Refinement of a brief anxiety sensitivity reduction intervention.

Anxiety disorders are a highly prevalent and disabling form of psychopathology (Greenberg, et al., 1999; Kessler, et al., 2005). While there are many well-established cognitive behavioral treatments for anxiety (Chambless & Ollendick, 2001); research focused on the amelioration of anxiety risk and maintenance factors remains in a nascent stage (Feldner, Zvolensky, & Schmidt, 2004). Research has consistently linked anxiety sensitivity (AS), a fear of anxiety-related symptoms, to the development and maintenance of anxiety problems. Individuals with preexisting anxiety and mood disorders report higher levels of AS than the general population (Olatunji & Wolitzky-Taylor, 2009). Prospective studies indicate that elevated AS predicts future occurrences of anxiety symptoms, panic attacks and anxiety disorders (Schmidt, Lerew, & Jackson, 1997; Schmidt, Zvolensky, & Maner, 2006). Within treatment investigations, AS has been shown to mediate symptom reduction in panic (Olatunji & Wolitzky-Taylor, 2009) and predict symptom reduction in PTSD (Fedoroff, Taylor, Asmundson, & Koch, 2000). A review of the relationship between AS and pain indicates that AS is associated with a number of pain-related outcomes including disability (Ocanez, McHugh, & Otto, 2010). Among daily smokers, AS predicts a decrease in perceived health and impairments in mental health and social functioning (McLeish, Zvolensky, Smits, Bonn-Miller, & Gregor, 2007). To reduce the public health burden associated with anxiety psychopathology, several studies have focused specifically on the amelioration of AS. Gardenswartz and Craske (2001) compared a 1-day CBT-based workshop to a waitlist. Group differences were not reported in the reduction of AS but those in the workshop were less likely to develop panic disorder during follow-up. Schmidt et al. (2007) compared ASAT (Anxiety Sensitivity Amelioration Training) to a health and nutrition based control condition. The ASAT condition produced a significantly larger reduction in AS than the control condition (30% vs. 17%, respectively). While the two-year follow-up was limited by sample attrition, findings demonstrated that those in the ASAT condition had a lower incidence of Axis I diagnoses. Broman-Fulks and Storey (2008) evaluated the effect of an exercise regimen on AS amelioration. Those in the exercise condition reported a significant decrease in AS (38%), whereas the control group showed no reduction (4% increase). Feldner and colleagues’ (2008) investigation targeted AS and smoking. The AS-smoking group experienced a greater AS reduction than the control group (34% vs. 22% respectively). Interoceptive exposure (IE) is thought to be an essential component of AS reduction and involves repeated exposure to feared bodily sensations with the aim of habituating to the fear of those sensations (Schmidt & Trakowski, 2004). While each of the previously mentioned AS amelioration investigations incorporated IE, there were a number of limitations in its utilization. Specifically, IE was not tailored to the participant and while some encouraged home practice, none assessed whether IE was completed independently. Therefore, the potency of IE may not have been fully maximized. Additionally, none of these investigations assessed the effect of current psychiatric status on AS amelioration. It stands to reason that those with an Axis I diagnosis would be less responsive to AS-focused interventions. The current study extends this literature by focusing on an AS reduction paradigm that has increased potency in reducing this established risk factor. To this end, the current study refined the ASAT intervention and utilized a similar one-treatment session two-condition design among a sample of individuals with elevated AS. The intervention was modified to include in-session practice and homework (HW) of IE exercises tailored to the AS fears of each participant. It was anticipated that the treatment group would show a greater reduction in AS than the control group and that those gains would be maintained at the six month follow-up. Second, it was expected that current psychopathology would result in a diminished treatment response. Third, we hypothesized that greater HW adherence would result in larger AS reduction among the intervention group.