttraumatic stress disorder: A pilot study

Journal of Anxiety Disorders

(2007)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders

(1994)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders

(2000)

A. Bernstein et al.

Anxiety sensitivity: Selective review of promising research and future directions

Expert Review of Neurotherapeutics

(2007)

A. Bernstein et al.

Taxometric and factor analytic models of anxiety sensitivity: Integrating approaches to latent structural research

Psychological Assessment

(2007)

D.D. Blake et al.

The development of a clinician-administered PTSD scale

Journal of Traumatic Stress

(1995)

N. Breslau

Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders

Canadian Journal of Psychiatry

(2002)

N. Castellanos et al.

Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic and risk-taking behaviours

Journal of Mental Health

(2006)

J.R. Davidson et al.

Post-traumatic stress disorder in the community: An epidemiological study

Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences

(1991)

G.H. Eifert et al.

Acceptance & commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change strategies

(2005)

I.C. Fedoroff et al.

Cognitive factors in traumatic stress reactions: Predicting PTSD symptoms from anxiety sensitivity and beliefs about harmful events

Behavioural and Cognitive Psychotherapy

(2000)

M.T. Feldner et al.

Anxiety sensitivity as a moderator of the relation between trauma exposure frequency and posttraumatic stress symptomatology

Journal of Cognitive Psychotherapy

(2006)

E.J. Fierman et al.

Trauma and posttraumatic stress disorder in subjects with anxiety disorders

American Journal of Psychiatry

(1993)

M. First et al.

Structured Clinical Interview for DSM-IV

(1995)

E.B. Foa

Posttraumatic Stress Diagnostic Scale manual

(1995)

E.B. Foa et al.

The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale

Psychological Assessment

(1997)

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Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis
2024, Journal of Anxiety Disorders
Given the high rate of trauma exposure among the general population, it is important to delineate the risk factors for post-traumatic stress disorder (PTSD). While historically implicated in panic disorder, anxiety sensitivity is increasingly found to play a role in PTSD. The present review investigated the size of the relationship between anxiety sensitivity and PTSD symptoms among trauma exposed adults. A systematic search on multiple electronic databases (PTSDpubs, CINAHL, MEDLINE and PsycINFO) generated a total of 1025 records, among which 52 (n = 15173) met study inclusion criteria and were included in our random effects meta-analysis. Our results indicated a medium effect size (r = .46, 95% CI =.41,.50) for the relationship between anxiety sensitivity and PTSD symptoms. There was significant between-study heterogeneity. Furthermore, sub-group analyses revealed that study design (cross-sectional vs. longitudinal) may significantly moderate the association between anxiety sensitivity and PTSD severity. No moderation effect was found for assessment of PTSD through interview versus questionnaire, interpersonal versus non-interpersonal trauma, or low versus high study quality. Such patterns of results are consistent with cognitive models of PTSD. Clinical implications, strengths and limitations of the review were discussed.
Investigating pathways from anxiety sensitivity to impairment in a treatment-seeking sample
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Citation Excerpt :
AS-focused interventions have previously shown efficacy in reducing anxiety and/or depressive symptoms (Norr et al., 2014; Olthuis et al., 2014) and improving functional impairment (Olthuis et al., 2014). The implications of AS interventions for functional impairment should be further investigated; current evidence is limited as findings tend to be from small trials (Vujanovic et al., 2012) and do not consistently show improvements in functional impairment (Norr et al., 2017). It is important to note, of course, that the while alcohol use, sleep problems, and exercise avoidance may not explain the association between AS and functional impairment in the present findings, they may be complicating factors in the treatment of AS and anxiety and/or depressive symptoms (e.g., alcohol use problems may increase risk for treatment dropout, Buckman et al., 2018) and may still warrant clinical attention.
Previous research suggests that high anxiety sensitivity (AS) – a fear of arousal-related body sensations – may have implications not only for mental health symptoms but also for functional impairment. The aim of the present study was to examine whether elevated AS is associated with functional impairment by way of heightened anxiety symptoms and resultant depressive symptoms or unhealthy coping behaviours (i.e., alcohol use, exercise avoidance, sleep problems) in a chained mediation model.
Participants were 128 treatment-seeking individuals with high AS who qualified for an anxiety, depression, or posttraumatic stress disorder diagnosis. They completed self-report measures of AS, anxiety, depression, and unhealthy coping behaviours as part of a pre-treatment assessment battery for a larger study examining the efficacy of a cognitive behavioural intervention for AS. Data were analyzed using path analysis.
Results revealed a direct association between AS and functional impairment that was partially mediated through a chained indirect pathway from AS to anxiety symptoms to depression symptoms to functional impairment. Unhealthy coping behaviours did not serve as mediators.
Results are limited by the cross-sectional nature of the data.
The present findings have clinical implications insofar as supporting the relevance of reducing AS and focusing on depressive symptoms when seeking to improve clients' functioning.
The effects of exercise on transdiagnostic treatment targets: A meta-analytic review
2019, Behaviour Research and Therapy
The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE).
We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target.
The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26).
This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.
Refinement of anxiety sensitivity measurement: The Short Scale Anxiety Sensitivity Index (SSASI)
2018, Psychiatry Research
Anxiety sensitivity, defined as the fear of anxiety and arousal-related sensations, has been among the most influential cognitive-based transdiagnostic risk and maintenance factors in the study and treatment of emotional and related disorders. The currently available anxiety sensitivity measures are limited by their length. Specifically, the length of these instruments discourages the adoption of routine anxiety sensitivity assessment in clinical or medical settings (e.g., primary care). The goals of this study were to develop and assess the validity and reliability of a short version of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007), entitled the Short Scale Anxiety Sensitivity Index (SSASI), using three independent clinical samples. Results indicated that the abbreviated five-item version of the SSASI had good internal consistency and a robust association with the ASI-3. Further, across the samples, there was evidence of unidimensionality and excellent convergent and discriminant validity. There also was evidence of partial measurement invariance across sex and full measurement invariance across time. Overall, the five-item scale offers a single score that can be employed to measure anxiety sensitivity. Use of the SSASI may facilitate screening efforts and symptom tracking for anxiety sensitivity, particularly within clinical settings where practical demands necessitate the use of brief assessment instruments.
Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review
2018, Clinical Psychology Review
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, “gold standard” treatments for PTSD/SUD comorbidity are currently available. Thus, it is imperative to better understand cognitive-affective mechanisms, targetable via cognitive-behavioral intervention (i.e., malleable), that may be related to both disorders in order to improve the theory and treatment of PTSD/SUD. Anxiety sensitivity is a malleable cognitive-affective factor with relevance to both PTSD and SUD. This systematic review focused on the published literature on anxiety sensitivity and trauma/PTSD and substance use/SUD from 1966 – May 1, 2018, and includes a total of 35 manuscripts. The state of the literature, limitations, and future research directions are discussed.
The role of anxiety sensitivity in reactivity to trauma cues in treatment-seeking adults with substance use disorders
2017, Comprehensive Psychiatry
Exposure to traumatic events and posttraumatic stress disorder (PTSD) are common among individuals with substance use disorders (SUDs). Although the presence of trauma exposure and/or PTSD among those with SUDs is associated with a range of negative outcomes, much remains to be understood about the factors contributing to these outcomes. Anxiety sensitivity (the tendency to respond fearfully to the signs and symptoms of anxiety) has been linked to greater PTSD symptoms and the use of substances to cope with PTSD symptoms, and is a promising factor for understanding the negative outcomes associated with co-occurring PTSD and SUDs.
This study examined the association between anxiety sensitivity and trauma cue reactivity among 194 trauma-exposed patients with SUDs (27.3% met criteria for current PTSD). Participants completed ratings of negative affect and substance cravings prior to and after exposure to a personally-relevant trauma cue.
Results indicated that anxiety sensitivity was associated with greater emotional reactivity (but not craving reactivity) to the trauma cue; neither PTSD symptom severity nor PTSD diagnosis moderated these associations. PTSD symptom severity was associated with greater emotional and craving reactivity to the trauma cue.
Results highlight the potential utility of targeting anxiety sensitivity in treatments for trauma-exposed patients with SUDs with and without PTSD.

