Anxiety Sensitivity Index - an overview (2022)

The ASI showed strong internal consistency and moderate correlations with measures of related constructs.

From: Encyclopedia of Applied Psychology, 2004

Panic Disorder as an Emotional Disorder

G.M. Sullivan, in Encyclopedia of Neuroscience, 2009

Anxiety Sensitivity Theory of Panic Disorder

This model posits that particular individuals have a cognitive predisposition to interpret the arousal symptoms of anxiety as harmful beyond the inherent discomfort or displeasure experienced. Anxiety symptoms are interpreted as threatening to their physical, psychological, and/or social well-being, and the harm they cause may accumulate over time. PD patients score high on measures of anxiety sensitivity, such as the widely employed Anxiety Sensitivity Index (ASI). Notably, an ASI score is a good predictor of panic to a panicogen. In this model, the enhanced response of PD patients to challenge with a panicogen stems from catastrophic misinterpretations about the induced arousal symptoms rather than direct stimulation of a biochemical defect. Yet the anxiety sensitivity model is not inconsistent with a neurobiological explanation involving an enhanced sensitivity to afferent viscerosensory input transmitted via the glossopharyngeal and vagus nerves. These viscerosensory pathways synapse in the nucleus tractus solitarius (NTS), and the signals are relayed to the amygdala and hypothalamus, as well as the PBN and LC, potentially lowering the threshold for a fight-or-flight response. In this light, it is notable that an action common to most the panicogens is the activation of the viscerosensory areas of NTS (see Figure 1). Here too, inadequate top-down control of the amygdala, limiting the impact of cortically processed information provided to it through the hippocampus and/or PFC, could further lower the threshold for an inappropriately triggered fight-or-flight response.

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Anxiety Disorders in Late Life

Cheryl N. Carmin, ... Amy Buckley, in Encyclopedia of Applied Psychology, 2004

2.2 Panic Disorder and Agoraphobia

2.2.1 Assessment

Notably, very few studies have addressed the psychometric properties of measures of panic and related symptoms in older patient samples. Two studies, one using a nonclinical community sample and the other using patients drawn from a medical clinic, studied the properties of the Beck Anxiety Inventory (BAI), a well-known measure of anxiety and panic symptoms and found that the scale had good discriminant validity and internal consistency. The latter study also demonstrated the BAI four-factor solution with autonomic, neuromotor, cognitive, and panic subscales, suggesting that anxiety symptom clusters are slightly different from those found among younger adults.

The Anxiety Sensitivity Index (ASI) is a 16-item measure tapping the fear of anxiety sensations, which is known to be a risk factor for the development of panic. In 2000, Mohlman and Zinbarg tested the structure and validity of the ASI in 322 healthy older adults (mean age 75 years). The ASI showed strong internal consistency and moderate correlations with measures of related constructs. Confirmatory factor analysis indicated a hierarchical structure with three group factors—physical concerns, mental incapacitation concerns, and social concerns—as well as a general factor, consistent with previous investigations of the ASI in younger adults. In 1998, Deer and Calamari found that 49% of their older sample (mean age 81 years) reported panic symptoms and that 27% reported a panic attack during the past year. Anxiety sensations predicted unique variance in panic symptomatology and may function as a risk factor for the development of late-life panic.

2.2.2 Psychosocial Treatment of Late-Life Panic Disorder

Trials of psychosocial treatments in older samples with PD, panic disorder with agoraphobia (PDA), or agoraphobia without history of panic disorder (AWOHPD) are limited to case studies and three small pilot studies. One study found that principles of reality therapy, which focuses on an individual’s situation and worldview, were effective when used by a neighbor to mitigate an older adult’s paranoia and agoraphobia.

Early investigations of behavioral treatments conducted during the 1970s included relaxation, imagery, and exposure. In 1996, Rathus and Sanderson used CBT with two older panic patients: one 70-year-old male and one 69-year-old female. Treatment components were education, cognitive restructuring, interoceptive and situational exposure, and diaphragmatic breathing. Both participants achieved panic-free status and decreased depression following 4 to 5 months of therapy.

In 1991, King and Barrowclough tested CBT for panic and anxiety in a small sample of adults ages 66 to 78 years. Of the 10 participants, 8 had primary diagnoses of PDA. After treatment, 7 were free of panic and 2 showed decreased symptom severity. Six months later, 8 of the remaining 9 participants were panic free and 6 showed improvement on depression.

In 1996, Swales and colleagues tested 10 90-minute sessions of CBT in 15 adults ages 55 to 80 years. Participants experienced decreased severity and frequency of panic attacks, depression, avoidance, and role impairment, and this was apparent at both posttreatment and 3-month follow-up. A reanalysis of Gorenstein and colleagues by Mohlman indicated that CBT plus medication management (n = 5) was somewhat more effective than medication management alone (n = 5) in assisting older adults with PD to decrease anxiety while tapering off anxiolytic medication. The use of interoceptive exposure was believed to facilitate habituation to sensations related to PD and medication withdrawal simultaneously.

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(Video) What Is Anxiety Sensitivity, and Do I Have It?

Interaction of Psychological and Emotional Effects with Breathing Dysfunction

Christopher Gilbert, in Multidisciplinary Approaches to Breathing Pattern Disorders, 2002


The Anxiety Sensitivity Index (ASI) is a 16-item scale developed to differentiate two kinds of anxiety: general apprehension about many things, and specific apprehension about the symptoms of anxiety itself (Box 5.1). It has been reported in research to distinguish panic patients and those displaying symptoms of hyperventilation syndrome from other anxiety disorders. A key trait in most panic patients is anxiety about the symptoms of being anxious. This is a self-referential problem that is often called a ‘vicious circle’ and is akin to ‘fear of fear.’ Whether the attention is focused on accelerated heart rate, sweating, dyspnea, light-headedness, or some other body sign of anxiety, some people react strongly to appearance of these symptoms. This response tendency makes them high scorers on the ASI.

Reiss et al (1986), originators of the ASI, suggested that anxiety sensitivity functions as an amplifier of anxiety. In their words:

…anxiety sensitivity may be a predisposing factor in the development of fears and other anxiety disorders. According to this view, people who believe that anxiety has few or no negative effects may be able to cope with a relatively high level of exposure to anxiety-provoking stimuli. In contrast, people who believe that anxiety has terrible effects, such as heart attacks and mental illnesses, may tend to have anxiety reactions that grow in anticipation of severe consequences. Anxiety sensitivity implies a tendency to show exaggerated and prolonged reactions to anxiety-provoking stimuli.

Reported symptoms are not necessarily ‘objective’ data just because they are physical. Sturges et al (1998) gave female college students the ASI and then a hyperventilation challenge task consisting of eight 15-second intervals of hyperventilation, separated by 10-second periods in which they tried to estimate their heart rates. Skin conductance was also monitored. Subjects rated both the magnitude of their physiological sensations and their subjective degree of distress. Those who had high scores on the ASI judged their heart rate changes as larger, and their anxiety as higher, than those with low scores on the ASI. The physiological changes measured, however, did not differ between the two groups. This means that the group difference was due to biased perception alone. ‘Anxiety sensitivity’ somehow amplified the bodily changes in the minds of the subjects. Factor analysis has shown that simply having higher general anxiety is not responsible for high ASI scores; the questionnaire taps a specific kind of anxiety which might be termed a ‘body phobia.’

The ASI is more specific to panic and to hyperventilation than a standard anxiety test such as the STAI or Hamilton Anxiety Inventory, which do not discriminate between panic and other anxiety disorders such as generalized anxiety disorder, obsessive-compulsive disorder, and simple phobias. According to some studies (e.g. Cox et al 1996, 1987), the ASI contains four somewhat separate factors:


Fear of cardiorespiratory distress and gastrointestinal symptoms


Fear of cognitive/psychological symptoms


Fear of symptoms visible to others (social fear)


Fear of fainting and trembling.

