Cited by 485Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychosomatic Disorders and Their TreatmentsChild and Adolescent Psychosocial and Emotional Development

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Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology

Schmidt, Norman B., Zvolensky, Michael J., Maner, Jon K.·2006·Journal of Psychiatric Research

DOI 10.1016/j.jpsychires.2006.07.009

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Abstract

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N=404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: 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.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.

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BackgroundSelf-citation
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The Role of Anxiety Sensitivity in terms of Asthma Control: A Pilot Test among Young Adult Asthmatics
McLeish, A. C., Zvolensky, M. J., & Luberto, C. M. (2010) · Journal of Health Psychology · doi:10.1177/1359105310382584 · Cited by 75
Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative
Hamm, A. O., Richter, J., Pané‐Farré, C. A., Westphal, D., Wïttchen, H., Voßbeck-Elsebusch, A. N., Gerlach, A. L., Gloster, A. T., Ströhle, A., Lang�, T., et al. (2016) · Psychophysiology · doi:10.1111/psyp.12553 · Cited by 72
Cognitive vulnerability to anxiety in the stress generation process: Interaction between the Looming Cognitive Style and Anxiety Sensitivity
Riskind, J. H., Black, D., & Shahar, G. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.09.007 · Cited by 73
The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: Mediation through affect tolerances
Norr, A. M., Allan, N. P., Macatee, R. J., Keough, M. E., & Schmidt, N. B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.011 · Cited by 72
Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation.
Johnson, K. A., Stewart, S. H., Rosenfield, D., Steeves, D., & Zvolensky, M. J. (2011) · Psychology of Addictive Behaviors · doi:10.1037/a0024133 · Cited by 72
Anxiety sensitivity and marijuana use: an analysis from ecological momentary assessment
Buckner, J. D., Zvolensky, M. J., Smits, J. A. J., Norton, P. J., Crosby, R. D., Wonderlich, S. A., & Schmidt, N. B. (2011) · Depression and Anxiety · doi:10.1002/da.20816 · Cited by 77
“[4] Although not all individuals with elevated AS experience anxiety disorders (and not all individuals with anxiety disorders experience elevated AS),[5] AS is elevated in anxiety conditions, such as panic psychopathology and social anxiety disorder, and prospectively predicts the future development of these problems…”
Background
Serotonin transporter gene and childhood trauma - a G × E effect on anxiety sensitivity
Klauke, B., Deckert, J., Reif, A., Pauli, P., Zwanzger, P., Baumann, C. R., Arolt, V., Glöckner-Rist, A., & Domschke, K. (2011) · Depression and Anxiety · doi:10.1002/da.20840 · Cited by 75
“[7–9] The most frequently used measure of AS is the Anxiety Sensitivity Index (ASI).”
Method
Is anxiety sensitivity a predictor of PTSD in children and adolescents?
Kılıç, E. Z., Kılıç, C., & Yılmaz, S. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.02.013 · Cited by 71
“Additional evidence exists that demonstrating AS is not merely a reflection of trait anxiety, but it is shown to be related to disorders other than anxiety, namely somatoform disorders and substance use disorders [11–13].”
Background
Trends in Psychiatry and Psychotherapy
(2020) · Trends in Psychiatry and Psychotherapy · doi:10.47626/2237-6089 · Cited by 70
The interaction of early life experiences with COMT val158met affects anxiety sensitivity
Baumann, C. R., Klauke, B., Weber, H., Domschke, K., Zwanzger, P., Pauli, P., Deckert, J., & Reif, A. (2013) · Genes Brain & Behavior · doi:10.1111/gbb.12090 · Cited by 74
A Bifactor Model of Anxiety Sensitivity: Analysis of the Anxiety Sensitivity Index-3
Ebesutani, C. K., McLeish, A. C., Luberto, C. M., Young, J. N., & Maack, D. J. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9400-3 · Cited by 72
Prediction of “fear” acquisition in healthy control participants in a de novo fear-conditioning paradigm
Otto, M. W., Leyro, T. M., Christian, K., Deveney, C. M., Reese, H., Pollack, M. H., & Orr, S. P. (2007) · Behavior Modification · doi:10.1177/0145445506295054 · Cited by 66
Neuropeptide S receptor gene (NPSR) and life events: G × E effects on anxiety sensitivity and its subdimensions
Klauke, B., Deckert, J., Zwanzger, P., Baumann, C. R., Arolt, V., Pauli, P., Reif, A., & Domschke, K. (2012) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2011.646302 · Cited by 67
“AS refl ects fear of anxiety symptoms (Reiss et al. 1986) and is suggested as a predictor of anxiety disorders, especially panic disorder (Schmidt et al. 1997, 1999; Schmidt et al. 2006).”
Background
Dimensional, categorical, or dimensional-categories: testing the latent structure of anxiety sensitivity among adults using factor-mixture modeling.
Bernstein, A., Stickle, T. R., Zvolensky, M. J., Taylor, S., Abramowitz, J., & Stewart, S. (2010) · The Behavior Therapist · doi:10.1016/j.beth.2010.02.003 · Cited by 67
Anhedonia and Anxiety Sensitivity: Prospective Relationships to Nicotine Withdrawal Symptoms During Smoking Cessation
Langdon, K. J., Leventhal, A. M., Stewart, S. H., Rosenfield, D., Steeves, D., & Zvolensky, M. J. (2013) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2013.74.469 · Cited by 66
“Past non-smoking-oriented work has demonstrated that anxiety sensitivity is related to depressive symptoms and disorders (Cox et al., 1999; Otto et al., 1995; Schmidt et al., 2006).”
Background
Suicidality and Anxiety Sensitivity in Adults with HIV
Capron, D. W., Gonzalez, A., Parent, J. M., Zvolensky, M. J., & Schmidt, N. B. (2012) · AIDS Patient Care and STDs · doi:10.1089/apc.2011.0429 · Cited by 66
Anxiety Sensitivity Prospectively Predicts Posttraumatic Stress Symptoms Following a Campus Shooting
Boffa, J. W., Norr, A. M., Raines, A. M., Albanese, B. J., Short, N. A., & Schmidt, N. B. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.02.006 · Cited by 66
Altered top-down and bottom-up processing of fear conditioning in panic disorder with agoraphobia
Lueken, U., Straube, B., Reinhardt, I., Maslowski, N. I., Wïttchen, H., Ströhle, A., Wittmann, A., Pfleiderer, B., Konrad, C., Ewert, A., et al. (2013) · Psychological Medicine · doi:10.1017/s0033291713000792 · Cited by 69
