Developmental antecedents of anxiety sensitivity
Introduction
The expectancy model of fear and anxiety posits that anxiety sensitivity (AS), that is, concern over anxiety sensations such as shakiness, nervousness, and lack of concentration, helps to explain fearful behavior in any situation during which such sensations might be encountered (Reiss, 1991; Reiss & McNally, 1985). Congruent with these implications, much empirical research has focused on relationships between AS and anxious distress (Taylor, 1999). Indeed, increased levels of AS have been found among persons with a wide range of anxiety disorder diagnoses, including panic disorder with and without agoraphobia, posttraumatic stress disorder, generalized anxiety disorder, obsessive–compulsive disorder, and social phobia, as well as among nonclinical persons with panic symptomatology (Brown & Cash, 1990; Lau, Calamari, & Waraczynski, 1996; Rabian, Peterson, Richters, & Jensen, 1993; Stewart, Knize, & Pihl, 1992; Taylor, Koch, & McNally, 1992). Moreover, several studies have found that AS prospectively predicts panic attacks and anxious symptomatology (Maller & Reiss, 1992; Schmidt et al., 1997, Schmidt et al., 1999). Thus, AS may play a role in the development of pathological anxiety.
Of late, research has also begun to focus on AS in forms of distress bearing some relationship with anxiety; most of this research has focused on AS in depression. Such studies have indicated that AS is a concomitant of major depression and depressive symptomatology (Otto, Pollack, Fava, Uccello, & Rosenbaum, 1995; Taylor, Koch, Woody, & McLean, 1996). Moreover, AS has also been shown to prospectively predict depressive symptomatology (Schmidt et al., 1997). Thus, AS may be important in the development of depression as well as anxiety.
Despite evidence that AS plays a role in both anxiety and depressive disorders, and the possibility that this role may be etiologic in nature, little is known regarding the developmental antecedents of this sensitivity. Indeed, only one study to our knowledge has investigated such antecedents. In that study, Watt, Stewart, and Cox (1998) (1) examined the ability of childhood operant and vicarious learning experiences to predict overall AS among university students and (2) compared the childhood operant and vicarious learning experiences of university students with high, moderate, and low levels of overall AS. They found that parental reinforcement of sick role behavior in response to both childhood anxiety symptoms and childhood cold symptoms, observation of parental uncontrolled behavior (e.g., due to being drunk or angry), and observation of parental sick role behavior in response to parents’ own anxiety symptoms predicted overall AS. Additionally, students with high AS retrospectively reported: (1) more parental reinforcement of sick role behavior in response to their childhood anxiety symptoms than moderate and low AS students, (2) more parental reinforcement of sick role behavior related to their childhood cold symptoms than moderate and low AS students, (3) more frequent observation of parental sick role behavior in response to parents’ own anxiety symptoms compared to low AS students, and (4) more frequent observation of parental uncontrolled behavior compared to moderate AS students. Thus, both operant and vicarious learning processes were implicated in the development of AS. Given such findings, further investigation of childhood experiences in the development of AS seems warranted.
In addition to traditional learning theory perspectives, one potentially useful framework for understanding development of AS is Bowlby, 1969/1982, Bowlby, 1973, Bowlby, 1980 attachment theory. Bowlby (1969/1982) suggested that an attachment relationship consisting of proximity-maintaining behaviors by the human infant and the behaviors of his or her primary caregivers typically forms during the first year of the infant’s life, with the goals of security and protection of the infant. He further suggested that from infancy forward, interactions within the context of these ongoing childhood attachment relationships contribute to the development of people’s internal working models about the world and how it operates. Moreover, Bowlby hypothesized that the quality of interactions within the context of these childhood attachment relationships could influence persons’ psychological health, presumably through these interactions’ effects on working models.