If, for example, a person is interpreting mental fogginess accompanying hyperventilation as an indicator of losing his mind, this could be addressed with explanations and reassurance about the limits to the deficit. Another person may be unconcerned about the mental fogginess but may be quite anxious about the palpitations as possible warning signs of a heart attack. This could also be dealt with by education and reassurance. The test, ideally, directs the psychological treatment as surely as a blood test would direct treatment in another clinical realm.

Hyperventilation-related cognitive and performance deficits

Many authors have observed and collected data on transient mental deficits resulting from hyperventilation. Low CO2 is known to cause cerebral vasoconstriction, which in turn causes brain hypoxia of variable degree. The EEG is generally slowed by this hypoxia. A surge of research occurred in the 1940s and 1950s, stimulated by study of Second World War combat pilots experiencing dangerous problems in performance (Hinshaw et al 1943; Balke & Lillehei 1956). PaCO2 in student pilots during training flights was found to be as low as 15 mmHg (Wayne 1958). Various studies have found loss of concentration, memory, motor coordination, reaction time, judgment, and general intellectual functioning. Wyke (1963) summarized most of this early literature, which at times had poor experimental controls for such factors as possible distraction by other symptoms, and also impaired motor coordination interfering with manual rest responses.

More recently, Van Diest et al (2000) used a test of visual attention to measure the effect of overbreathing. The task was a challenging visual task which required subjects to alternate between naming numbers and making judgments about figure sizes. Trials were run under two conditions of normal breathing and deep breathing (30 breaths per minute for 3 minutes). In addition, PaCO2 was allowed to fall naturally during one trial of hyperventilation, but in another trial the PaCO2 was unobtrusively replaced in order to maintain normal PaCO2 in the subject. Subjects were 42 ‘normal’ women (those with signs of hyperventilation or panic were excluded). The task was presented in the 3 minutes during recovery from the hyperventilation.

With these controls applied, there was a clear deficit in performance, both in slower reaction times and in more errors, in a subset of subjects during the ‘true hyperventilation’ trials in which PCO2 was actually lowered (the ‘sham hyperventilation’ did not create deficits). Subjects whose performance suffered generally had brief apneas during the 3-minute recovery stage. The resulting performance deficits were tentatively explained as due to ‘prolonged central hypoxia.’ The authors describe other data showing that while PaCO2 recovered faster in subjects with apneas, oxygen saturation stayed lower.

Breathing pauses during the recovery stage are common because the breathing drive is reduced by the lower PaCO2 level. Recovery from brief hyperventilation poses a conflict for the brain's regulatory centers: CO2 returns to normal in the blood more quickly after hyperventilation if there are apneas during recovery, but at those moments of suspended breathing there is no oxygen taken in, and because of the vasoconstriction the brain is in a more vulnerable state.

The most focused research on this matter was by Han et al (1997) with data gathered from 399 patients with either hyperventilation syndrome or anxiety disorders, as compared with 347 normal controls. The observations were brief, consisting of a 5-minute quiet breathing baseline period, then 3 minutes of hyperventilation followed by another 5 minutes of quiet breathing. The authors found that recovery to baseline PaCO2 was slower in the patient group than in the control group, confirming the Hardonk & Beumer (1979) study. The incidence of pauses during recovery was clearly higher in the control subjects than in the patients, and this difference was especially obvious in younger subjects. Control subjects seemed to terminate the hyperventilation more definitively, whereas the patient group in effect kept on hyperventilating to some degree, at least by not pausing. If the conclusions of Van Diest's study described above can be generalized from the smaller number of subjects, it means that the slow-recovering hyperventilators without apneas are less prone to errors of performance and perception. The authors speculate that the resistance to pausing may indicate a higher level of vigilance, a quality which the patients presumably had in abundance.

Ley & Yelich (1998) reviewed several studies which found lower PaCO2 in naturally occurring stressful situations. They studied end-tidal PaCO2 levels of 32 boys and girls (12–14 years old) divided into high and low test-anxious, determined by a standard questionnaire. The students were given tests of mathematics and word recall, and questioned in a separate session about frequency of symptoms as listed in the Nijmegen Hyperventilation Questionnaire (see Chapter 7). High test-anxiety students did not perform more poorly than the low test-anxiety students, but they did average lower end-tidal CO2 (36.6 mmHg vs. 38.3 mmHg) as well as a faster breath rate during the tasks. They also reported significantly more symptoms on the Nijmegen questionnaire. The authors concluded by proposing that: ‘the propensity to hyperventilate may exist as a trait which requires stressful conditions for its expression as a negative emotional state. This suggests the possibility that hyperventilatory complaints may, to some extent, be state-dependent and thus contingent on the context in which hyperventilation appears.’

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(Video) The Relationship Between Attachment Styles, Environmental Empathy, and Anxiety Sensitivity

Panic Disorder

L.E. Heuer, ... D.S. Charney, in Encyclopedia of Neuroscience, 2009

Clinical Presentation

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), a patient with PD has recurrent and unexpected panic attacks (Table 1). A minimum of one of the attacks must have been followed by 1 month (or more) of one (or more) of the following symptoms: persistent concern about having additional attacks, worry about the implications of the attack or its consequences, and/or a significant change in behavior related to the attacks. The panic attacks must not be due to effects of a substance of abuse (e.g., stimulant) or general medical condition (e.g., hyperthyroidism), and the panic attacks are not better accounted for by another psychiatric disorder, such as posttraumatic stress disorder, social phobia, and specific phobia.

Table 1. Diagnostic criteria for PD with/without agoraphobia

A. Both 1 and 2:
1. Recurrent unexpected panic attacks
2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) Persistent concern about having additional attacks, (b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, ‘going crazy’), (c) a significant change in behavior related to the attacks
B. Presence/absence of agoraphobia
C. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism)
D. The panic attacks are not better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to a specific phobic situation), obsessive–compulsive disorder (e.g., on exposure to dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., in response to stimuli associated with a severe stressor), or separation anxiety disorder (e.g., in response to being away from home or close relatives)

Adapted from First MB (2000) Diagnostic and Statistical Manual – Text Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Publishing Group.

It has been suggested that the current DSM-IV categorical system fails to capture the full spectrum of subclinical and atypical manifestations associated with PD and implies that if an individual fails to meet the full criteria for a ‘disorder’ he or she has no disorder. Recent research has supported the view that subthreshold disorders might be as significant as those meeting full DSM criteria and can lead to a decrease in quality of life.

Assessment Instruments

There are several validated instruments for the assessment of panic and related symptoms. The Panic and Agoraphobia Scale (PAS) is a widely used instrument that contains five subscales – panic attacks, avoidance, anticipatory anxiety, disability, and health worries – found to reduce quality of life in PD patients. The application of the PAS in a double-blind-placebo-controlled PD trial demonstrated its sensitivity to detect differences between panic treatments. Another measurement tool, the Panic Disorder Severity Scale (PDSS), is a seven-item instrument assessing each core symptom of DSM-IV symptoms of PD, with or without agoraphobia, as well as work and social impairment. Items include frequency of panic attacks and limited-symptom episodes, distress caused by panic and limited-symptom episodes, anticipatory anxiety, agoraphobic fear/avoidance, and work and social impairment.

