Anxiety sensitivity dimensions in young individuals with at-risk-mental states

  • Andrea Pozza | andrea.pozza@unisi.it Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
  • Anna Meneghelli Programma 2000 Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca’ Granda Hospital, Milan, Italy.
  • Maria Meliante Programma 2000 Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca’ Granda Hospital, Milan, Italy.
  • Luisa Amato Programma 2000 Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca’ Granda Hospital, Milan, Italy.
  • Davide Dèttore Department of Health Sciences, University of Florence, Florence, Italy.

Abstract

Anxiety Sensitivity (AS) is a transdiagnostic risk factor involved in the development and maintenance of different psychopathological conditions including anxiety disorders and psychosis. It consists of Physical Concerns (e.g., the belief that palpitations lead to a cardiac arrest), Social Concerns (the belief that observable anxiety reactions will elicit social rejection), and Cognitive Concerns (the belief that cognitive difficulties lead to mental incapacitation). No study investigated whether specific AS dimensions are related to At-Risk Mental States (ARMS). This study compared AS dimensions between young individuals with ARMS, patients after a recently occurred First-Episode Psychosis (FEP) and matched community controls. Based on models of ARMS and previous evidence, it was hypothesized that ARMS individuals have higher physical, social and cognitive concerns than FEP patients and controls. Thirty individuals with ARMS and 30 with FEP and 30 controls recruited from the general population completed the Anxiety Sensitivity Index-3 (ASI-3) and Penn State Worry Questionnaire. ARMS and FEP individuals had higher scores than controls on ASI-3 Cognitive Concerns [F(2,87)= 11.48, p<.001]. Individuals with ARMS had higher ASI-3 Physical Concerns scores than FEP patients [F(2,87)= 5.10, p<.01] and at a marginal significance level than controls. No between-group difference was found on Social Concerns. Higher ASI-3 Physical Concerns scores [B = -.324, Wald’s χ2(1) = 8.29, p < .01] and psychiatric comorbidities [B = -2.726, Wald’s χ2(1) = 9.33, p < .01] were significantly related to ARMS than FEP. Higher ASI-3 Social Concerns scores were related to FEP, despite at a marginal significance level [B =.213, Wald’s χ2(1) = 3.79, p = .052]. Interventions for AS Cognitive/Physical Concerns could be incorporated in the treatment of ARMS. A replication of the findings is required. Future longitudinal studies should examine whether Cognitive Concerns predict development of FEP in ARMS to improve early detection and prevention strategies.

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References

Abel, K. M., Drake, R., & Goldstein, J. M. (2010). Sex differences in schizophrenia. International Review of Psychiatry, 22, 417-428. DOI: https://doi.org/10.3109/09540261.2010.515205

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073. DOI: https://doi.org/10.1037/0003-066X.57.12.1060

Barcaccia, B., Baiocco, R., Pozza, A., Pallini, S., Mancini, F., & Salvati, M. (2019). The more you judge the worse you feel. A judgemental attitude towards one's inner experience predicts depression and anxiety. Personality and Individual Differences, 138, 33-39.

Beck, K., Andreou, C., Studerus, E., Heitz, U., Ittig, S., Leanza, L., & Riecher-Rössler, A. (2019). Clinical and functional long-term outcome of patients at clinical high risk (CHR) for psychosis without transition to psychosis: A systematic review. Schizophrenia Research, 210, 39-47. DOI: https://doi.org/10.1016/j.schres.2018.12.047

Boldrini, T., Tanzilli A., Pontillo M., Chirumbolo A., Vicari S., & Lingiardi V. (2019). Comorbid personality disorders in individuals with an at-risk mental state for psychosis: A meta-analytic review. Frontiers in Psychiatry, 10, 429. DOI: https://doi.org/10.3389/fpsyt.2019.00429

Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behaviour Research and Therapy, 28, 153–158. DOI: https://doi.org/10.1016/0005-7967(90)90027-G

Cohen, J. (1998). Statistical power analysis for the behavioral sciences. New York, NY: Routledge.

