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Cited by 7Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPsychological Treatments and Assessments

Anxiety Sensitivity and Experiential Avoidance: Relations with Anxiety Severity and Treatment Outcomes in Anxious Youth

Open access
Lehrbach, Kyler R., Crane, Margaret E., Olino, Thomas M., Kendall, Philip C.·2023·Cognitive Therapy and Research
DOI 10.1007/s10608-023-10408-2PMC PMC11410366
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Abstract

Purpose: Anxiety sensitivity (AS) and experiential avoidance (EA) are associated with anxiety in both adults and youths. This study examined the separate contributions of AS and EA in predicting (a) anxiety (symptom severity) and (b) differential treatment outcomes in anxious youth receiving cognitive behavioral therapy (CBT). Methods: Participants (N = 89; age 10–17 years; 37% male; 78% white) met diagnostic criteria for an anxiety disorder and received CBT (Coping Cat). AS and EA were child-report measures collected at baseline. The outcome variables were anxiety symptom severity (Multidimensional Anxiety Scale for Children; child- and parent-reported) and Independent Evaluator-rated anxiety severity (Child Global Impression-Severity) collected at baseline and posttreatment. Multilevel models (MLM) examined independent and relative contributions of AS and EA to the outcome variables as a secondary analysis. Results: Both AS and EA were associated with levels of anxiety symptom severity at pretreatment and at posttreatment, varying by reporter. Neither AS nor EA predicted differential treatment outcomes: youth at varying levels had comparably favorable outcomes. Conclusions: Findings suggest similarity in AS and EA, and that both constructs may be adequately and equally addressed in CBT. Future research could consider examining change in AS and EA and anxiety across treatment in diverse populations. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Integrity signals

Registry

Crossref · 10.1007/s10608-023-10408-2

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 14 cited sources checked · 1 supported · 0 flagged

  • Premisecitation

    Few consistent moderators of CBT treatment efficacy for anxious youth have been identified.

    “thus far, few consistent moderators of CBT treatment efficacy for anxious youth have been identified (Norris & Kendall, 2021).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Norris & Kendall, 2021 source
  • Findingown data

    There was no significant difference between the main effect of anxiety sensitivity and the main effect of experiential avoidance on child-reported anxiety symptoms (t = 3.18 vs t = 2.36; difference 0.82 not significant; linear hypothesis test not significant).

    “The difference between both t values is 0.82, meaning there was not a significant difference between the main effect of AS on child-reported anxiety symptoms and the main effect of EA on child-reported anxiety symptoms. Directly comparing the coefficients using a linear hypothesis test also showed the difference between the coefficients was not significant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    CBT produced a significant decrease in independent evaluator-rated anxiety severity (CGI-S; b = −.89, p < .001).

    “lower IE-rated anxiety severity (CGI-S; b = −.89; p <.001)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Changes from pretreatment to posttreatment are attributable to CBT rather than to passage of time, regression to the mean, or other factors.
  • Findingown data

    When controlling for experiential avoidance, higher anxiety sensitivity was associated with higher parent-reported anxiety symptoms (MASC-P; b = .60, p = .03, r = 0.23).

    “and of AS for parent-reported anxiety symptoms (MASC-P; b = .60; p = .03, r = 0.23)”
    Quote in the paperSubstantial claim
  • Findingown data

    Child- and parent-reported anxiety symptoms were correlated r = .50 in the present sample.

    “correlations found in the present study between child- and parent-reported anxiety symptoms (r = .50)”
    Quote in the paperSubstantial claim
  • May combine two claims. 10
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    Neither anxiety sensitivity nor experiential avoidance predicted different treatment responses; youths with different levels of these constructs had similar favorable outcomes.

    “Neither AS nor EA predicted differential treatment outcomes: youth at varying levels had comparably favorable outcomes.”
    • Also stated in: § Discussion · plain
      “Higher pretreatment levels of AS and EA did not significantly predict differential treatment outcomes in anxious youth receiving CBT.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The study had sufficient statistical power to detect differential treatment outcomes (interactions between anxiety sensitivity or experiential avoidance and time).

  • May combine two claims.

    Findingown data

    Both anxiety sensitivity and experiential avoidance were related to anxiety symptom severity before and after treatment, with the association depending on who reported the anxiety.

    “Both AS and EA were associated with levels of anxiety symptom severity at pretreatment and at posttreatment, varying by reporter.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In youth, only one study has examined the relationship between anxiety sensitivity and experiential avoidance in a non-clinical sample of 10-12-year-old children, finding that experiential avoidance accounted for more variance than anxiety sensitivity for children's anxiety and social anxiety symptoms.

    “In youth, only one study has examined the relationship between AS and EA in a non-clinical sample of 10–12-year-old children, finding that EA had accounted for more variance than AS with regards to children’s anxiety and social anxiety symptoms (Epkins et al., 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Epkins et al., 2016 source

  • May combine two claims.

    Interpretationown data

    Youths with more anxiety sensitivity and experiential avoidance have more anxiety but do not improve at different rates than youths with less of these constructs.

    “In other words, youth with more AS and EA have more anxiety but do not improve at rates differently than youth with less AS and EA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Anxiety sensitivity and experiential avoidance are overlapping but somewhat distinct constructs that may impact treatment outcomes.

    “Taken together, it appears that AS and EA are overlapping, but somewhat distinct constructs that may impact treatment outcomes.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Taylor, 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Hayes et al., 1996 source

  • May combine two claims.

    Premisecitation

    CBT has proven effective for most anxious youths, yet as many as 40% of those receiving treatment are still diagnosed as clinically anxious upon finishing treatment.