In addition to the clinician-administered PDSS, a self-report version of the PDSS was found to have good test–retest reliability, good sensitivity to change in treatment, and a reliable format, thus providing another useful tool for clinical and research settings. Other tools which can be used in busy outpatient primary care offices include the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, and a simple screening question (“In the last four weeks, have you had an anxiety attack – suddenly feeling fear or panic?”). Finally, the Anxiety Sensitivity Index (ASI) is a 16-item scale developed to measure ‘fear of fear,’ that is, the degree to which a person believes that physical symptoms of anxiety have negative consequences. Anxiety sensitivity is a construct that has been specifically linked to PD. Persons with high ASI scores tend to attribute physical signs of arousal as representing a serious illness (e.g., palpitations signaling imminent cardiac arrest) rather than a more benign cause (palpitations due to drinking coffee).

Panic-Agoraphobic Spectrum

The Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS), a 114-item tool assessing eight primary domains, was developed in accordance with the view that PD patients have heterogeneous domains of symptomatology. The first domain is that of separation sensitivity, which is highly correlated with separation anxiety in childhood. Other features include the patients’ uneasiness with sleeping alone or away from home, reluctance to leave their home for vacation or work, fearing harm to their family members, and developing highly dependent, unusually intense, close relationships. The second domain is paniclike symptoms. With this domain, patients report panic attacks without fear, only experiencing physical symptoms, such as rapid heart rate, chest tightness, and sweating. In addition, the patient may change their emotional life and behavior in ways that can cause the development of an anxious, dependent, avoidant personality. Stress sensitivity is the third domain, in which a patient will experience an onset of panic symptoms after a period of high tension or after exiting a stressful situation, rather than during the stressor. This may result in the person avoiding stressors, negative news, and resisting change in their daily routine. The fourth domain is medication and substance abuse sensitivity, which may manifest in the patient’s resistance to taking psychoactive drugs. In addition, these patients seem to have increased sensitivity to ingested substances (over-the-counter medications, street drugs, caffeine) and increased sensitivity to withdrawal (benzodiazepines, alcohol). The person may develop a persistent state of vigilance or alertness even in the absence of frequent panic attacks, known as anxious expectation, which is the fifth domain. Agoraphobia is the sixth domain and may be marked by a fear of being home alone, in a public square or mall, traveling through a tunnel or over a bridge, or being in crowded places. Additionally, less obvious, ‘atypical’ symptoms of agoraphobia should be accounted for. These may include perceived obstacles to breathing (ties, turtlenecks), fear of natural phenomena (thunderstorms, high winds, flooding, earthquakes), and fear of humiliation if panic symptoms should arise, all of which can interfere with social or work relationships. Domain seven is illness phobia and hypochondriasis, usually manifesting as a fear of bodily sensations. The last domain, or domain eight, is reassurance orientation. Patients that fit into this domain will experience immediate relief from anxiety when reassured by ‘protective’ figures.

Course of Illness

PD, much like major depressive disorder, is generally episodic in nature, although approximately 20–25% percent of patients have a more pernicious and unremitting course. In one longitudinal study over a course of 11 years, it was found that many patients recover from panic attacks and disabilities, and some will achieve full remission. Specifically, 66.7% reported no panic attacks during the year before follow-up, 87.5% reported no panic attacks the month before follow-up, 54% reported no or only mild phobic avoidance, and 33% of the patients were completely remitted according to a composite remission criterion. Another study examined the long-term follow-up (2–14 years, median 8 years) of 132 patients with PD with agoraphobia successfully treated by exposure therapy alone. Two hundred patients satisfying the DSM-IV criteria for PD with agoraphobia were originally treated with a standard therapy protocol consisting of 12 sessions of psychotherapy and exposure homework. One hundred and thirty-six patients became panic free following this treatment and 132 of these patients were available for followup. The study found a high probability of remaining in remission 2–14 years following treatment. Specifically, three out of four patients remained well after 7 years. Positive associations with remission included a younger patient and the absence of any personality disturbances or residual agoraphobia. Higher initial levels of depressed mood and use of antidepressant drugs were related to a poor outcome.

Using observational/longitudinal data from the Harvard/Brown Anxiety Disorders Research Program, recurrence of panic symptoms after remission in women were compared to men. Although the rates of remission at 5 years for patients with PD with or without agoraphobia were equivalent in both men and women (39%), 25% of these women and 15% of these men reexperienced symptoms in the following 6 months. At the 8-year follow-up, cumulative remission rates were equivalent among men and women. However, relapse events for uncomplicated panic were threefold higher in women than in men by 8 years.

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Modeling disorders of fear and anxiety in animals

Kurt Leroy Hoffman, in Modeling Neuropsychiatric Disorders in Laboratory Animals, 2016

3.4.4 Anxiety sensitivity

Anxiety sensitivity is a trait characteristic that involves fearing the subjective experience of anxiety itself, such as increases in heart rate, inability to concentrate, and externally detectable signs such as trembling and blushing. Such fears of anxiety and its consequences amplify the intensity of anxiety symptoms. Anxiety sensitivity is most often measured by the Anxiety Sensitivity Index (Peterson and Reiss, 1992; Taylor et al., 2008), in which the subjects rate on a scale of 1–5, their agreement with statements such as: “It scares me when my heart beats rapidly”; “When I am nervous, I worry that I might be mentally ill”; and “It is important for me not to appear nervous.” This trait has been particularly associated with increased risk for panic attacks, but prospectively designed studies have shown that anxiety sensitivity is a general risk factor for the later development of anxiety symptoms in children and adolescents (Schmidt et al., 2010; Waszczuk et al., 2013), as well as clinically diagnosed panic disorder and other anxiety disorders (Schmidt et al., 2006). Anxiety sensitivity has a complex etiology, being influenced by both genetic and environmental factors in women, while in men being solely determined by environmental factors, and showing no evidence of heritability (Taylor et al., 2008).

Anxiety sensitivity is related to sensitivity to the anxiety-provoking effects of CO2, in the sense that each demonstrate an association with increased risk for panic attacks. However, in a prospective study, each of these measures was found to predict unique aspects of pathologic anxiety independently. CO2 sensitivity at baseline was uniquely associated with increased risk for future spontaneous panic attacks, even when controlling for anxiety sensitivity. Increased anxiety sensitivity by itself was not associated with future panic attacks, but when co-occurring with increased CO2 sensitivity, anxiety sensitivity increased the risk for future panic attacks above and beyond that associated with CO2 sensitivity alone. However, anxiety sensitivity was predictive of a future diagnosis of panic disorder or other anxiety disorders, even when controlling for CO2 sensitivity (Schmidt et al., 2008). Thus, although both have been associated with anxiety and panic symptoms, they appear to be distinct predictors of anxiety.

One dimension of anxiety sensitivity involves the emotional reaction to bodily sensations and reactions that are normally associated with fear and anxiety, for example, being frightened by experiencing an increase in heart rate, butterflies in the stomach, or trembling of the hands. In other words, anxiety sensitivity essentially involves increased attention to, and awareness of, certain bodily sensations and experiences. Studies that have looked at the relationship between anxiety and measures of “interoceptive sensitivity” have found that increased conscious perception of bodily sensations is associated with anxiety sensitivity, panic disorder, SAD, and GAD (for review, see Domschke et al., 2010). Heartbeat perception is one measure of interoceptive sensitivity, and can be readily assessed by the Schandry task, in which the subject is asked to count their heartbeats silently during a specific time interval, and this is compared to the actual, measured heartbeat. Individuals with panic disorder show an increased ability to perceive their own heartbeat, and this capacity is associated with anxiety sensitivity in nonclinical subjects.

(Video) Conners 3: Introduction and Application

In humans, the insular cortex mediates heartbeat perception and other forms of subjective interoceptive awareness. In humans and in nonhuman primates, the dorsal insular cortex (the “interoceptive cortex”) receives nociceptive, thermoceptive, chemoceptive, and general visceral sensory information from all parts of the body via the lamina I spinothalamocortical pathway. The dorsal insular cortex, therefore, contains a sensory representation of the physiologic state of all body tissues, including visceral and muscle sensations as well as pain, itch, and temperature (Craig, 2002). In humans, this sensory information is re-represented in the anterior insula, and then forwarded to the orbitofrontal cortex (OFC). The anterior insula is suggested to underlie the capacity to form a subjective mental representation of bodily states, while the OFC is associated with assigning motivational salience to cues based on the current homeostatic needs of the body.