“A positive association with anxiety sensitivity, which has been suggested as a subclinical trait marker of PD (Schmidt et al. 2006; Bernstein et al. 2009), was expected.”
Background
A Variable-Centered and Person-Centered Evaluation of Emotion Regulation and Distress Tolerance: Links to Emotional and Behavioral Concerns
Van Eck, K., Warren, P., & Flory, K. (2017) · Journal of Youth and Adolescence · doi:10.1007/s10964-016-0542-y · Cited by 63
“The anticipation of experiencing distress and difficulty tolerating it has been associated with anxiety symptoms (Schmidt et al. 2006; Wolitzky-Taylor et al. 2015).”
Background
Reduction of cognitive concerns of anxiety sensitivity is uniquely associated with reduction of PTSD and depressive symptoms: A comparison of civilians and veterans
Mitchell, M. A., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.10.013 · Cited by 63
“Additionally, elevated AS prospectively predicts anxiety symptoms and syndromes and changes in depressive symptoms (Schmidt et al, 1997, 2006, 1999).”
Background
The Interactive Effects of Anxiety Sensitivity and Emotion Dysregulation in Predicting Anxiety-related Cognitive and Affective Symptoms
Vujanovic, A. A., Zvolensky, M. J., & Bernstein, A. (2007) · Cognitive Therapy and Research · doi:10.1007/s10608-007-9148-8 · Cited by 69
“Finally, although AS, an established risk factor for anxiety problems ( Schmidt et al., 2006 ), was conceptualized a priori as a cognitive factor ideally suited to the examination of singular and interactive associations with emotion dysregulation, it is only one of many risk factors for panic problems.”
BackgroundInfluential
An examination of the relationship between misophonia, anxiety sensitivity, and obsessive-compulsive symptoms
Cusack, S. E., Cash, T. V., & Vrana, S. R. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.06.004 · Cited by 63
Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: A comparison of three models
Mitchell, M. A., Riccardi, C. J., Keough, M. E., Timpano, K. R., & Schmidt, N. B. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.12.003 · Cited by 62
Self-citation
Direct and indirect predictors of social anxiety: The role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self-consciousness
Panayiotou, G., Karekla, M., & Panayiotou, M. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.08.045 · Cited by 61
Ataque de nervios: relationship to anxiety sensitivity and dissociation predisposition
Hinton, D. E., Chong, R., Pollack, M. H., Barlow, D. H., & McNally, R. J. (2007) · Depression and Anxiety · doi:10.1002/da.20309 · Cited by 61
“Elevated scores on the ASI predict increased risk for spontaneous panic attacks [Schmidt et al., 1997], panic and other anxiety disorders [Schmidt et al., 2006], and anxious response to symptom-provocation procedures such as hyperventilation or carbon dioxide inhalation [McNally, 2002; McNally and…”
Background
Anxiety sensitivity and CO2 challenge reactivity as unique and interactive prospective predictors of anxiety pathology
Schmidt, N. B., & Zvolensky, M. J. (2007) · Depression and Anxiety · doi:10.1002/da.20267 · Cited by 67
“Prior work suggests that both challenge reactivity and AS are related to the development of panic attacks, and that AS is related to anxiety disorder diagnoses [Schmidt et al., 2006].”
Examination of Anxiety Sensitivity and Distress Tolerance as Transdiagnostic Mechanisms Linking Multiple Anxiety Pathologies to Alcohol Use Problems in Adolescents
Wolitzky-Taylor, K. B., Guillot, C. R., Pang, R. D., Kirkpatrick, M. G., Zvolensky, M. J., Buckner, J. D., & Leventhal, A. M. (2015) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12638 · Cited by 59
“AS plays a key role in the etiology and maintenance of many forms of anxiety psychopathology (Olatunji and Wolitzky-Taylor, 2009; Schmidt et al., 2006).”
Background
The effects of exercise on transdiagnostic treatment targets: A meta-analytic review
Jacquart, J., Dutcher, C. D., Freeman, S. Z., Stein, A. T., Dinh, M., Carl, E., & Smits, J. A. J. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.11.007 · Cited by 56
Panic Attack History and Anxiety Sensitivity in Relation to Cognitive-Based Smoking Processes Among Treatment-Seeking Daily Smokers
Johnson, K. A., Farris, S. G., Schmidt, N. B., Smits, J. A. J., & Zvolensky, M. J. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr332 · Cited by 57
Anxiety sensitivity: selective review of promising research and future directions
Bernstein, A., & Zvolensky, M. J. (2007) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.7.2.97 · Cited by 56
Self-citation
Don't panic: interpretation bias is predictive of new onsets of panic disorder.
Woud, M., Zhang, X.-C., Becker, E., McNally, R., & Margraf, J. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.11.008 · Cited by 51
“Moreover, although Schmidt et al. (2006) found that anxiety sensitivity predicted new onsets of Axis I disorders in general, they did not find that it specifically increased risk for new onsets of panic disorder per se.”
Background
The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters
Paulus, D. J., Gallagher, M. W., Bartlett, B. A., Tran, J., & Vujanovic, A. A. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.03.012 · Cited by 55
Psychosocial predictors of the onset of anxiety disorders in women: Results from a prospective 3-year longitudinal study
Calkins, A. W., Otto, M. W., Cohen, L. S., Soares, C. N., Vitonis, A. F., Hearon, B. A., & Harlow, B. L. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.022 · Cited by 55
“For example, Schmidt et al. (2006) found anxiety sensitivity to predict the incidence of anxiety disorder diagnoses (social anxiety disorder, panic disorder, generalized anxiety disorder, and specific phobias).”
A Single Bout of Aerobic Exercise Reduces Anxiety Sensitivity But Not Intolerance of Uncertainty or Distress Tolerance: A Randomized Controlled Trial
LeBouthillier, D. M., & Asmundson, G. J. G. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1028094 · Cited by 57
Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder
Blakey, S. M., Abramowitz, J. S., Reuman, L., Leonard, R. C., & Riemann, B. C. (2017) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2017.05.003 · Cited by 55
The genetics of panic disorder
Schumacher, J., Kristensen, A. S., Wendland, J. R., Nöthen, M. M., Mors, O. N., & McMahon, F. J. (2011) · Journal of Medical Genetics · doi:10.1136/jmg.2010.086876 · Cited by 54

