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Open Dissertation-Defense-Final.Pdf The Pennsylvania State University The Graduate School College of the Liberal Arts ANXIETY SENSITIVITY, BEHAVIORAL INHIBITION, AND COGNITIVE BIASES AS RISK FACTORS FOR ANXIETY: CUMULATIVE, INCREMENTAL, AND MEDIATED INFLUENCES A Dissertation in Psychology by Andres G. Viana © 2011 Andres G. Viana Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy August 2011 ii The dissertation of Andres G. Viana was reviewed and approved* by the following: Brian Rabian Associate Professor of Psychology Dissertation Adviser Chair of Committee Karen L. Bierman Distinguished Professor of Psychology Kristin A. Buss Associate Professor of Psychology Mark T. Greenberg Edna Peterson Bennett Endowed Chair in Prevention Research Professor of Human Development and Family Studies Melvin M. Mark Head of the Department of Psychology *Signatures are on file in the Graduate School. iii ABSTRACT The present study aimed to advance understanding of the cumulative, incremental, and mediated influences of anxiety sensitivity, behavioral inhibition, and interpretive and judgment biases on anxiety outcomes. Cumulative and multiple-risk factor models, as well as direct and indirect pathways linking anxiety sensitivity and behavioral inhibition with anxiety outcomes, were examined in 862 emerging adults. Exploratory cluster analyses were also performed in an effort to identify subgroups of participants with different constellations of risk. The cumulative and multiple-risk factor models significantly predicted anxiety outcomes, although the statistical prediction offered by the latter model was superior. Additionally, variability in each risk factor significantly predicted anxiety outcomes after controlling for the total number of risks, supporting the value of the content of risk to the prediction of anxiety outcomes. Structural equation modeling revealed that interpretive and judgment biases partially mediated pathways linking anxiety sensitivity and behavioral inhibition with anxiety outcomes. Anxiety sensitivity and behavioral inhibition were also directly linked with anxiety outcomes. Results were similar for males and females. Finally, cluster analyses revealed four clusters with varying combinations of risk and somewhat different levels of anxiety. Findings, implications for intervention, and limitations are discussed. iv TABLE OF CONTENTS LIST OF TABLES………………………………………………………………………………..vi LIST OF FIGURES……………………………………………………………………………...vii ACKNOWLEDGEMENTS……………………………………………………………………..viii 1. Introduction……………………………………………………………………………………1 1.1 Cumulative versus Incremental Risk for Anxiety……………………………………….....3 1.2 Overview and Significance…………………………………………………………...........6 1.3 Anxiety and Distorted Thinking……………………………………………………………7 1.4 A Cognitive Information Processing Model of Anxiety…………………………………...8 1.4.1. Stage I: Initial registration…………………………………………………………...9 1.4.2. Stage II: Immediate preparation……………………………………………………..9 1.4.3. Stage III: Secondary elaboration…………………………………………………...11 1.5. Interpretive Biases………………………………………………………………………..12 1.6. Judgment Biases………………………………………………………………………….20 1.7. Anxiety Sensitivity, Behavioral Inhibition, and Anxiety………………………………...24 1.7.1. Anxiety sensitivity………………………………………………………………….24 1.7.2. Behavioral inhibition……………………………………………………………….28 1.8. The Present Study………………………………………………………………………...31 2. Method………………………………………………………………………………………..33 2.1 Participants………………………………………………………………………………..33 2.2 Measures…………………………………………………………………………………..34 2.2.1 Risk factors………………………………………………………………………….34 2.2.1.1 Interpretive biases…………………………………………………………...34 2.2.1.2 Judgment Biases…………………………………………………………….35 2.2.1.3 Anxiety Sensitivity………………………………………………………….36 2.2.1.4 Behavioral Inhibition………………………………………………………..37 2.2.2 Anxiety outcomes…………………………………………………………………...38 2.2.2.1 Clinical anxiety……………………………………………………………...38 2.2.2.2 Trait anxiety………………………………………………………………...39 2.2.2.3. Negative affectivity………………………………………………………...40 2.2.2.4. Worry……………………………………………………………………….40 2.2.3 Cumulative risk computation……………………………………………………….41 2.3. Procedure…………………………………………………………………………………41 3. Results………………………………………………………………………………………...42 3.1. Preliminary Analyses…………………………………………………………………….42 3.1.1. Description of behavioral inhibition………………………………………………..42 3.1.2. Description of anxiety sensitivity…………………………………………………..42 3.1.3. Description of judgment biases…………………………………………………….42 3.1.4. Description of interpretive biases…………………………………………………..43 3.1.5. Description of anxiety problems…………………………………………………...43 3.2. Individual Risk Variables and Anxiety Problems………………………………………..43 3.3. Multiple Risk Factors and Anxiety Problems……………………………………………45 3.4. Cumulative Risk and Anxiety Problems…………………………………………………46 