Elsevier

Clinical Psychology Review

Volume 49, November 2016, Pages 67-78
Clinical Psychology Review

Review
Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion

https://doi.org/10.1016/j.cpr.2016.07.003Get rights and content

Highlights

  • AS and WMC are linked to a wide range of negative health behaviors.

  • Both are modifiable by intervention, with beneficial effects on health behaviors.

  • These documented risk factors warrant additional research and clinical attention.

Abstract

Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors—anxiety sensitivity (AS) and working memory capacity (WMC)—for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.

Introduction

Health behaviors—such as diet, exercise, and substance use and abuse—account for more than 40% of the risk for preventable premature death in the United States (McGinnis and Foege, 1993, Schroeder, 2007). Given the importance of behavioral processes to health, NIH has accelerated investigations into common mechanisms of behavior change relevant to these health behaviors (Science of Behavior Change; https://commonfund.nih.gov/behaviorchange/overview). Moreover, research on health risk and health behavior promotion makes clear that (1) individuals do not benefit equally from prevention or interventions efforts (e.g., Fishbein et al., 2006, Mercken et al., 2012, Warner and Burns, 2003), (2) failing to attend to these individual differences has the potential to increase health disparities (Ceci & Papierno, 2005), and (3) understanding the nature and influence of specific risk profiles and their implications for intervention and health promotion is increasingly important. The purpose of this article is to document the value of two factors for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors: high anxiety sensitivity (AS) and low working memory capacity (WMC). We provide a conceptual model for the separate roles of AS and WMC in negative health behaviors, review findings supporting these models, provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage further research in this domain. Specifically, we argue that AS and WMC are important common factors across a range of health behaviors and should be considered more broadly for understanding success and failure in health behavior promotion.

Section snippets

AS: model and measurement

AS refers to a fear of anxiety-related sensations due to the belief that they have catastrophic consequences (Peterson & Reiss, 1992). Empirically, AS is distinguishable from the tendency to experience more frequent anxiety symptoms (e.g., trait anxiety) and other negative affect propensity variables (e.g., neuroticism; Zvolensky, Lejuez, Kahler, & Brown, 2003). Although AS was initially conceptualized as a specific vulnerability factor for panic disorder, due to the prominence of fears of

Exemplars of AS and WM associations with negative health behaviors

In the sections below we review separately the evidence for AS and WMC as relevant mechanistic variables influencing risk for initiation and maintenance of negative health behaviors. Specific health behaviors—eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep—are reviewed as exemplars of the influence of AS and WM. Next, we discuss developmental factors influencing the modification of AS and WM. We close by examining the value of AS and WM as treatment targets for

The development of AS

AS has been characterized from both trait-like (Reiss & Havercamp, 1996) and state-dependent (Schmidt et al., 2000, Szuhany and Otto, 2015) perspectives. In the former, the trajectory of AS is expected to remain stable over time, while in the latter, levels of AS may change due to contextual factors such as exposure to social stressors. In both models, AS is presumed to be responsive to targeted intervention. Understanding the etiology and development of AS and WMC is important for taking a

The development of WMC

The basic modular structure of WM is present by at least 6 years of age, with each component undergoing sizable expansion and functional capacity during childhood and adolescence (Gathercole, Pickering, Ambridge, & Wearing, 2004). Indeed, almost all measures of WMC show a steady increase from preschool through adolescence (Isaacs and Vargha-Khadem, 1989, Siegel, 1994). Mechanism for the change with age, include speed of memory scanning during retrieval (Cowan, Wood, Wood, Keller, Nugent, &

Treatment effects for AS and WMC: target engagement and influence on health behaviors

An additional feature of importance of both AS and WMC is that they are both modifiable with treatment, making them tempting mechanistic targets for modifying health behaviors. Concerning the modification of AS, research on anxiety disorders have provided strong evidence of its responsivity to psychosocial treatment. For example, a meta-analysis of 24 randomized-controlled trials (N = 1851) indicated that treatment—prominently including exposure therapy directed to feared bodily sensations

Conclusions and future directions

Overall, we find AS and WMC to be compelling examples of the sort of mechanistic variables that can have a broad-based impact on health behavior promotion. Each has predictive power across a striking range of health behaviors, each is potentially modifiable by intervention, and the modification of these risk factors has early support for having significant functional effects on health behaviors. Accordingly, both of these factors warrant additional research and clinical attention.

For the agenda

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