Activity in the right anterior insula is associated with accurate heartbeat perception, as well as a variety of other subjective emotional experiences such as pain, sadness, sexual arousal, and responsiveness to music (Craig, 2002; Domschke et al., 2010). Anxiety sensitivity in subjects with specific phobia, as well as in healthy control subjects, was significantly correlated with right anterior insula activation during preconscious and conscious processing of emotional faces (Killgore et al., 2011; Stein et al., 2007). Likewise, anxiety sensitivity was positively correlated with right anterior insula volume in healthy controls and in subjects with specific phobia (Rosso et al., 2010). Notably, nonhuman primates may not have a re-representation of interoceptive information in the anterior insula. Instead, information from the dorsal insular cortex is sent directly to the OFC. Moreover, nonprimate species lack the thalamocortical pathways that, in primates, carry interoceptive information to the insular cortex, suggesting that this type of information is processed and perhaps subjectively experienced in a significantly different manner in nonhuman species. Therefore, anxiety sensitivity might be a characteristic unique to humans.

Some reports indicate a gene by environment interaction involving childhood maltreatment and 5-HTTLPR polymorphisms. In one study, individuals homozygous for the short allele that had experienced higher levels of childhood maltreatment showed increased anxiety sensitivity (Stein et al., 2008). By contrast, another study reported that homozygosity for the long allele interacted with childhood maltreatment to increase anxiety sensitivity (Klauke et al., 2011). The T allele of the NPSR increased anxiety sensitivity in subjects with panic disorder, but not in healthy controls (Domschke et al., 2011). Interestingly, this effect of the NPSR polymorphism on anxiety sensitivity was observed only in women. The T allele was also associated with increased risk for panic disorder, an effect that likewise was seen only in women (Domschke et al., 2011).

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Internalizing Conditions

NICOLE M. KLAUS, ... KERI BROWN KIRSCHMAN, in Developmental-Behavioral Pediatrics, 2008


Since the 1980s, attention has been directed toward developing reliable and valid assessment measures for anxiety disorders in children and adolescents for accurate diagnosis and for formulating treatment plans and monitoring treatment outcome.4,46 Readers are referred to excellent reviews by Kearney and Wadiak,46 Silverman and Ollendick,15 and Velting and associates.4 The following discussion outlines recommended assessment protocols from these reviews; measures specific to individual disorders are listed in subsequent sections.

A multimethod and a multisource assessment approach is recommended for examining biological, cognitive, and behavioral aspects of anxiety from a variety of sources, such as the child, the parents, and the teachers, through the use of diverse methods, including structured interviews, rating scales, and observations. Kendall and colleagues47 also proposed a multistage sampling design in which a screening measure is administered first and followed by a more detailed diagnostic interview for persons identified from the initial screening. This process focuses on identifying the existence of an anxiety disorder and then determining the exact nature of the disorder. In general, self-report, parent, and teacher rating scales are frequently used for screening purposes. These rating scales also are administered to identify specific symptoms, to discriminate between anxiety and other constructs, and to examine treatment outcome. Semistructured and structured interviews are employed primarily to diagnose specific anxiety disorders, as well as to identify symptoms and to evaluate treatment effectiveness. Finally, rating scales, direct observations, and self-monitoring are used to identify specific aspects of anxiety that serve to maintain its occurrence and changes during treatment.

Various problems are evident with assessment methods and measures for anxiety disorders in youths. The predictive power of methods and measures requires further exploration. For example, a greater number of individuals may be identified as having anxiety symptoms or disorders at initial screening because of the higher false-positive values in comparison with true-positive values on self-report rating scales.34 Many assessment methods are limited in terms of developmental differences, including age and gender.46 Diagnostic interviews are difficult to administer, and self-report measures are less reliable with younger children.48 Furthermore, self-monitoring and behavioral observations may be more reactive with older children and adolescents. Many assessment measures lack appropriate cultural variations, such as idioms of distress and interpretation of worry.49

A medical condition or substance use should be confirmed or ruled out when anxiety symptoms are assessed.49 Therefore, a targeted medical examination should be completed before a final diagnosis is established, with the use of data from other methods. Individuals should be questioned about prescription medications; over-the-counter medications, especially those containing ephedrine and appetite suppressants; and caffeine intake, such as colas and chocolate. Othmer and Othmer50 provide a detailed list of medication side effects related to mental health symptoms. Fong and Silien49 describe a range of medical conditions associated with anxiety symptoms, such as specific neurological disorders (e.g., multiple sclerosis, temporal lobe epilepsy), endocrine disorders (e.g., hyperthyroidism, Cushing syndrome), immune and collagen disorders (e.g., lupus erythematosus), and cardiovascular disorders (e.g., anemia, mitral valve prolapse).

Semistructured and Structured Interviews

Semistructured and structured interviews offer the most reliable means of diagnosis because of the degree of information solicited from children and their parents.51 However, the 2 to 3 hours needed to complete these interviews may be prohibitive in some settings.4 The length appears related to the experience of the interviewer, the cooperation of the family, and the level of functional impairment of the youth. In addition, children report fewer symptoms than do their parents and may be less reliable in specifying symptom onset and duration.52 Examples of common interviews for school-aged children and adolescents include the Schedule for Affective Disorders and Schizophrenia in School-Aged Children53 and the Diagnostic Interview Schedule for Children.54 The Anxiety Disorders Interview Schedule for Children55 assesses for the presence and severity of anxiety, mood, and externalizing disorders, and it screens for learning and developmental disorders, substance abuse, eating disorders, psychotic symptoms, and somatoform disorders. This measure has strong psychometric properties and has been studied extensively in the literature on anxiety disorders.15

Self-Report Rating Scales

Self-report rating scales provide information from the youth's perspective about the frequency and intensity of cognitive, behavioral, and physiological aspects of anxiety. The majority of self-report scales for anxiety disorders require a second to third grade reading level but take only about 10 to 15 minutes to complete and can be manually scored easily.4 Examples of self-report rating scales for general anxiety include the Revised Children's Manifest Anxiety Scale (RCMAS),56 the State-Trait Anxiety Inventory for Children,57 the Screen for Anxiety and Related Emotional Disorders (SCARED),58 and the Children's Anxiety Sensitivity Index.59 The Negative Affect Self-Statement Questionnaire60 may be considered because of the relevance of negative affect and comorbidity between anxiety and depression. Finally, the Youth Self-Report61 and the Behavior Assessment System for Children62 may be given as general self-report measures of both internalizing problems and externalizing problems. The SCARED appears to be useful in clinical practice, whereas the RCMAS and the State-Trait Anxiety Inventory for Children are used often in research.4,15 Appendix A provides a listing of resources for ordering specific self-report and parent and teacher rating scales. The specific websites should be consulted about restrictions of who may order and administer these measures. Measures not listed in Appendix A can be obtained by contacting the authors noted in the reference section.

Parent and Teacher Rating Scales

Data from multiple informants are crucial for accurate assessment because of the high parent-child discordance, especially with internalizing disorders such as anxiety and depression.15 The perspective of parents and teachers should be solicited with regard to the range of symptoms shown by the youth, in order to place the anxiety symptoms within a context of other problems.4 In addition, symptoms may be quantified and may be monitored over the course of treatment.15 These rating scales are time and cost efficient and are fairly easy to administer and to score, with the use of hand-scoring templates or computer programs, but the problem of self-disclosure is considerable.4,15 Examples of general, corresponding parent and teacher rating scales are the Child Behavior Checklist63 and the Teacher Report Form,64 the Conners' Parent and Teacher Rating Scales,65 and a parent version of the SCARED. A measure of family environment, such as the Family Environment Scale,66 or of marital functioning, such as the Marital Adjustment Scale,67 also may be administered to obtain additional data about family factors that affect the presence of anxiety symptoms.

