Cited by 349Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCardiac Health and Mental HealthPsychosomatic Disorders and Their Treatments

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The Cardiac Anxiety Questionnaire: development and preliminary validity

Eifert, Georg H, Thompson, Risa N, Zvolensky, Michael J, Edwards, Kimberly, Frazer, Nicole L, Haddad, John W, Davig, James·2000·Behaviour Research and Therapy

DOI 10.1016/s0005-7967(99)00132-1

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Abstract

Heart-focused anxiety (HFA) is the fear of cardiac-related stimuli and sensations because of their perceived negative consequences. Although HFA is common to a wide variety of persons who experience chest pain and distress, it often is unrecognized and misdiagnosed, particularly in cardiology and emergency room patients without and with heart disease. To address these concerns, this article reports on the development and preliminary psychometric evaluation of the Cardiac Anxiety Questionnaire (CAQ) designed to measure HFA. In Study 1, 188 cardiology patients completed the CAQ. Item and factor analyses indicated a three-factor solution pertaining to heart-related fear, avoidance, and attention. Reliability analysis of the 18-item CAQ revealed good internal consistency of the total and subscale scores. In Study 2, 42 patients completed the CAQ and several other anxiety-related questionnaires to assess its convergent and divergent properties. Although preliminary validity results are promising, further psychometric study is necessary to cross-validate the CAQ, examine its test-retest reliability, and confirm the stability of the factor structure. Taken together, the CAQ appears to assess HFA, and may therefore be a useful instrument for identifying patients with elevated HFA without and with heart disease.