Congruent with the idea that maladaptive attachment interactions might lead to psychological distress, Bowlby, 1973, Bowlby, 1980 identified two sets of caregiver behaviors that might contribute to the development of anxiety and depression: threatening behaviors and hostile, rejecting behaviors. He suggested that threatening behaviors, that is, behaviors that indicate a caregiver may not be physically or emotionally available when needed, are particularly characteristic of anxious individuals’ childhood attachment relationships. These threats can take many forms, including threats to stop loving a child if (s)he does not behave, threats to abandon a child, and threats to leave the home, become ill, or commit suicide (Bowlby, 1973). Bowlby, 1980, Bowlby, 1988 further suggested that hostile, rejecting behaviors, that is, behaviors that imply a caregiver certainly will not be available when needed, are particularly characteristic of depressed individuals’ childhood attachment relationships. Such hostility and rejection is embodied by a child being told (s)he is unlovable, inadequate, and incompetent, and, unlike caregiver threatening behavior, typically includes constant, active rebuffs of the child’s bids for responsive behavior. In sum, Bowlby suggested childhood attachment experiences that might differentially lead to anxiety and depression.
We believed that Bowlby’s ideas about the kinds of caregiver behavior that may lead to anxiety and depression might also contribute to knowledge about development of AS. AS can be conceptualized as a type of internal working model that appears to develop early in life, preceding the onset of psychological distress. Consequently, experiences with primary caregivers would seem to have particular importance in the development of AS. Thus, to better understand the origins of AS and expand upon the work of Watt et al. (1998), the current study investigated the role of parental threatening, hostile, and rejecting behavior in the development of AS.
We examined two main sets of hypotheses. First, based on findings that high overall AS has been related to both anxiety and depression (Otto et al., 1995, Taylor et al., 1992, Taylor et al., 1996), we predicted that both sets of negative parental behavior (i.e., threatening behavior and hostile, rejecting behavior) would be related to the development of overall AS. Second, based on the work of Taylor et al. (1996), we predicted differential relationships between parental behavior and AS factors.
In their study of relationships between AS, depression, and anxiety, Taylor et al. (1996) found three factors of AS: (1) fear of publicly observable anxiety symptoms such as fears of shaking, (2) fear of anxiety-related bodily sensations, such as fears of nausea, and (3) fear of losing control over one’s thoughts, such as worrying one is mentally ill. Moreover, these investigators found that the first two factors were closely associated with anxiety symptomatology, whereas the latter factor was closely associated with depressive symptomatology. Thus, we believed that the latter factor (fear of losing control over one’s thoughts) might be best predicted by parental hostile, rejecting behaviors, hypothesized by Bowlby (1980) as an antecedent of depression. Furthermore, we believed that the first two factors (fear of publicly observable anxiety symptoms and fear of anxiety-related bodily sensations) might be best predicted by parental threatening behaviors, hypothesized by Bowlby (1973) as an antecedent of anxiety.
Providing that expected relationships were found between parenting and AS scores, we planned to examine a third set of hypotheses. Specifically, we were interested in the extent to which AS and its factors might mediate relationships between parenting and both current and past anxious and depressive symptoms. Indeed, Bowlby, 1973, Bowlby, 1980 theorizing about differential antecedents of anxiety and depression, research findings that AS acts as a vulnerability factor for the development of anxiety and depression (Maller & Reiss, 1992; Schmidt et al., 1997, Schmidt et al., 1999), and Taylor et al.’s (1996) findings of unique relationships between AS factors and anxiety and depression suggest specific mediational relationships between parenting, AS, and both current and past symptoms. For example, overall AS would be expected to mediate relationships between parental threatening behavior and current and past anxiety symptoms, while fear of losing control over one’s thoughts would be expected to mediate relationships between parental hostile, rejecting behavior and current and past depression symptoms. We planned to examine mediational hypotheses when predicted relationships between parenting and AS were found.
To investigate our hypotheses, university students completed self-report measures assessing exposure to negative parenting behaviors during childhood, AS, current anxious and depressive symptoms, and history of anxiety and depressive disorder symptoms. Multiple regression analyses and partial correlations were used to examine the hypotheses.
Section snippets
Participants
Two hundred forty-nine undergraduate psychology students volunteered to complete a battery of self-report measures investigating the developmental antecedents of anxiety and depression. Students received class credit for their participation. Participants ranged in age from 17 to 54 years (M=19.55, S.D.=3.71); 82.7% were female and 17.3% were male. Most participants identified their ethnicity as Caucasian (45.8%), Hispanic (27.3%), or Asian (12.9%); the remainder identified themselves as
Statistical analyses for main hypotheses
Multiple regression analyses and partial correlations were used to investigate the ability of parental threatening, hostile, and rejecting behaviors to predict AS and its factors. Analyses were conducted using SPSS for the Power Macintosh Version 6.1. Standardized and unstandardized regression coefficients for the regression analyses are displayed in Table 3.