Behavior Observations

Behavioral observations include such procedures as behavioral approach tests, observational ratings, and role-play tests. Behavioral approach tests usually consist of five 5-minute phases that are held in analogue settings (e.g., giving speech), under stimulated conditions (e.g., tape recordings of thunder or visual displays of spiders), or in a naturalistic setting (e.g., at school): adaptation, baseline, walking baseline, approach, and post-baseline to assess social anxiety, specific phobias, or generalized anxiety.46 Observational ratings are provided by clinicians, parents, or teachers on diverse aspects of anxiety, including overt statements, trembling, and avoidance of the situation.68 Direct observational procedures are most useful in specialty clinics or experimental settings because of their obtrusive nature and complexity of implementation.15 An alternative approach may be to videotape at home and view the tape in the clinic setting.4 Examples of direct observational measures include the Observer Rating Scale of Anxiety,69 the Procedure Behavior Rating Scale,70 and the Behavioral Assertiveness Test for Children.71 An addition to these methods is to observe family interactions in order to examine the factors that may be maintaining anxiety symptoms, such as misinterpreting ambiguous situations and reinforcing avoidant behavioral styles.15 These observations are categorized as the Family Behavioral Test.17,72


Self-monitoring involves monitoring and recording components of anxiety, including physical sensations, related thoughts, and behavior, along with the situation in which these symptoms occur.4 Self-monitoring is used to identify and quantify symptoms and controlling variables and to evaluate and monitor treatment outcomes.73 Self-monitoring is of limited value because in many trials, only between 31% and 39% of children record requested information for a full 2-week period.15 A brief description of symptoms, specific antecedents, and consequences of these symptoms can be recorded in a diary format. In addition, an anxiety rating (on a scale of 0 to 100) may be given to each description, as well as to an overall daily rating. Thought-listing and think-aloud procedures may be included within this method of assessment.46 Thought listing consists of recording thoughts associated with the anxious reaction,74 whereas think-aloud procedures involve audiotaping verbalizations of thoughts and placing these thoughts into categories.75

Physiological Assessment

Various physiological responses may be used as a measure of anxiety, although their reliability and validity have been mixed.4,15 In addition, there are few normative data by which to compare baseline responses or changes after interventions. Examples of physiological measures include heart rate and blood pressure, to examine cardiovascular reactivity; respiration and skin temperature, to assess blood flow to extremities and physiological arousal; and electromyography, to measure electrical activity in tense muscles.4,15

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The effects of osteopathic treatment on psychosocial factors in people with persistent pain: A systematic review

Madalina Saracutu, ... Darren J. Edwards, in International Journal of Osteopathic Medicine, 2018

Appendix 1

AuthorType of painInterventionDurationControl groupOutcome measuresResults
Bialowski etal., 2009LBP (N=36)
average age=32.3
Spinal manipulative
therapy (SMT)
4 manipulations 5min; QST protocol (thermal pain sensitivity)Nonspecific activity
(Stationary bicycle)
Specific activity
(Lumbar extension exercise)
Fear of Pain Questionnaire
(FPQ-III); The Tampa
Scale Kinesiophobia (TSK) Coping Strategies Questionnaire
(CSQ-R); State-Trait Anxiety Inventory (STAI); Anxiety Sensitivity Index (ASI)
Catastrophizing (r=. 67, p= 0.02) and state anxiety (r=. 62, p= 0.04) sig. associated with changes in A fiber–mediated pain sensitivity in lower extremity SMT group
Castro-Sanchez etal., 2011Fibromyalgia (N=74)Massage-myofascial
Release therapy
90min session/
Week for 20 weeks
Placebo (sham treatment)State-Trait Anxiety Inventory (STAI); Beck Depression Inventory (BDI); SF-36Int. group sig. improvement in trait anxiety (p < 0.041) vs. baseline and placebo; sig. improvements in physical function, physical role, body pain, social function
Cheung Lau etal., 2010Neck pain (N=120,
Thoracic manipulation (TM)
Infrared radiation therapy
(IRR) and educational material
8 sessions (twice/week)Infrared radiation therapy (IRR) and educational material onlySF-36TM group –sig. improvement in Physical Component Score (PCS) of SF36 (p=. 002) post-intervention and at
6-months follow-up.
Chown etal., 2008LBP
Manipulative physiotherapy
5 treatment sessions
(30min each)
Group exercise with physiotherapistEQ-5DMean EQ-5D scores increased by around 0.1 in all groups (p<0.5)
Cleland etal., 2007Neck pain
(N=60, age 18–60)
Thoracic spine thrust mobilization/manipulationSingle sessionNonthrust mobilization/manipulationFear-Avoidance Beliefs Questionnaire (FABQ)No sig. difference in side effects experienced by subjects in both groups or in FABQ
Gamber etal., 2002Fibromyalgia (N=24)G1-Osteopathic Manipulation in addition to current medication;
G2-Osteopathic Manipulation, Teaching group & current medication
23 weeksCurrent medication aloneCentre for Epidemiological Studies Depression Scale DepressionG1, G2-less bothered, less frequently depressed, less frequent losses of energy, less often restless, less often lonely
No sig. main effect on Depression
Hough etal., 2007Non-specific low back pain (N=39)Manual therapy8 treatments over
4 weeks
Active rehabilitation (progressive exercise and education programme)Linton & Hallden
(Psychosocial factors linked to development of chronic non-specific low back pain)
LH score not sig. for any variables (p=0.699 for RMQ, 0.611 for PRI, p=0.405 for VAS); None of the interaction effects were sig.
Licciardone etal., 2015LBP (N=455)Osteopathic Manipulative treatment (OMT)
Ultrasound physical therapy (UPT)
One hour/week
12 weeks
OMT with sham UPT
UPT with sham OMT
Sham OMT with sham UPT
SF-36OMT× comorbid depression
Interaction effects (p=. 02)
Patients without depression more likely to recover from chronic LBP with OMT (RR, 3.21; 95% CI, 1.59–6.50; p<. 001)
Lopez-Lopez etal., 2015Neck pain (N=48)HVLA (high velocity and low amplitude manipulation)
Posteroanterior mobilization
Single sessionSustain appophyseal natural glide (SANG)State Trait Anxiety Inventory (STAI); Beck Depression Inventory (BDI –II) Spanish version; Tampa Scale for Kinesiophobia; Pain Catastrophysing Scale (PCS)Sig. three-way treatment x anxiety x time interaction, with respect to VAS F (2, 24)=6.65, p=0.005, ηp2=0.36; High anxiety interacts with mobilization and SNAG effects
Moustafa & Diab, 2015Fibromyalgia (N=120)Multimodal program (education, exercise & CBT) and upper cervical manipulative
12-week program plus 12 sessions of cervical manipulative therapy (3/week)Multimodal program aloneBeck Anxiety Inventory (BAI)
Beck Depression Inventory (BDI)
Pain Catastrophizing Scale (PCS)
1-year follow-up, sig. differences between the experimental and control groups for all variables ( FIQ, PCS, PSQI, BAI, and BDI)
Niemistö etal., 2003LBP (N=204)Manipulative
Treatment with stabilizing
60-minute evaluation, treatment,
4 exercise sessions and education
Physician's Consultation and educational bookletHealth-related quality of life
No sig. differences between the groups in health-related quality of life or in costs
UK BEAM trial, 2004Back pain
G1-Spinal manipulation;
(Techniques representative of UK chiropractic, osteopathic & physiotherapy)
G2-Spinal Manipulation and exercise
8×60min sessions over 4–8 weeks & “refresher” class in week 12G3-Best care in General Practice and ‘’The Back Book’’Fear avoidance beliefs
Questionnaire (FABQ)
SF-36 (health status)
EuroQol (EQ-5D)
Manipulation –sig. improvement of SF-36 physical score at both 3 and 12 months; Manipulation & exercise sig. effect on fear avoidance at 3 & 12 months Mean=2.40 (1.41–3.39) p<0.001; Mean=1.24 (0.07–2.41) p<0.5
Van Dongen etal., 2015Ns neck pain (N=180)Manual therapy6 sessions
(30–60min each)
Physical therapy (standard care, active exercise)SF-36 EQ-5DNo sig. dif. between the MTU and PT group in functional status (β=−1.03; 95 %CI:−2.55–0.48), and QALYs (β=−0.01; 95 %CI:−0.04–0.03)
Voigt etal., 2011Migraine
(N=42, all female)
Osteopathic manipulative treatments (OMT)5×50-minute osteopathic manipulative treatmentsNo OMT/sham/physical therapy
Only filled in questionnaires
SF-364/8 HRQoL domains of SF-36 in the OMT group showed sig. improvement (vitality, p<0.01; mental health, p=0.05; bodily pain, p=0.05 and physical role functioning, p<0.01)
Williams etal., 2013
Neck or back pain (N=201)GP care and 3 Osteopathic Manipulation sessions3 or 4 sessions
Every week x 1–2 weeks.
GP care aloneSF-12 health status
EuroQol (EQ-5D)
Osteopathic group – sig. improvement in SF-12 mental score (95% CI 2.7–10.7) at 2 months, 6 months- improvement in osteopathy group remained sig. >for SF-12 mental score (95% CI 1.0–9.9)
Youn-Bum Sung etal., 2014LBP (N=36)Mobilization (trunk mobilization after sling Neurac exercise)
Manipulation (trunk
Manipulation after sling Neurac exercise)
Single SessionControl group (Sling Neurac exercise)Fear-avoidance beliefs questionnaire (FABQ)Sig. change in FABQ only in manipulation group (pre-test 73.6±7.3, post-test 87.9±4.2)