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Zhang, X., Zhao, Q., Wang, M., Yang, M., & Fan, X. (2022) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvac075 · Cited by 39
Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy
Sardinha, A., de Araújo, C. G. S., Soares‐Filho, G. L., & Nardi, A. E. (2011) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.10.170 · Cited by 39
Heart-Focused Anxiety and Chest Pain in Postangiography Medical Patients
Zvolensky, M. J., Eifert, G. H., Feldner, M. T., & Leen-Feldner, E. (2003) · Journal of Behavioral Medicine · doi:10.1023/a:1023456419736 · Cited by 39
“In previous studies, we have utilized this tactic successfully (e.g., Eifert et al., 2000a).”
BackgroundMethodInfluentialSelf-citation
Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy
Deppermann, S., Vennewald, N., Diemer, J., Sickinger, S., Haeussinger, F. B., Dresler, T., Notzon, S., Laeger, I., Arolt, V., Ehlis, A., et al. (2017) · NeuroImage Clinical · doi:10.1016/j.nicl.2017.09.013 · Cited by 38
“, 2005) is a self-report questionnaire with good reliability and validity, designed to assess heart focused anxiety (Eifert et al., 2000; Hoyer et al., 2005).”
BackgroundInfluential
Effects of threat context and cardiac sensitivity on fear responding to a 35% CO2 challenge: A test of the context-sensitivity panic vulnerability model
Telch, M. J., Smits, J. A. J., Brown, M., Dement, M., Powers, M. B., Lee, H., & Pai, A. V. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.03.008 · Cited by 37
“However, as noted by Eifert et al. (2000) less than 3% of college”
Background
Does rTMS Alter Neurocognitive Functioning in Patients with Panic Disorder/Agoraphobia? An fNIRS-Based Investigation of Prefrontal Activation during a Cognitive Task and Its Modulation via Sham-Controlled rTMS
Deppermann, S., Vennewald, N., Diemer, J., Sickinger, S., Haeussinger, F. B., Notzon, S., Laeger, I., Arolt, V., Ehlis, A., Zwanzger, P., et al. (2014) · BioMed Research International · doi:10.1155/2014/542526 · Cited by 36
“Anxiety was measured with the following questionnaires: Panic and Agoraphobia Scale (PAS; [43]),Hamilton Anxiety Rating Scale (HAM-A; [44]), and Cardiac Anxiety Questionnaire (CAQ; [45, 46]).”
Method
Sexual Activity and Heart Patients: A Contemporary Perspective
Stein, R., Sardinha, A., & de Araújo, C. G. S. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.10.010 · Cited by 36
Anxiety and Depression in Adults with Congenital Heart Disease: When to Suspect and How to Refer
Roseman, A., & Kovacs, A. H. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1237-2 · Cited by 35
Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept
Schmitz, C., Wedegärtner, S. M., Langheim, E., Kleinschmidt, J., & Köllner, V. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.836750 · Cited by 37
Changes in Quality of Life, Depression, General Anxiety, and Heart-Focused Anxiety After Defibrillator Implantation
Kindermann, I., Wedegärtner, S. M., Bernhard, B., Ukena, J., Lenski, D., Karbach, J., Schwantke, I., Ukena, C., & Böhm, M. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13416 · Cited by 35
“A specific pattern of anxiety is heart-focused anxiety (HFA).(10,11) It comprises the fear of cardiac-related OR IG INAL RESEARCH ART ICLE”
BackgroundMethod
Mental symptoms in patients with cardiac symptoms and normal coronary arteries
Christoph, M., Christoph, A., Dannemann, S., Poitz, D. M., Pfluecke, C., Strasser, R. H., Wunderlich, C., Köllner, V., & Ibrahim, K. S. (2014) · Open Heart · doi:10.1136/openhrt-2014-000093 · Cited by 34
“report inventory scored on a five-point Likert-type scale, anchored from 0 (never) to 4 (always).(12) The CAQ includes three subscales: A.”
Background
Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial
Norlund, F., Olsson, E. M., Burell, G., Wallin, E., & Held, C. (2015) · Trials · doi:10.1186/s13063-015-0689-y · Cited by 33
“CAQ measures fear of, avoidance of, and focus on cardiacrelated stimuli and sensations.”
Method
Cardiac Exposure History as a Determinant of Symptoms and Emergency Department Utilization in Noncardiac Chest Pain Patients
Aikens, J. E., Michael, E., Levin, T. N., Myers, T. C., Lowry, E., & McCracken, L. M. (1999) · Journal of Behavioral Medicine · doi:10.1023/a:1018745813664 · Cited by 33
Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the anxiety-CHF study
Bunz, M., Lenski, D., Wedegärtner, S., Ukena, C., Karbach, J., Böhm, M., & Kindermann, I. (2016) · Clinical Research in Cardiology · doi:10.1007/s00392-015-0909-1 · Cited by 33
“HFA is defined as ‘‘the fear of cardiac-related stimuli and sensations based upon their perceived negative consequences’’ [12], whereas ‘negative consequences’ refer to harmful cardiac incidents, i.”
BackgroundMethodInfluential
Is the Internet-administered CIDI-SF Equivalent to a Clinician-administered SCID Interview?
