Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion
Open accessAbstract
Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors-anxiety sensitivity (AS) and working memory capacity (WMC)-for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.
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Anxiety sensitivity, and intolerance of distress more broadly, amplifies negative emotions and bodily sensations, increasing the urge to escape or avoid them.
“M.W. Otto and associates (2016) conceptualize anxiety sensitivity (and the intolerance of distress more generally) as a negative emotion/somatic sensation amplification factor, enhancing the need to escape/avoid negative affective or somatic experiences.”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M.W. Otto et al., 2016
Low working memory capacity is strongly associated with delay discounting, many negative health behaviors, and addictive disorders.
“Consistent with this model, low WMC is strongly linked to delay discounting and a range of negative health behaviors and addictive disorders (Bickel, Quisenberry, Moody, & Wilson, 2015; M. W. Otto et al., 2016; Sheffer et al, 2013).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Working memory capacity moderates stress effects; higher capacity may help people withstand stress and pursue adaptive goals better than lower capacity.
“Furthermore, WMC moderates the effects of stress, such that high WMC may help individuals better withstand the derailing and demotivating effects of stress, and help them apply adaptive behaviors or pursue adaptive goals relative to their low WMC counterparts (A.R. Otto, Raio, Chiang, Phelps, & Daw, 2013; M. W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Low distress tolerance predicts negative emotional or bodily sensations and also interacts with them to predict poor outcomes.
“Hence, low DT both predicts negative affective or somatic sensations and interacts with these to predict negative outcomes (Leventhal & Zvolensky, 2015; M. W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Low distress tolerance and low working memory capacity are distinct vulnerabilities for lapses in health behavior and self-control, especially when stress is high.
“M.W. Otto and associates (2016) provided a model for the way in which low DT and low WMC represent separate liabilities for health-behavior and self-control lapses, particularly under conditions of stress.”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M.W. Otto et al., 2016
What makes distress tolerance predictive is not negative affect or sensations alone but how intolerable those experiences are.
“Further, we believe the predictive power of DT (assessed by anxiety sensitivity or other indices of DT) relies on the fact that “it is not just negative affect/sensations that drives maladaptive or impulsive behavior, but the relative intolerance of these experiences” (p. 67; M. W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Anxiety sensitivity predicts many negative health behaviors, such as tobacco, alcohol, and other drug use, avoiding exercise, overeating, and other cardiac risk behaviors.
“Consistent with this accounting, anxiety sensitivity predicts engagement in a wide range of negative health behaviors, including tobacco, alcohol, and other drug use as well as exercise avoidance, overeating, and other cardiac risk behaviors (for review see Horenstein et al., 2018; M. W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Distress tolerance and working memory capacity are modifiable risk factors, and mindfulness training is at least one intervention that targets both.
“Evidence suggests that both DT and WMC are modifiable risk factors, and they appear to have at least one intervention in common – mindfulness training (M. W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M. W. Otto et al., 2016
Low distress tolerance and low working memory capacity place people at risk for negative health behaviors.
“This work is based on a comprehensive accounting of the role of low DT and WMC in placing individuals at risk for negative health behaviors, and the potential improvements in health behaviors provided by ameliorating these deficits (Bickel et al., 2015; M.W. Otto et al., 2016).”
From A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults (2020) · cites this paper as M.W. Otto et al., 2016
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“and individuals with panic disorder (Hoge et al., 2011), although there is research to suggest that higher order concepts such as neuroticism may be a stronger predictor of sleep dysfunction than AS (Calkins, Hearon, Capozzoli, & Otto, 2013).”
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Self-citationIncremental validity of anxiety sensitivity in relation to Marijuana withdrawal symptoms
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Self-citationAnxiety Sensitivity and Negative Urgency
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Response to Comment on “Poverty Impedes Cognitive Function”
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Working memory‐related brain activity is associated with outcome of lifestyle intervention
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Psychological, addictive, and health behavior implications of the COVID-19 pandemic
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How does anxiety sensitivity increase risk of chronic medical conditions?
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Positive Expectancies for E-Cigarette Use and Anxiety Sensitivity Among Adults
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Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria?
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Self-citationAnxiety sensitivity, health behaviors, and the prevention and treatment of medical illness.
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Self-citationLOGICAL FOUNDATION OF COGNITIVE BEHAVIOR THERAPY
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Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y)
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Self-citationPost-traumatic Stress Disorder and Working Memory: a Systematic Review
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Self-citationAnxiety Sensitivity and Fast-Food Ordering Habits Among Black Adults
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Self-citation
- Authors
- Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., Smits, J. A. J., & Doan, S. N.
- Affiliations
- Boston University (US)
- Albright College (US)
- Virginia Tech (US)
- The University of Texas MD Anderson Cancer Center (US)
- The University of Texas at Austin (US)
- Claremont McKenna College (US)
- Corresponding author
- Otto, Michael W.
- ORCID
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 49
- Pages
- 67-78
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2497708923
- Cited by
- 136
- References
- 175
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 12 · 2023: 9 · 2022: 13 · 2021: 16 · 2020: 18 · 2019: 19 · 2018: 21 · 2017: 7
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Scholarship - Claremont (Claremont Colleges) (submittedVersion, cc-by-nc-nd)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- anxiety sensitivity, working memory capacity, health behavior promotion, risk factors, stress, coping, dietary habits, obesity, physical activity, smoking, alcohol consumption, sleep promotion, treatment goals
- MeSH terms
- Anxiety, Health Promotion, Humans, Memory, Short-Term, Health Behavior
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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