Anxiety Sensitivity Index - an overview (1)

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The role of music therapy in the treatment of children with cancer: A systematic review of literature

Maria Facchini, Chiara Ruini, in Complementary Therapies in Clinical Practice, 2021

3.5 Outcome measurements and results

Outcome measurements will be described incorporating the main effect of the three music-therapy interventions. Outcome measurements can be classified into four types: a) self-report (n=12 articles) [28–31,33,35–38,41,45,46], b) interviews (n=5 articles) [32,34,35,42,43], c) behavioural observation (n=6 articles) [23,27,29,41,45] and d) physiological measures (n=3 articles) [28,35,39]. The study of Robb and Ebberts [38] carried out also a qualitative analysis of the texts of the songs produced by patients.

Distress. The distress is one of the main parameter that was measured throughout the studies included in the review. 52% (n=10) of the studies focused on it. This parameter however, has several dimensions, such as anxiety, negative mood, fear, stress and related behavioural expressions of discomfort and suffering. Each study analysed one or more of them. Stress was evaluated with these measures: the Visual Analogue Scale (VAS) in one article [28,30,46] the semi-structured interview KIDCOPE [47] in one article [32], the Observational Scale of Behavioural Distress (OSBD) [48] in one article [29], the Child Health Questionnaire [49] in one article [33] and the McCorkle Symptom Distress Scale [50] in one article [36]. Anxiety was evaluated with: the VAS in one article [30], the Spielberger's State-Trait Anxiety Inventory-Child Version (STAIC) [51] in three articles [33,35,37], the Modified Yale Pre-operative Anxiety Scale (m-YPAS) in one article [27] and the Anxiety Sensitivity Index (ASI) in one article [31]. Depression was measured with: the Children's Depression Inventory (CDI) [52] in one article [37] and the Mental Health Scale of Child Health Questionnaire [49] in one article [33]. Fear was evaluated through the Faces Scale for Fear [53] in one article [29].

Among all studies, two showed a greater reduction of distress in the experimental group compared to the control group [35,37]. Other two studies [29,30] showed a reduction of distress in the comparison between the pre-test condition of standard medical procedure and the post-test evaluation after musical listening procedure. An exception is the study of Barry et al. [32] where no significant differences in the level of distress experienced between the experimental group and the control one was observed. Moreover, 4 studies showed a significant reduction of anxiety, compared to the control group in three case [27,31,37], and in the comparison between pre and post-intervention in the other one [30]. The investigations by Nguyen et al. [35] and by Burns et al. [33] do not allow conclusions on their results concerning the reduction of anxiety, because of the absence of homogeneity between the two groups in the first case, and the presence of an excessive drop-out rate in the other research.

In conclusion, music listening seems to be effective in reducing the high distress that children have to deal with during the medical procedures, whereas TMV interventions (active interventions) showed a reduction on anxiety and stress, especially at the follow-up [33,41].

Well-being. Some studies evaluated also the positive effect of MT on well-being (n=8), referring to aspects such as: positive affect facial expression, adaptive coping strategies, courageous coping, self-efficacy, meaning making, life quality, vitality and frequency of interaction and playing activities. Well-being was measured with: the Jalowiec Symptom Coping Scale [54] in two articles [33,36], the Reed Spiritual Perspective Scale [55] in two articles [33,36], the Herth Hope Index [56] in one article [36], the Haase Adolescent Resilience in Cancer Scale [57] in one article [36], the Rosenberg Self-esteem Scale [58] in one article [33], the Index of Well-being [59] in one article [33], the Perceived Social Support Scale [60] in one article [36], the Parent-Adolescent Communication Scale [61] in one article [36], the PedsQL 4.0 generic core scale and the PedsQL 3.0 cancer module [62] in one article [46] the Profile of Mood State [63] in one article [41] and the General Self-efficacy Scale in one article [31]. The main results showed a good efficacy of music-therapy interventions on well-being. In particular, Robb et al. [23] and Robb et al. [41] found a significant increase in the frequency of positive affect facial expression and active engagement in the experimental group, compared to the control one, with effect sizes ranging from 1.03 to 1.80 for positive affect, and from 1.97 to 2.41 for active engagement, in the first study, and with an effect size of 1.07 for positive affect and of 0.19 for active engagement, in the second study. Barrera et al. [45] found similar results. Robb et al. [36] showed the positive effect of MT in increasing courageous coping, social integration and a better family environment compared to the control group.

In conclusion, active and combined type of MT showed an increase of well-being as measured in participants, whereas receptive MT did not evaluate this issue.

Pain and physiological parameters. Some studies also evaluated the effect of MT on physiological parameters concerned with pain (n=5 articles) [29,33,35,45,46], heart rate variability (n=3 articles) [28,35,39], and with blood pressure, oxygen saturation and respiratory rate (n=2 articles) [35,39]. Concerning pain, 3 studies found no significant effect [29,45,46], Nguyen et al. [35] showed a significant reduction in the experimental group, and Burns et al. [33] provided inconclusive results because of drop-out rate. Relatively to the heart rate and respiratory rate, Nguyen et al. [35] and Uggla et al. [39] documented a significant effect of the MT. Conversely, Kemper et al. [28] showed that MT condition presented a lower value in the High frequency (HF) parameter compared to controls. This parameter is usually associated to the activity of the parasympathetic system, indicating subjective relaxation.

In conclusion, the effect of receptive interventions on pain perception and physiologic parameters is generally positive, but half of the investigations found no statistical significance of their results. Similarly, combined type of MT showed positive effects on physiologic parameters, like heart rate variability, blood pressure and saturation. None of the above studies reported the effect sizes of their interventions’ effects.