Carlbring, P., Forslin, P., Ljungstrand, P., Willebrand, M., Strandlund, C., Ekselius, L., & Andersson, G. (2002) · Cognitive Behaviour Therapy · doi:10.1080/165060702321138573 · Cited by 32
“In connection with the SCID-interview the following questionnaires were administered to the participants; Mobility Inventory for Agoraphobia (MI; Chambless, Caputo, Jasin, Gracely, & Williams, 1985), Anxiety Sensivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986) and Cardiac Anxiety Questionaire (CAQ; Eifert e…”
Method
Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain
Lessard, M.-J., Marchand, A., Pelland, M., Belleville, G., Vadeboncoeur, A., Chauny, J., Poitras, J., Dupuis, G., Fleet, R., Foldes-Busque, G., et al. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465811000506 · Cited by 32
“A French translation of the Cardiac Anxiety Questionnaire (CAQ; Eifert et al., 2000) was used to measure heart-focused anxiety, i.e. the fear of cardiac-related stimuli and sensations because of their perceived negative consequences.”
Method
Design, methodology and baseline characteristics of the Women's Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)
Quesada, O., AlBadri, A., Wei, J., SHUFELT, C. L., Mehta, P. K., Maughan, J., Suppogu, N. S., Aldiwani, H., Cook‐Wiens, G., Nelson, M. D., et al. (2019) · American Heart Journal · doi:10.1016/j.ahj.2019.11.017 · Cited by 32
Development and initial validation of the Exercise Sensitivity Questionnaire
Farris, S. G., Burr, E. K., Kibbey, M. M., Abrantes, A. M., & DiBello, A. M. (2020) · Mental health and physical activity · doi:10.1016/j.mhpa.2020.100346 · Cited by 33
Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: An Uncontrolled Pilot Study
Särnholm, J., Skúladóttir, H., Rück, C., Pedersen, S. S., Braunschweig, F., & Ljótsson, B. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.06.001 · Cited by 30
Feasibility and Acceptability of Mindfulness-based Cognitive Therapy Compared with Mindfulness-based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a Three-Arm Randomised Controlled Trial
Alsubaie, M., Dickens, C. M., Dunn, B. D., Gibson, A., Ukoumunne, O. C., Evans, A., Vicary, R., Gandhi, M., & Kuyken, W. (2018) · Mindfulness · doi:10.1007/s12671-018-0999-8 · Cited by 31
Anxiety Predicts Poor Perceived Health in Patients With an Implantable Defibrillator
van den Broek, K. C., Nyklíček, I., & Denollet, J. (2009) · Psychosomatics · doi:10.1016/s0033-3182(09)70841-2 · Cited by 29
Different cardiovascular risk factors and psychosocial burden in symptomatic women with and without obstructive coronary artery disease
Konst, R. E., Elias‐Smale, S. E., Lier, A., Bode, C., & Maas, A. H. E. M. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318814298 · Cited by 28
One-year follow up of cardiac anxiety after a myocardial infarction: a latent class analysis.
van Beek, M., Mingels, M., Voshaar, R. O., van Balkom, A. V., Lappenschaar, M., Pop, G., & Speckens, A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.09.004 · Cited by 27
Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention
Laferton, J. A. C., Auer, C. J., Mora, M. C. S., Moosdorf, R., & Rief, W. (2015) · Psychology Health & Medicine · doi:10.1080/13548506.2015.1051063 · Cited by 28
“…and anxiety using the hospital anxiety and depression scale (HADS) (Zigmond & Snaith, 1983); (4) cardiac anxiety using the cardiac anxiety questionnaire (Eifert et al., 2000); and (5) perceived social support using the ENRICHD Social Support Inventory (ESSI) (ENRICHED Investigators, 2000).”
Method
Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients: the Cardiac Distress Inventory
Jackson, A. C., Rogerson, M., Grande, M. R. L., Thompson, D. R., Ski, C. F., Alvarenga, M. E., Amerena, J. V., Higgins, R. O., Raciti, M., & Murphy, B. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-034946 · Cited by 27
“Examples of cardiac-specific measures include the Cardiac Depression Scale, 32 the Cardiac Event Threat Questionnaire, 33 the Cardiac Anxiety Questionnaire, 34 the MacNew Quality of Life measure, 35 the Screening Tool for Psychological Distress (STOP-D), 36 the Myocardial Infarction Dimensional Assessment Scale (MIDAS…”
Method
Strength of the genetic counselor: patient relationship is associated with extent of increased empowerment in patients with arrhythmogenic cardiomyopathy
Murray, B. A., Tichnell, C., Burch, A. E., Calkins, H. G., & James, C. A. (2021) · Journal of Genetic Counseling · doi:10.1002/jgc4.1499 · Cited by 27
Symptom Severity and Health-Related Quality of Life in Patients with Atrial Fibrillation: Findings from the Observational ARENA Study
Sadlonova, M., Senges, J., Nagel, J., Celano, C. M., Klasen-Max, C., Borggrefe, M., Akın, İ., Thomas, D., Schwarzbach, C. J., Kleeman, T., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11041140 · Cited by 27
“The probability of having EHRA class 3 or 4 rather than 1 increased with higher levels of stress related to work (OR 1.3, p = 0.026) and CAQ-2 (OR 1.2, p 0.001).”