3.5. Structural Equation Modeling of Direct and Indirect Pathways Linking Anxiety v Sensitivity, Behavioral Inhibition, and Interpretive and Judgment Biases, to Anxiety Symptoms………………………………………………………………………………..50 3.6. Patterns of Risk and Relations to Anxiety Outcomes……………………………………53 4. Discussion…………………………………………………………………………………….56 4.1. Individual Risk Variables and Anxiety Problems………………………………………..56 4.2. Multiple Risk Factors and Anxiety Problems……………………………………………57 4.3. Cumulative Risk and Anxiety Problems…………………………………………………60 4.4. Structural Equation Modeling of Direct and Indirect Pathways Linking Anxiety Sensitivity, Behavioral Inhibition, and Interpretive and Judgment Biases, to Anxiety Symptoms………………………………………………………………………………..63 4.5. Patterns of Risk and Relations to Anxiety Outcomes……………………………………67 5. Concluding remarks…………………………………………………………………………69 References………………………………………………………………………………………..71 Appendix: Standardized Factor Loadings for the Full Mediational Model……………………...92 Footnotes………………………………………………………………………………………..107 vi LIST OF TABLES Table 1. Demographic characteristics of the sample (N = 862)………………………………….93 Table 2. Risk variables, means and standard deviations for the total sample (N = 862) as well as by sex and ethnic group……………………………………………………….94 Table 3. Intercorrelations among all variables and those included in SEM analyses……………96 Table 4. Demographic and continuous risk variables predicting anxiety outcomes: Initial and unique regression models…………………………………………………….98 Table 5. Percentage of cases meeting the dichotomous risk criterion for the total sample as well as by sex and ethnic group………………………………………………99 Table 6. Demographic and dichotomous risk variables predicting anxiety outcomes: Initial and unique regression models…………………………………………………...100 Table 7. Mean scores for risk factors and anxiety outcomes for the four-cluster solution, and additional characteristics of each group (N = 314)………………………………...101 vii LIST OF FIGURES Figure 1. Hypothesized mediational model showing direct and indirect pathways from anxiety sensitivity and behavioral inhibition to anxiety symptoms………………103 Figure 2. Full Mediational model: Paths linking anxiety sensitivity and behavioral inhibition, with anxiety symptoms through interpretive and judgment biases…………104 Figure 3. Step 2 of mediational analyses: Paths linking both mediators to anxiety are constrained to zero and shown as dashed, gray arrows………………………………...105 Figure 4. An examination of patterns of risk for the final, four-cluster solution……………….106 viii ACKNOWLEDGMENTS I would like to thank my wife, Mariana, for her unconditional love, support, and encouragement throughout the many stages of this project. She was the endless source of laughter and joy I so much needed to see this project to completion. I also would like to thank my parents and my beautiful extended family, in the United States and overseas, for always encouraging me to pursue my academic endeavors and supporting me in many ways along the journey. I would also like to thank my advisor, Brian Rabian, Ph.D., for his tireless support and advice throughout the process of completing my dissertation, and for always encouraging me to believe in and pursue my own ideas. I also would like to extend my gratitude to the members of my committee, Kristin Buss, Ph.D., Mark Greenberg, Ph.D., and Karen Bierman, Ph.D., whose comments and advice helped shape this project into its final state. I would especially like to thank Karen Bierman, Ph.D., whose comments on various drafts of my dissertation were instrumental to its completion. I would also like to acknowledge Janet Welsh, Ph.D., whose encouraging support and guidance was invaluable, not only during the writing of my dissertation, but all throughout graduate school. I also would like to thank Peter Molenaar, Ph.D., Robert Nix, Ph.D., and Aidan Wright, M.S., for their statistical advice. ix DEDICATION To my wife, Mariana, who gives meaning to everything that I do. 1 1. Introduction The relation of interpretive and judgment biases to elevated anxiety and internalizing difficulties has been the subject of growing attention (Vasey & MacLeod, 2001; see Craske & Pontillo, 2001, and Weems & Watts, 2005, for excellent reviews). Research evidence suggests that men and women with anxiety commonly make threatening interpretations of, and misjudge their ability to cope with, ambiguous or neutral stimuli (Beck, Emery, & Greenberg, 1985; Mathews & MacLeod, 2002; McNally, 1996; Weems, Silverman, Rapee, & Pina, 2003). Research also suggests that interpretive and judgment biases may be causally related to elevated anxiety, thereby exacerbating risk for anxiety problems (e.g., Yiend & Mathews, 2002). However, two important areas on this topic have received relatively
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