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Anxiety Sensitivity : Validity of the Anxiety Sensitivity Profile on a Clinical Sample Sharon V Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2004 Anxiety Sensitivity : Validity of the Anxiety Sensitivity Profile on a Clinical Sample Sharon V. Elwell Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Elwell, Sharon V., "Anxiety Sensitivity : Validity of the Anxiety Sensitivity Profile on a Clinical Sample" (2004). PCOM Psychology Dissertations. Paper 42. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Philadelphia Col1ege of Osteopathic Medicine Department of Psychology ANXIETY SENSITIVITY: VALIDITY OF THE ANXIETY SENSITIVITY PROFILE ON A CLINICAL SAMPLE By Sharon V. Elwel1 Copyright 2004 Sharon V. Elwell Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology May 2004 Dissertation Approval This is to certify that the thesis presented to us by Sharon V. Elwell on the 13th day of May 2004, in partial fulfillment ofthe requirements for the degree of Doctof of Psychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members' Signatures: Elizabeth A. Gosch, Ph.D., ABPP, Chairperson Robert A. DiTomasso, Ph.D. ABPP Jonathan B. Grayson, Ph.D. Robert A. DiTomasso, Ph.D. ABPP, Chair, Department of Psychology Anxi ety Sensitivity: Validity of the ASP iii Acknowledgments I wish to express my sincere thanks to Elizabeth A. Gosch, Robert A. DiTomasso, and Jonathan B. Grayson for their expertise, support, and encouragement throughout this process. It was indeed a privilege and a pleasure to experience the guidance and direction they provided each step of the way. I wish to express my heartfelt thanks to my family and friends for all their patience and understanding during the past seven years. I truly appreciate all their support during those difficult times I encountered along the way. Finally, I wish to express my appreciation for the support provided by private practitioners and their patients, support groups and their leaders, Philadelphia College of Osteopathic Medicine interns and their patients, and psychology and medical students who volunteered to serve as subjects. They generously supported this effort to make a contribution to the research and treatment of anxiety disorders. Anxiety Sensitivity: Validity of the ASP iv Abstract The psychometric properties of the Anxiety Sensitivity Index (ASI) have been criticized. Although it has been the gold standard in research and assessment, its reliability (Le., internal consistency) has been questioned. There are doubts about its ability to identifY accurately the underlying factors for anxiety sensitivity. To provide a more accurate description of the anxiety sensitivity construct, Taylor and Cox (1998) developed the Anxiety Sensitivity Profile (ASP) and performed analyses based on a sample of 349 university students. The current study utilized a clinical sample to test the hypotheses that the ASP would have convergent validity with the ASI and discriminant validity with the trait version of the State-Trait Anxiety Inventory (STAl). This correlational study was conducted with a clinical sample of 105 adults, 19 to 65 years old, who have an anxiety disorder. Each subject completed the ASP, ASI, STAl, and the computerized version of the SClD-IfP. Results supported the hypotheses. Large correlations at the .01 level were found for the ASP and ASI total scores and ASP subscale scores. Modest correlations were found for the ASI and ASP total and subscale scores and the trait version of the STAl at the .05 leveL Reliability (internal consistency) for the ASI total scores and ASP subscales was high. Therefore this study provides evidence for convergent validity with the ASI. It also provides necessary, although not sufficient evidence for construct validity for the ASP subscales. Internal consistency reliability cannot be determined for all of the underlying domains of the ASI, because one of the domains consists of only one item. This Anxiety Sensitivity: Validity ofthe ASP v evidence implies that the ASP is psychometrically superior to the ASI for research and treatment. Instead of the three underlying factors of the ASI, six factors are implied. Evidence is provided through convergent validity and internal consistency reliability found for the six ASP subscales. It is speculated that utilization of the ASP will support improved consistency in research through the use of congruence (i.e., matching the symptoms caused by a provocation task and the symptoms a person fears). Furthennore the ASP wil1 support accurate identification