Prediction of overall AS
To investigate the collective contribution of the parenting variables to overall AS, total PTI scores and rejection/aggression/hostility
Discussion
This study revealed that parental behaviors hypothesized as etiologic in the development of anxiety and depression might also be etiologic in the development of AS. Results revealed that parental hostile, rejecting, and threatening behaviors predicted approximately 7% of the variance in overall AS, with parental threatening behaviors bearing the strongest relationship to this variable. In addition, parental hostile, rejecting, and threatening behaviors were differentially related to AS factors.
Acknowledgements
We would like to thank Dr. Sherry H. Stewart for providing comments on an earlier draft of this paper.
References (38)
- et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clinical Psychology Review
(1988) - et al.
The phenomenon of nonclinical panic: parameters of panic, fear, and avoidance
Journal of Anxiety Disorders
(1990) - et al.
The Beck Anxiety Inventory in a non-clinical sample
Behaviour Research and Therapy
(1995) - et al.
Panic attack symptomatology and anxiety sensitivity in adolescents
Journal of Anxiety Disorders
(1996) - et al.
Anxiety sensitivity in 1984 and panic attacks in 1987
Journal of Anxiety Disorders
(1992) - et al.
Elevated Anxiety Sensitivity Index scores in patients with major depression: correlates and changes with antidepressant treatment
Journal of Anxiety Disorders
(1995) Potential role of childrearing practices in the development of anxiety and depression
Clinical Psychology Review
(1997)Expectancy model of fear, anxiety, and panic
Clinical Psychology Review
(1991)- et al.
Anxiety sensitivity, anxiety frequency and the prediction of fearfulness
Behaviour Research and Therapy
(1986) - et al.
The Parent Threat Inventory: development, reliability and validity
Child Abuse & Neglect
(2002)
Anxiety sensitivity and the pathogenesis of anxiety and depression: evidence for symptom specificity
Behaviour Research and Therapy
Anxiety sensitivity and dependency in clinical and non-clinical panickers and controls
Journal of Anxiety Disorders
How does anxiety sensitivity vary across the anxiety disorders?
Journal of Anxiety Disorders
A retrospective study of the learning history origins of anxiety sensitivity
Behaviour Research and Therapy
The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
An inventory for measuring clinical anxiety: psychometric properties
Journal of Consulting and Clinical Psychology
Cited by (61)
Parental threats and adolescent depression: The role of emotion dysregulation
2019, Psychiatry ResearchCitation Excerpt :A separate investigation found that parental threatening behaviors—conceptualized as behaviors that convey threats of rejection, abandonment, or punishment, which communicate to a child that others are unpredictable and the world is unsafe (Scher et al., 2002)—may play a central role in adolescent depression (Scher et al., 2002). Scher and colleagues found that retrospective reports of childhood exposure to parental threatening behaviors were related to current depressive distress and disorders among undergraduates (Scher et al., 2002; Scher and Stein, 2003). A separate investigation also found that recalled levels of perceived threat from family—and parents specifically—during childhood were significantly associated with depressive symptom severity (Gilbert et al., 2003).
Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion
2016, Clinical Psychology ReviewCitation Excerpt :With regards to environmental influences on AS, stressors, modeling, insecure attachment, and vicarious conditioning, all may play a role in the development of elevated AS (Schmidt et al., 2000; Watt, Stewart, & Cox, 1998). For example, emotional maltreatment during childhood, particularly with the presence of threatening parental behaviors, has been associated with higher levels of AS in young adults (Sher & Stein, 2003). Stressful life events, particularly events related to health or family discord has also shown to longitudinally predict increases in AS in a diverse community sample of adolescents (McLaughlin & Hatzenbuehler, 2009).
Are childhood trauma exposures predictive of anxiety sensitivity in school attending youth?
2014, Journal of Affective DisordersAnxiety sensitivity and social support in veterans with emotional disorders
2023, Journal of Clinical PsychologyChildhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress
2023, Journal of Clinical PsychologyThe Role of Anxiety Sensitivity in the Association between Childhood Maltreatment and Sleep Disturbance among Adults in Psychiatric Inpatient Treatment
2023, Journal of Nervous and Mental Disease