Finally 37% (n=7) of studies evaluated the degree of satisfaction and positivity perceived by participants, parents and medical staff. This aspect was evaluated through interviews or questionnaires, which showed a sense of satisfaction (n=2), acceptance (n=1) and a sense of positivity from the experience of MT (n=2).

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(Video) Reducing Anxiety with Interoceptive Exposure - Ted Schubert


What is the anxiety sensitivity Index? ›

The ASI (Reiss et al., 1986) is a 16-item self-report questionnaire designed to assess the construct of anxiety sensitivity: the dispositional tendency to fear the somatic and cognitive symptoms of anxiety due to a belief that these symptoms may be dangerous or harmful.

What is a high anxiety score? ›

The following guidelines are recommended for the interpretation of scores: 0–9, normal or no anxiety; 10–18, mild to moderate anxiety; 19–29, moderate to severe anxiety; and 30–63, severe anxiety.

What are normal anxiety levels? ›

Normal levels of anxiety lie on one end of a spectrum and may present as low levels of fear or apprehension, mild sensations of muscle tightness and sweating, or doubts about your ability to complete a task. Importantly, symptoms of normal anxiety do not negatively interfere with daily functioning.

What is the best anxiety questionnaire? ›

The most common measure used to assess anxiety in treatment outcome studies is the Hamilton Anxiety Scale (HAM-A),7 8 which is a primary measure for generalised anxiety disorder (GAD) and is often used to assess general anxiety symptoms across conditions.

What is the difference between anxiety and anxiety sensitivity? ›

Anxiety sensitivity was originally seen as a vulnerability factor for the development of panic disorder. It is conceptually distinct from anxiety itself and instead involves one's response to anxiety symptoms, or the 'fear of fear.

How can I reduce anxiety sensitivity? ›

Interventions that reduce anxiety sensitivity include psychoeducation, cognitive restructuring, interoceptive exposure, and situational exposure.

What are the 5 levels of anxiety? ›

What are the five major types of anxiety disorders?
  • Generalized Anxiety Disorder. ...
  • Obsessive-Compulsive Disorder (OCD) ...
  • Panic Disorder. ...
  • Post-Traumatic Stress Disorder (PTSD) ...
  • Social Phobia (or Social Anxiety Disorder)

What are the 7 anxiety disorders? ›

There are several types of anxiety disorders:
  • Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little or no reason.
  • Panic disorder. ...
  • Social anxiety disorder. ...
  • Specific phobias. ...
  • Agoraphobia. ...
  • Separation anxiety. ...
  • Selective mutism. ...
  • Medication-induced anxiety disorder.
24 Apr 2022

What is a normal GAD-7 score? ›

Most patients (89%) with GAD had GAD-7 scores of 10 or greater, whereas most patients (82%) without GAD had scores less than 10. The mean (SD) GAD-7 score was 14.4 (4.7) in the 73 patients with GAD diagnosed according to the MHP and 4.9 (4.8) in the 892 patients without GAD.

What are the 6 main anxiety disorders? ›

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.

Is anxiety considered a disability? ›

Is Anxiety Considered a Disability? Anxiety disorders, such as OCD, panic disorders, phobias or PTSD are considered a disability and can qualify for Social Security disability benefits. Those with anxiety can qualify for disability if they are able to prove their anxiety makes it impossible to work.

Can you self diagnose anxiety? ›

Only a trained mental health professional, such as a psychiatrist or psychologist, can diagnose a mental health disorder like social anxiety. While you cannot self-diagnose, you can take steps to figure out if your symptoms are the result of normal shyness or if they could be something more.

What is the Goldberg anxiety Scale? ›

The Goldberg Anxiety and Depression Scale (GADS) is an 18-item self-report symptom inventory that was developed by Goldberg and colleagues from 36 items in the Psychiatric Assessment Schedule [9]. The GADS has been used in several studies of community-dwelling older adults [10].

What is an example of anxiety sensitivity? ›

For example, someone with high anxiety sensitivity might fear the dizziness that comes with being anxious, thinking it means they're going to snap and have a mental breakdown. Another might fear the pounding heart that comes from walking into a room of strangers, thinking a heart attack is around the corner.

What causes anxiety sensitivity? ›

Stressful events may contribute to the development of anxiety sensitivity by setting in motion a process similar to rumination that involves increased self-focused attention to bodily sensations and to physical and cognitive symptoms of anxiety, as well as increased thought about the causes and consequences of those ...

Is anxiety sensitivity a personality trait? ›

Abstract. Anxiety sensitivity is associated with the onset of panic attacks, anxiety, and other common mental disorders. Anxiety sensitivity is usually seen as a relative stable trait.

Are highly sensitive people more prone to anxiety? ›

A recent study showed that people with a more sensitive "startle" reflex, that is, highly sensitive people, are more susceptible to anxiety disorders because we have different genes than others, making it harder for us to deal with emotional arousal.

How does exercise reduce anxiety? ›

How does exercise help depression and anxiety? Regular exercise may help ease depression and anxiety by: Releasing feel-good endorphins, natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can enhance your sense of well-being.

What's the longest phobia? ›

Hippopotomonstrosesquippedaliophobia is one of the longest words in the dictionary — and, in an ironic twist, is the name for a fear of long words. Sesquipedalophobia is another term for the phobia.

What is the highest level of anxiety? ›

Panic-Level Anxiety

Panic-level of anxiety is the most disruptive and challenging, as it overwhelms your capacity to function normally. You may experience an inability to move or speak, but sometimes the opposite is true. Some people take off running or find it impossible to sit or stay still.

Can anxiety get worse as you age? ›

Does anxiety get worse with age? Anxiety disorders don't necessarily get worse with age, but the number of people suffering from anxiety changes across the lifespan. Anxiety becomes more common with older age and is most common among middle-aged adults.

Is anxiety a mental health? ›

An anxiety disorder is a type of mental health condition. If you have an anxiety disorder, you may respond to certain things and situations with fear and dread. You may also experience physical signs of anxiety, such as a pounding heart and sweating.

What is false anxiety? ›

Unwanted thoughts are one of the most common examples of false anxiety. Often time we as humans tend to be cynical, thinking about worst case scenarios, 'what if' thoughts so to speak. We tend to get so caught up in our thoughts that we end up getting trapped by them.

Is anxiety genetic? ›

Most researchers conclude that anxiety is genetic but can also be influenced by environmental factors. In other words, it's possible to have anxiety without it running in your family.

What is extreme anxiety? ›

Extreme feelings of fear or anxiety that are out of proportion to the actual threat. Irrational fear or worry about different objects or situations. Avoiding the source of your fear or only enduring it with great anxiety. Withdrawing from social situations or isolating yourself from friends and family.

How do you read a GAD score? ›

Using a cut-off of 8 the GAD-7 has a sensitivity of 92% and specificity of 76% for diagnosis generalized anxiety disorder.
  1. Score 0-4: Minimal Anxiety.
  2. Score 5-9: Mild Anxiety.
  3. Score 10-14: Moderate Anxiety.
  4. Score greater than 15: Severe Anxiety.

What does a GAD score of 21 mean? ›

GAD-7 total score for the seven items ranges from 0 to 21. 0–4: minimal anxiety. 5–9: mild anxiety. 10–14: moderate anxiety. 15–21: severe anxiety.

What does a GAD-7 score of 11 mean? ›

GAD-7 Anxiety Severity

Scores represent: 0-5 mild. 6-10 moderate. 11-15 moderately severe anxiety. 15-21 severe anxiety.