    “Cognitive-behavioral therapy (CBT) has proven to be effective in the treatment of the majority of anxious youth, yet as many as 40% of those receiving treatment are still diagnosed as clinically anxious upon finishing treatment (Higa-McMillan et al., 2016; James et al., 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Higa-McMillan et al., 2016 source
    • cites James et al., 2013 source

  • May combine two claims.

    Interpretationreasoning

    Within the cognitive behavioral model, CBT may reduce both negative interpretation of anxiety symptoms (anxiety sensitivity) and tendency to avoid internal experiences (experiential avoidance).

    “these results might suggest that CBT may reduce both an individual’s negative interpretation of anxiety symptoms (AS), as well as their tendency to avoid internal experiences of anxiety (EA; Beck, 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Beck, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the CASI had a Cronbach's alpha of .89.

    “In the present sample, Cronbach’s alpha was .89.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All youth completed the full treatment.

    “All youth completed the full treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the MASC had a Cronbach's alpha between .87 and .95 for parent and child versions.

    “In the present sample, Cronbach’s alpha was between .87 and .95 for parent and child version of the MASC.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the present sample, the AFQ-Y had a Cronbach's alpha of .91.

    “In the present sample, Cronbach’s alpha was .91.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Listwise deletion removed two participants who did not complete posttreatment measures, and there was no significant difference between baseline anxiety sensitivity and experiential avoidance scores for completers and non-completers.

    “Listwise deletion was used to remove two participants who did not complete posttreatment measures. There was no significant difference between the baseline scores of AS and EA for those who did and did not complete posttreatment measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Treatment was provided by graduate student therapists who received specialized training in CBT for youth anxiety and weekly supervision by a licensed psychologist.

    “Treatment was provided by graduate student therapists, who received specialized training in providing CBT for youth anxiety and weekly supervision by a licensed psychologist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Inter-rater reliability of primary anxiety disorders amongst assessors was ICC = .82-.94 based on a subset of interviews (n = 20).

    “The inter-rater reliability of primary anxiety disorders amongst assessors was (ICC = .82–.94) based on a subset of interviews (n = 20).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The ADIS-C/P has concurrent validity, inter-rater reliability (k = .92), and test-retest reliability (r between .80 and .92).

    “The ADIS-C/P has been shown to have concurrent validity, inter-rater reliability (k = .92), and test-retest reliability (r between .80 and .92) (Lyneham et al., 2007; Silverman et al., 2001; Wood et al., 2002)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Lyneham et al., 2007 source
    • cites Silverman et al., 2001 source
    • cites Wood et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The CGI-S was correlated .3 and .4 with the child and parent versions of the MASC in the present sample.

    “The CGI-S was correlated .3 and .4 with the child and parent versions of the MASC in the present sample (Pearson’s r).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Diagnosticians were deemed reliable after receiving ADIS training and providing agreeing diagnoses on three out of four consecutive ADIS assessments.

    “Diagnosticians were deemed to be reliable after receiving ADIS training and providing agreeing diagnoses on three out of four consecutive ADIS assessments.”
    Quote in the paperNot a substantial claim
17 of 17

  • The paper relies on this without support.

    Changes from pretreatment to posttreatment are attributable to CBT rather than to passage of time, regression to the mean, or other factors.

    “MLM examined the association between time (treatment) and anxiety outcomes, finding that there were significant treatment effects for lower child-reported anxiety symptoms (MASC-C; b = −16.02, p < .001)”

  • The paper relies on this without support.

    The study had sufficient statistical power to detect differential treatment outcomes (interactions between anxiety sensitivity or experiential avoidance and time).

    “Neither AS nor EA predicted differential treatment outcomes: youth at varying levels had comparably favorable outcomes.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Treatment protocol differs between the abstract and methods

    Minor

    The abstract describes all participants as receiving Coping Cat, but the methods say participants aged 13-17 received the C.A.T. Project protocol instead.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Albano, A. M., & Silverman, W. K. (2015). The anxiety Disorders interview schedule for children for DSM-5 (child and parent versions. Oxford University Press.
  2. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond, 2nd ed (pp. xix, 391). Guilford Press.
  3. Kämpfe, C. K., Gloster, A. T., Wittchen, H. U., Helbig-Lang, S., Lang, T., Gerlach, A. L., Richter, J., Alpers, G. W., Fehm, L., Kircher, T., Hamm, A. O., Ströhle, A., & Deckert, J. (2012). Experiential avoidance and anxiety sensitivity in patients with panic disorder and agoraphobia: Do both constructs measure the same? International Journal of Clinical and Health Psychology, 12(1), 5–22.

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Related

Authors
Lehrbach, K. R., Crane, M. E., Olino, T. M., & Kendall, P. C.
Affiliations
Temple University (US)
Corresponding author
Lehrbach, Kyler R.
ORCID
Venue
Cognitive Therapy and Research
Publisher
Springer Science and Business Media LLC
Published
2023-07-04
Volume
47
Issue
5
Pages
841-850
ISSN
  • 0147-5916 (ISSN-L)
  • 1573-2819
DOI
10.1007/s10608-023-10408-2
PMC
PMC11410366
OpenAlex
W4383816338
Cited by
7
References
63
Citations by year
2026: 4 · 2025: 2 · 2024: 1
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Cognitive Therapy and Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Ministerio de Economía y Competitividad
  • National Institute of Mental Health (F31MH123038, F31MH124346)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
anxiety sensitivity, experiential avoidance, anxiety symptom severity, cognitive behavioral therapy, treatment outcome predictors, parent-reported anxiety

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