of the domains underlying anxiety sensitivity that contribute to its association with all anxiety disorders. Finally, there are applied implications. These include the fact that those at risk can be identified and given brief cognitive-behavioral therapy as a preventive intervention. Also, treatment can target congruent cognitions, and elevated anxiety sensitivity at the end of treatment can be targeted for further interventions. Anxiety Sensitivity: Validity of the ASP VI Table of Contents Chapter 1: Literature Review 1 Introduction 1 Theoretical Background and Rationale 10 Theoretical Background 10 Expectancy theory 10 Does anxiety sensitivity meet the criteria of a fundatnentalfear? 12 Expectancy theory and anxiety expectancies 16 Fear, anxiety. and avoidance 18 The Expectancy Theory of Fear 19 The Possible Role of Anxiety Sensitivity in the Etiology and Maintenance of Anxiety Disorders 22 Sources of the fear of anxiety 22 Challenges to expectancy theory 24 The proposed role of anxiety sensitivity in the other anxiety disorders 26 Information-Processing Biases for Threat 32 Interpretive bias 33 Attentional bias 33 Memory bias 34 Interoceptive acuity bias 35 Anxiety Sensitivity: Validity of the ASP vii Cognitive biases, high anxiety sensitivity, and people at risk for developing panic attacks. 35 Anxiety Sensitivity and Personality 36 Developmental trajectory of anxiety sensitivity 40 Anxiety sensitivity and children 41 Heritable Components of Anxiety Sensitivity and Panic Disorder 42 Environmental Contributions to Elevated Anxiety Sensitivity 43 Parental reinforcement 43 Parental uncontrolled behavior 45 Chronic illness 46 Learning vs genetics 46 Prospective Evaluations of Anxiety Sensitivity 47 Possible Benefits to Be Derived from Promotion of the Understanding of the Mechanics of Anxiety Sensitivity for Prevention, Treatment, and Relapse Prevention of the Symptoms of Anxiety 50 Prevention issues 51 Research and assessment issues 54 Treatment intervention research: children 57 Treatment intervention: adults 58 Related Research 62 Anxiety Sensitivity and Depression: Symptom Specificity and the Tripartite Model 62 Anxiety Sensitivity: Validity of the ASP viii Anxiety Sensitivity: Dimensional or Categorial 66 Evidence for the Hierarchical Structure and Factor Saturation of the ASI 68 Factor Structure of Other Measures of Anxiety Sensitivity 74 Relationship of Trait Anxiety and Anxiety Sensitivity in the Hierarchical Structure 75 Limitations on the Dimensionality of Anxiety Sensitivity in the Current Literature 77 Construct validity 78 To Summarize 79 Specific Hypotheses 82 Chapter 2: Methods 84 Participants 84 Overview of the Research Design 85 Measures 87 Procedures 89 Chapter 3 : Results 92 Descriptive 92 Internal Consistency 95 Hypothesis 1 98 Hypothesis 2 100 Anxiety Sensitivity: Validity of the ASP ix Chapter 4: Discussion 105 Summary and Explanation 105 Convergent Findings 106 Divergent Findings 112 Contributions 116 Theoretical Implications 117 Research Implications 118 Applied Implications 121 Limitations 123 Suggestion 125 Suggestions for Future Studies 126 Conclusion 129 References 131 Appendix Anxiety Sensitivity Profile 163 Anxiety Sensitivity: Validity of the ASP x List of Tables Table 1. Mean Subscale Scores and Standard Deviations for the Anxiety Sensitivity Profile (ASP) 94 Table 2. Reliability Analysis of the Anxiety Sensitivity Index (ASI) Total Scores and the Anxiety Sensitivity Profile (ASP) Subscale Scores 96 Table 3. Corrected Item-Subscale Total Score Correlations for ASP Factors 97 Table 4. Intercorrelations Between Subscales ofthe Anxiety Sensitivity Profile (ASP) and Total Scores of the Anxiety Sensitivity Index (ASI) and Stait-Trait Anxiety Inventory (STAI) 101 Table 5. Intercorrelations Between the Anxiety Sensitivity Profile (ASP), Anxiety Sensitivity Index (AS I) and the Stait-Trait Anxiety Inventory (STAI) Total Scores 104 Anxiety Sensitivity: Validity of ASP 1 Chapter One: Literature Review Introduction Attempts are being made to discover the factors involved in the etiology of anxiety pathology (Silverman & Weems, 1999). The goals of these attempts are the identification of individuals at risk and the application of appropriate preventive treatments to arrest the development of pathological anxiety. One risk factor is the construct referred to as anxiety sensitivity. It is currently viewed as an important, inherited predisposition for anxiety disorders in general and panic disorder in particular (Taylor & Cox, 1998). Initial studies
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