Does anxiety show up in blood tests? ›

A New Test to Diagnose Anxiety

After reviewing the psychiatric history of 461 volunteers, researchers found that by checking for high levels of acetylcholinesterase (AChE), a blood protein people release when under stress, they could identify anxiety disorders 90% of the time.

How do I know if it's ADHD or anxiety? ›

The symptoms of ADHD are slightly different from those of anxiety. ADHD symptoms primarily involve issues with focus and concentration. Anxiety symptoms, on the other hand, involve issues with nervousness and fear.

How do you deal with high functioning anxiety? ›

Strategies for Coping with High-Functioning Anxiety
  1. Learn to recognize their symptoms for what they are. ...
  2. Refuse to engage their anxious thoughts. ...
  3. Act before (over)thinking. ...
  4. Embrace a healthy lifestyle. ...
  5. Find trustworthy confidantes. ...
  6. Remember that little successes add up to big changes. ...
  7. Ask for help, and accept it.

Can anxiety disorder be cured? ›

Anxiety is not curable, but there are ways to keep it from being a big problem. Getting the right treatment for your anxiety will help you dial back your out-of-control worries so that you can get on with life.

When does anxiety become a disorder? ›

Anxiety becomes a disorder when it's irrational, excessive and when it interferes with a person's ability to function in daily life. Anxiety disorders include: Generalised anxiety disorder. Social phobias – fear of social situations.

Does alcohol reduce anxiety? ›

Alcohol is a depressant. It slows down processes in your brain and central nervous system, and can initially make you feel less inhibited. In the short-term, you might feel more relaxed - but these effects wear off quickly. In fact, if you're experiencing anxiety, drinking alcohol could be making things worse.

How much disability can I get for anxiety? ›

30% VA Rating for Depression and Anxiety.

Is anxiety a chronic illness? ›

Clinical and epidemiological data suggest that generalized anxiety disorder (GAD) is a chronic illness causing patients to suffer for many years leading to significant distress in daily life functioning.

Is anxiety a Neurodiversity? ›

But the definition has since expanded to include other conditions in advocacy movements and social justice circles. “With this definition, anxiety can be considered a form of neurodivergence, although it may not be as commonly recognized as ADHD, autism, or trauma,” she says.

What does anxiety feel like in your body? ›

The autonomic nervous system produces your fight-or-flight response, which is designed to help you defend yourself or run away from danger. When you are under stress or anxious, this system kicks into action, and physical symptoms can appear — headaches, nausea, shortness of breath, shakiness, or stomach pain.

When should you seek anxiety medication? ›

7 Signs You Might Benefit from Anti-Anxiety Medication
  • You're Perpetually Nervous and on Edge. ...
  • You Avoid Things That Are Good for You. ...
  • You Toss and Turn Every Night. ...
  • You Have Mysterious Aches and Pains. ...
  • You Have a Permanent Bellyache. ...
  • You Work Hard but Get Nothing Done. ...
  • You Regularly Fly Off the Handle.

What does anxiety feel like? ›

feeling tense, nervous or unable to relax. having a sense of dread, or fearing the worst. feeling like the world is speeding up or slowing down. feeling like other people can see you're anxious and are looking at you.

What does the general health questionnaire measure? ›

GHQ-28 or 'Scaled' GHQ: Provides four scores measuring somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression.

What is Mental Health World Health Organization? ›

The World Health Organization (WHO) conceptualizes mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

What is anxiety sensitivity examples? ›

For example, someone with high anxiety sensitivity might fear the dizziness that comes with being anxious, thinking it means they're going to snap and have a mental breakdown. Another might fear the pounding heart that comes from walking into a room of strangers, thinking a heart attack is around the corner.

What causes anxiety sensitivity? ›

Stressful events may contribute to the development of anxiety sensitivity by setting in motion a process similar to rumination that involves increased self-focused attention to bodily sensations and to physical and cognitive symptoms of anxiety, as well as increased thought about the causes and consequences of those ...

How do you score panic and agoraphobia scale? ›

Scoring and Interpretation

Each item on the measure is rated on a 5-point scale (0=Never; 1=Occasionally; 2=Half of the time; 3=Most of the time, and 4=All of the time). The total score can range from 0 to 40 with higher scores indicating greater severity of agoraphobia.

What is intolerance of uncertainty scale? ›

The Intolerance of Uncertainty Scale (IUS) assesses emotional, cognitive, and behavioral reactions to ambiguous situations, implications of being uncertain, and attempts to control the future.

Is anxiety sensitivity a personality trait? ›

Abstract. Anxiety sensitivity is associated with the onset of panic attacks, anxiety, and other common mental disorders. Anxiety sensitivity is usually seen as a relative stable trait.

Are highly sensitive people more prone to anxiety? ›

A recent study showed that people with a more sensitive "startle" reflex, that is, highly sensitive people, are more susceptible to anxiety disorders because we have different genes than others, making it harder for us to deal with emotional arousal.

Can anxiety symptoms change over time? ›

Yes, it's common for anxiety symptoms to change over time, such as suddenly getting new symptoms for no apparent reason. It's also common for one symptom or set of symptoms to change to another symptom or set of symptoms. Most people with anxiety disorder notice their anxiety symptoms change and shift over time.

What life events cause anxiety? ›

Ongoing stressful events
  • work stress or job change.
  • change in living arrangements.
  • pregnancy and giving birth.
  • family and relationship problems.
  • major emotional shock following a stressful or traumatic event.
  • verbal, sexual, physical or emotional abuse or trauma.
  • death or loss of a loved one.

Can you be fear of fear itself? ›

One specific phobia is the fear of fear itself — known as phobophobia. Having phobophobia can cause you to experience some of the same symptoms that other phobias trigger. Explaining to a doctor or caregivers that you're afraid of fear can feel intimidating.

Is hypervigilance a symptom of anxiety? ›

While hypervigilance isn't a diagnosis, it is a symptom that can show up as a part of a variety of other mental health conditions. Hypervigilance is related to anxiety. When you feel particularly on guard, nervous, or worried about a situation or event, you may experience a heightened level of awareness or arousal.

Can you get disability for agoraphobia? ›

Given this situation, you may have often wondered if suffering from agoraphobia makes you eligible for disability benefits from the Social Security Administration (known as SSDI benefits). The short answer is that, yes, you can qualify for disability due to agoraphobia.

How do I prove I have agoraphobia? ›

A diagnosis of agoraphobia can usually be made if: you're anxious about being in a place or situation where escape or help may be difficult if you feel panicky or have a panic attack, such as in a crowd or on a bus. you avoid situations described above, or endure them with extreme anxiety or the help of a companion.

How is social anxiety measured? ›

The Social Phobia Inventory (SPIN) is a questionnaire developed by Dr. Jonathan Davidson at Duke University for screening and measuring generalized social anxiety disorder. The assessment scale consists of 17 items covering the spectrum of social phobia such as fear, avoidance, and physiological factors.

How do you treat uncertainty intolerance? ›

Learning to act "as if"
  1. STEP 1: Make a List of Behaviours. ...
  2. STEP 2: Rank Them According to Anxiety. ...
  3. STEP 3: Practice Tolerating Uncertainty. ...
  4. STEP 4: Write It Down! ...
  5. STEP 5: Record What Happened. ...
  6. STEP 6: Build Momentum!

What is the fear of uncertainty called? ›

The psychological term for fear of the unknown is “xenophobia.” In modern usage, the word has evolved to mean the fear of strangers or foreigners — but its original meaning is much broader. It includes anything or anyone that's unfamiliar or unknown.

What is the intolerance of uncertainty scale 12? ›

The Intolerance of Uncertainty Scale-12 (IU-12) is commonly used across the globe to measure IU, however, its' psychometric properties are yet to be evaluated in Iran with a Persian-speaking population. Therefore, the purpose of this research was to translate and validate the IU-12 among Iranian undergraduate students.


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