Elsevier

Behavior Therapy

Volume 44, Issue 3, September 2013, Pages 417-431
Behavior Therapy

Anxiety Sensitivity and Interoceptive Exposure: A Transdiagnostic Construct and Change Strategy

https://doi.org/10.1016/j.beth.2013.03.006Get rights and content

Highlights

  • Elevated anxiety sensitivity levels are observed across emotional disorders

  • Anxiety sensitivity decreases across emotional disorders in transdiagnostic CBT

  • Changes in anxiety sensitivity are correlated with post-treatment outcome and follow-up

  • Changes in anxiety sensitivity coincide with introduction of interoceptive exposure

  • Interoceptive exposure can be similarly and effectively applied across different emotional disorders

Abstract

Recent findings support the relevance of anxiety sensitivity (AS) and interoceptive exposure (IE) across emotional disorders. This study (a) evaluated levels of AS across different anxiety disorders, (b) examined change in AS over the course of transdiagnostic psychological intervention, and its relationship with outcome, and (c) described the implementation of IE to address AS with patients with different anxiety disorders. Participants (N = 54) were patients who received treatment with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) in two consecutive treatment trials. Participants completed a measure of AS at pre- and posttreatment, and multiple occasions during treatment. Symptom severity was assessed at pre- and posttreatment, and clinical information related to physical symptoms and IE were collected as part of routine clinical practice. Elevated AS was observed at pretreatment across diagnoses and decreases in AS were observed from pre- to posttreatment. Similar changes occurred across the diagnostic categories, notably coinciding with the introduction of IE. Change in AS was correlated with reduced symptom levels at posttreatment and 6-month follow-up. Patients with different anxiety disorders endorsed similar physical symptoms and practiced similar IE exercises with similar effects. Results provide preliminary support for the usefulness of IE as a treatment strategy across the spectrum of anxiety disorders, and additional support for the transdiagnostic relevance of AS.

Section snippets

Specific Aims and Hypotheses

This paper had several aims, which we pursued by combining both quantitative and qualitative methods. Broadly, we were interested in providing preliminary evidence for the impact of the IE module of the UP in a sample of patients presenting with heterogeneous anxiety disorder diagnoses in two concurrent treatment trials.

First, in an attempt to replicate previous findings demonstrating that high levels of anxiety sensitivity are present in anxiety disorders other than PD (Naragon-Gainey, 2010,

Participants

This study’s sample included adults seeking treatment at an urban mental health center for anxiety and mood disorders, who were recruited to participate in one of two consecutive treatment outcome studies examining the efficacy of the UP. Inclusion/exclusion criteria were consistent across the two studies. To be eligible, participants needed to be 18 years or older in age, be fluent in English, be able to attend all treatment sessions and assessments, and be able to provide informed consent.

Missing Data

As is commonly the case in treatment research involving repeated assessments, missing data were present for some cases. In both of the trials of interest in this study, the ASI was administered at pretreatment, after Sessions 4, 8, and 12, and at posttreatment. A missing value analysis was conducted to examine the nature of the missing data (Little & Rubin, 2002) using SPSS 20 software. In addition to observed ASI scores, several variables were included in this analysis, in order to assist in

Discussion

Despite traditionally being associated with panic disorder (PD), both conceptually and empirically, the extant research using both clinical and nonclinical samples has shown that anxiety sensitivity is implicated in the development and maintenance of a broad range of emotional disorders (Naragon-Gainey, 2010, Schmidt et al., 2008). This implies that anxiety sensitivity may be an important transdiagnostic target of treatment, and that reductions in anxiety sensitivity may represent an important

References (62)

  • S.E. Sauer-Zavala et al.

    The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the Unified Protocol for the transdiagnostic treatment of emotional disorders

    Behaviour Research and Therapy

    (2012)
  • N.B. Schmidt et al.

    Interoceptive assessment and exposure in panic disorder: A descriptive study

    Cognitive and Behavioral Practice

    (2004)
  • M.K. Shear et al.

    Reliability and validity of the Panic Disorder Severity Scale: Replication and extension

    Journal of Psychiatric Research

    (2001)
  • N.M. Simon et al.

    Changes in anxiety sensitivity with pharmacotherapy for panic disorder

    Journal of Psychiatric Research

    (2004)
  • S. Taylor et al.

    How does anxiety sensitivity vary across the anxiety disorders?

    Journal of Anxiety Disorders

    (1992)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • A.J. Baillie et al.

    Panic attacks as risk markers for mental disorders

    Social Psychiatry and Psychiatric Epidemiology

    (2005)
  • A. Bandura

    Self-efficacy determinants of anticipated fears and calamities

    Journal of Personality and Social Psychology

    (1983)
  • D.H. Barlow

    Anxiety and its disorders: The nature and treatment of anxiety and panic

    (2002)
  • D.H. Barlow et al.

    The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Client workbook

    (2011)
  • D.H. Barlow et al.

    Cognitive behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial

    Journal of the American Medical Association

    (2000)
  • Barlow, D.H., Sauer-Zavala, S.E., Carl, J.R., Ellard, K.K., & Bullis, J.R. (in preparation). The origins, diagnosis, &...
  • T.D. Borkovec et al.

    Treatment of general tension: Subjective and physiological effects of progressive relaxation

    Journal of Consulting and Clinical Psychology

    (1978)
  • J.F. Boswell et al.

    Intolerance of uncertainty: A common factor in the treatment of emotional disorders

    Journal of Clinical Psychology

    (2013)
  • M.E. Bouton et al.

    A modern learning theory perspective on the etiology of panic disorder

    Psychological Review

    (2001)
  • T.A. Brown et al.

    A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment

    Psychological Assessment

    (2009)
  • T.A. Brown et al.

    Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders

    Journal of Abnormal Psychology

    (2001)
  • Carl, J.R., Gallagher, M.W., Sauer-Zavala, S.E., Bentley, K.H., & Barlow, D.H. (under review). Changes in temperament...
  • L. Clark

    A cognitive approach to panic

    Behaviour Research and Therapy

    (1986)
  • M.G. Craske et al.

    Mastery of your anxiety and panic: Therapist guide

    (2007)
  • M.G. Craske et al.

    Panic disorder: A review of DSM-IV panic disorder and proposals for DSM-V

    Depression and Anxiety

    (2010)
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