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^☆: The funding for this work was provided by a grant awarded to Anka Vujanovic from the Vermont Conference on the Primary Prevention of Psychopathology (VCPPP). Dr. Bernstein recognizes the funding support from the Israeli Council for Higher Education Yigal Alon Fellowship, the European Union FP-7 Marie Curie Fellowship International Reintegration Grant, and the Rothschild-Caesarea Foundation's Returning Scientists Project at the University of Haifa.

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Single-Session Anxiety Sensitivity Reduction Program for Trauma-Exposed Adults: A Case Series Documenting Feasibility and Initial Efficacy☆

Abstract

Highlights

Section snippets

Participants

Results

Discussion

Behavior Therapy

Biological Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Behavior Therapy

Journal of Anxiety Disorders

Biological Psychiatry

Journal of Psychiatric Research

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Comprehensive Psychiatry

American Journal of Geriatric Psychiatry

Journal of Anxiety Disorders

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

Anxiety sensitivity: Selective review of promising research and future directions

Expert Review of Neurotherapeutics

Taxometric and factor analytic models of anxiety sensitivity: Integrating approaches to latent structural research

Psychological Assessment

The development of a clinician-administered PTSD scale

Journal of Traumatic Stress

Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders

Canadian Journal of Psychiatry

Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic and risk-taking behaviours

Journal of Mental Health

Post-traumatic stress disorder in the community: An epidemiological study

Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences

Acceptance & commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change strategies

Cognitive factors in traumatic stress reactions: Predicting PTSD symptoms from anxiety sensitivity and beliefs about harmful events

Behavioural and Cognitive Psychotherapy

Anxiety sensitivity as a moderator of the relation between trauma exposure frequency and posttraumatic stress symptomatology

Journal of Cognitive Psychotherapy

Trauma and posttraumatic stress disorder in subjects with anxiety disorders

American Journal of Psychiatry

Structured Clinical Interview for DSM-IV

Posttraumatic Stress Diagnostic Scale manual

The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale

Psychological Assessment