MethodInfluential
Effectiveness of Enhanced External Counterpulsation Treatment on Symptom Burden, Medication Profile, Physical Capacity, Cardiac Anxiety, and Health-Related Quality of Life in Patients With Refractory Angina Pectoris
Wu, E., Desta, L., Broström, A., & Mårtensson, J. (2020) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000638 · Cited by 26
“The Cardiac Anxiety Questionnaire subscales score reflect fear, attention, and avoidance of activities.(35) The Seattle Angina Questionnaire, also a valid and reliable diseasespecific instrument, measures functional status and HRQoL in patients with CAD.”
BackgroundMethod
Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial
Herrmann‐Lingen, C., Albus, C., de Zwaan, M., Geiser, F., Heinemann, K., Hellmich, M., Michal, M., Sadlonova, M., Tostmann, R., Wachter, R., et al. (2020) · BMC Cardiovascular Disorders · doi:10.1186/s12872-020-01810-9 · Cited by 30
Internet-Delivered Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: Uncontrolled Pilot Trial
Särnholm, J., Skúladóttir, H., Rück, C., Klavebäck, S., Ólafsdóttir, E., Pedersen, S. S., Braunschweig, F., & Ljótsson, B. (2021) · JMIR Cardio · doi:10.2196/24524 · Cited by 25
Investigating the effect of multimedia education in combination with teach-back method on quality of life and cardiac anxiety in patients with heart failure: a randomized clinical trial
Mohammadi, F., Jahromi, M. S., Bijani, M., Karimi, S., & Dehghan, A. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02357-z · Cited by 26
Using a Flexible Virtual Environment for Treating a Storm Phobia
Botella, C., Baños, R., Guerrero, B., García‐Palacios, A., Quero, S., & Alcañíz, M. (2006) · Psychnology · Cited by 26
Psychosocial Adjustment and Quality of Life in Patients With Peripartum Cardiomyopathy
Rosman, L. A., Salmoirago-Blotcher, E., Cahill, J. M., & Sears, S. (2019) · Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000518 · Cited by 20
The associations between psychological distress and health-related quality of life in patients with non-cardiac chest pain
Mourad, G., Alwin, J., Jaarsma, T., Strömberg, A., & Johansson, P. (2020) · Health and Quality of Life Outcomes · doi:10.1186/s12955-020-01297-0 · Cited by 26
What is cardiac distress and how should we measure it?
Jackson, A. C., Murphy, B. M., Thompson, D. R., Ski, C. F., Alvarenga, M. E., Grande, M. R. L., Amerena, J. V., Higgins, R. O., & Barton, D. A. (2018) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2018.13.6.286 · Cited by 26
Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation
Achttien, R. J., Vromen, T., Staal, J. B., Peek, N. B., Spee, R. F., Niemeijer, V. M., Kemps, H., & panel, O. B. O. T. M. E. (2015) · Netherlands Heart Journal · doi:10.1007/s12471-015-0761-y · Cited by 24
Minding the Genes: a Multidisciplinary Approach towards Genetic Assessment of Cardiovascular Disease
Rhodes, A. C., Rosman, L., Cahill, J., Ingles, J., Murray, B. A., Tichnell, C., James, C. A., & Sears, S. F. (2016) · Journal of Genetic Counseling · doi:10.1007/s10897-016-0017-z · Cited by 23
“…by a preoccupation with cardiac symptoms, excessive cardiac symptom monitoring (e.g., fluctuations in heart rate and blood pressure), avoidance behaviors (e.g., avoiding physical activity due to feared increases in heart rate), and persistent cardiac-specific fear (Eifert et al. 2000).”
BackgroundInfluential
Heart-focused anxiety and health care seeking in patients with non-cardiac chest pain: A prospective study
Tremblay, M.-A., Denis, I., Turcotte, S., Fleet, R. P., Archambault, P. M., Dionne, C. E., & Foldes‐Busque, G. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.10.007 · Cited by 23
Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study
Murphy, B. M., Rogerson, M. C., Grande, M. R. L., Hesselson, S., Iismaa, S. E., Graham, R. M., & Jackson, A. C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296224 · Cited by 25

Authors: Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W., & Davig, J.
Affiliations: West Virginia University (US)
Corresponding author: Eifert, Georg H
ORCID: Eifert, Georg H
Zvolensky, Michael J
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2000-10
Volume: 38
Issue: 10
Pages: 1039-1053
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/s0005-7967(99)00132-1
OpenAlex: W2015235226
Cited by: 349
References: 44
Citations by year: 2026: 24 · 2025: 28 · 2024: 25 · 2023: 23 · 2022: 43 · 2021: 23 · 2020: 27 · 2019: 12 · 2018: 15 · 2017: 9 · 2016: 15 · 2015: 12 · 2014: 10 · 2013: 11 · 2012: 12
FWCI: 4.33
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: psychometric development, questionnaire validation, avoidance, attention, chest pain, cardiac patients, anxiety assessment, factor structure

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The Cardiac Anxiety Questionnaire: development and preliminary validity

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