Authors: Schmidt, N. B., Zvolensky, M. J., & Maner, J. K.
Affiliations: Florida State University (US)
University of Vermont (US)
Corresponding author: Schmidt, Norman B.
ORCID: Schmidt, Norman B.
Zvolensky, Michael J.
Maner, Jon K.
Venue: Journal of Psychiatric Research
Publisher: Elsevier BV
Published: 2006-12
Volume: 40
Issue: 8
Pages: 691-699
ISSN: 0022-3956 (ISSN-L)
DOI: 10.1016/j.jpsychires.2006.07.009
OpenAlex: W2061810459
Cited by: 485
References: 68
Citations by year: 2026: 7 · 2025: 8 · 2024: 13 · 2023: 13 · 2022: 16 · 2021: 22 · 2020: 17 · 2019: 15 · 2018: 35 · 2017: 28 · 2016: 32 · 2015: 41 · 2014: 40 · 2013: 32 · 2012: 36
FWCI: 35.74
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychiatric Research (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r21da016227-02, 5r01da018734-03, 1r03mh072848-01a1)
National Institute of Mental Health (MH62056, MH72848, R21MH062056)
National Institute on Drug Abuse (1R21 DA 016227-01, 1R01 DA 018734-01A1)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: anxiety sensitivity, panic attacks, anxiety disorders, Axis I diagnoses, premorbid risk factors, vulnerability factors, trait anxiety, Anxiety Sensitivity Index, young adults, prospective prediction
MeSH terms: Adult, Anxiety, Female, Humans, Interview, Psychological, Male, Predictive Value of Tests, Prospective Studies, Risk Factors, Sensitivity and Specificity, Incidence, Panic Disorder

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Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology

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