Anxiety Sensitivity Dimensions and Generalized Anxiety Severity: The Mediating Role of Experiential Avoidance and Repetitive Negative Thinking
Objective: Generalized anxiety disorder is one of the most common anxiety disorders in the general population. Several studies suggest that anxiety sensitivity is a vulnerability factor in generalized anxiety severity. However, some other studies suggest that negative repetitive thinking and experiential avoidance as response factors can explain this relationship. Therefore, this study aimed to investigate the mediating role of experiential avoidance and negative repetitive thinking in the relationship between anxiety sensitivity and generalized anxiety severity.
Method: This was a cross-sectional and correlational study. A sample of 475 university students was selected through stratified sampling method. The participants completed Anxiety Sensitivity Inventory-3, Acceptance and Action Questionnaire-II, Perseverative Thinking Questionnaire, and Generalized Anxiety Disorder 7-item Scale. Data were analyzed by Pearson correlation, multiple regression analysis and path analysis.
Results: The results revealed a positive relationship between anxiety sensitivity, particularly cognitive anxiety sensitivity, experiential avoidance, repetitive thinking and generalized anxiety severity. In addition, findings showed that repetitive thinking, but not experiential avoidance, fully mediated the relationship between cognitive anxiety sensitivity and generalized anxiety severity. α Level was p<0.005.
Conclusion: Consistent with the trans-diagnostic hypothesis, anxiety sensitivity predicts generalized anxiety severity, but its effect is due to the generating repetitive negative thought.
Sadock BJ, Sadock VA. Synopsis of psychiatry. New York: Ninth edition; 2003.
American psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed). Washington, DC: American Psychiatric Pub; 2013.
Marcus DK, Sawaqdeh A, Kwon P. The latent structure of generalized anxiety disorder in midlife adults. Psychiatry research. 2014 Feb 28; 215: 366-71.
Naragon-Gainey K. Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological bulletin 2010; 136: 128.
Tull MT, Stipelman BA, Salters-Pedneault K, Gratz KL. An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample. Journal of Anxiety Disorders 2009; 23: 275-282.
Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour research and therapy 1986; 24: 1-8.
Mennin DS. Emotion regulation therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy 2004; 11: 17-29.
Deacon B, Abramowitz J. Anxiety sensitivity and its dimensions across the anxiety disorders. Journal of Anxiety Disorders 2006; 20: 837-857.
Taylor S, Koch WJ, McNally RJ. How does anxiety sensitivity vary across the anxiety disorders? Journal of anxiety disorders 1992; 6: 249-259.
Narimani M, Taklavi S, Abolghasemi A, Mikaili N. The Effectiveness of Applied Relaxation Training Based on Mindfulness and Cognitive-Behavioral Therapy on Anxiety Sensitivity of Women with Generalized Anxiety Disorder. 2 2015; 6: 13-22.
Floyd M, Garfield A, LaSota MT. Anxiety sensitivity and worry. Personality and Individual Differences 2005; 38: 1223-1229.
Viana AG, Rabian B. Perceived attachment: relations to anxiety sensitivity, worry, and GAD symptoms. Behaviour research and therapy 2008; 46: 737-747.
Cox BJ, Enns MW, Taylor S. The effect of rumination as a mediator of elevated anxiety sensitivity in major depression. Cognitive Therapy and research 2001; 25: 525-534.
Kashdan TB, Barrios V, Forsyth JP, Steger MF. Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour research and therapy 2006; 44: 1301-1320.
Esteve R, Ramirez-Maestre C, Lopez-Martinez AE. Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain. European journal of pain (London, England) 2012; 16: 718-726.
Roemer L, Salters K, Raffa SD, Orsillo SM. Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research 2005; 29: 71-88.
Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine 2006; 166: 1092-1097.
Naeinian MR, Shaeiri MR, Sharif M, Hadian M. To Study Reliability and Validity for A Brief Measure for Assessing Generalized Anxiety Disorder (GAD-7). Clinical Psychology & Personality 2011; 2: 41-50.
Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological assessment 2007; 19: 176.
Allan NP, Albanese BJ, Short NA, Raines AM, Schmidt NB. Support for the general and specific bifactor model factors of anxiety sensitivity. Personality and Individual Differences 2015; 74: 78-83.
Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behavior Therapy 2011; 42: 676-688.
Abasi E, Fti L, Molodi R, Zarabi H. Psychometric properties of Persian Version of Acceptance and Action Questionnaire –II. Scientific Journal Management System 2012; 3: 65-80.
Ehring T, Zetsche U, Weidacker K, Wahl K, Schönfeld S, Ehlers A. The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry 2011; 42: 225-232.
Dugas MJ, Gosselin P, Ladouceur R. Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research 2001; 25: 551-558.
Grant DM. The Influence of Post-event Rumination on Social Anxiety. City: ProQuest; 2008.
McEvoy PM, Watson H, Watkins ER, Nathan P. The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders 2013; 151: 313-320.
Wells A. Metacognitive therapy for anxiety and depression. City: Guilford press; 2011.
Berman NC, Wheaton MG, McGrath P, Abramowitz JS. Predicting anxiety: the role of experiential avoidance and anxiety sensitivity. J Anxiety Disord 2010; 24: 109-113.
Pickett SM, Lodis CS, Parkhill MR, Orcutt HK. Personality and experiential avoidance: A model of anxiety sensitivity. Personality and Individual Differences 2012; 53: 246-250.
Davidson J, Frank RI. The Transdiagnostic Road Map to Case Formulation and Treatment Planning: Practical Guidance for Clinical Decision Making. City: New Harbinger Publications; 2014.
Beck JS. Cognitive behavior therapy: Basics and beyond. City: Guilford Press; 2011.
Borkovec T, Sharpless B. Generalized Anxiety Disorder: Bringing Cognitive-Behavioral Therapy into the Valued Present. 2004.
Dugas MJ, Robichaud M. Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. City: Taylor & Francis; 2007.