Coluccia, A., Ferretti, F., Fagiolini, A., & Pozza, A. (2015). Incidenza e fattori di rischio per disturbi psicotici nelle popolazioni migranti in Europa: una meta-analisi di studi trasversali. Italian Journal of Criminology, 9, 29–39.

Cotter, J., Yung, A. R., Carney, R., & Drake, R. J. (2017). Metacognitive beliefs in the at-risk mental state: a systematic review and meta-analysis. Behaviour Research and Therapy, 90, 25-31. DOI: https://doi.org/10.1016/j.brat.2016.12.004

Escocard, M. R. P. G., Fioravanti-Bastos, A. C. M., & Landeira-Fernandez, J. (2009). Anxiety sensitivity factor structure among Brazilian patients with anxiety disorders. Journal of Psychopathology and Behavioral Assessment, 31, 246-255. DOI: https://doi.org/10.1007/s10862-008-9103-3

First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997a). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Firenze: Giunti OS.

First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997b). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC, USA: American Psychiatric Press.

Freeman, D., Stahl, D., McManus, S., Meltzer, H., Brugha, T., Wiles, N., & Bebbington, P. (2012). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry and Psychiatric Epidemiology, 47, 1195–1203. DOI: https://doi.org/10.1007/s00127-011-0433-1

Fresán, A., Leon-Ortiz, P., Robles-García, R., Azcárraga, M., Guizar, D., Reyes-Madrigal, F., & de la Fuente-Sandoval, C. (2015). Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R). Journal of Psychiatric Research, 61, 168–173. DOI: https://doi.org/10.1016/j.jpsychires.2014.12.013

Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F., ... & Valmaggia, L. (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry, 70, 107-120. DOI: https://doi.org/10.1001/jamapsychiatry.2013.269

Fusar-Poli, P., Nelson, B., Valmaggia, L., Yung, A. R., & McGuire, P. K. (2014). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin, 40, 120-131. DOI: https://doi.org/10.1093/schbul/sbs136

Gross, G. (1989). The ‘basic’ symptoms of schizophrenia. The British Journal of Psychiatry, 155, 21-25. DOI: https://doi.org/10.1192/S0007125000291423

Häfner, H., Riecher, A., Maurer, K., Meissner, S., Schmidtke, A., Fätkenheuer, B., & Löffler, W. an der Heiden W. (1990). Ein Instrument zur retrospektiven Einschätzung des Erkrankungsbeginns bei Schizophrenie (Instrument for the Retrospective Assessment of the Onset of Schizophrenia–‘‘IRAOS’’) Entwicklung und Ergebnisse. Zeitschrift für klinische Psychologie, Psychiatrie und Psychotherapie, 19, 230-255.

Hartley, S., Haddock, G., Vasconcelos, E., Sa, D., Emsley, R., & Barrowclough, C. (2014). An experience sampling study of worry and rumination in psychosis. Psychological Medicine, 44, 1605–1614. DOI: https://doi.org/10.1017/S0033291713002080

Hui, C., Morcillo, C., Russo, D. A., Stochl, J., Shelley, G. F., Painter, M., … Perez, J. (2013). Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophrenia Research, 148, 175–180. DOI: https://doi.org/10.1016/j.schres.2013.05.026

Kemper, C. J., Lutz, J., Bähr, T., Rüddel, H., & Hock, M. (2012). Construct validity of the anxiety sensitivity index–3 in clinical samples. Assessment, 19, 89-100. DOI: https://doi.org/10.1177/1073191111429389

Klosterkötter, J., Hellmich, M., Steinmeyer, E. M., & Schultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry, 58, 158-164. DOI: https://doi.org/10.1001/archpsyc.58.2.158

Luzón, O., Harrop, C., & Nolan, F. (2007). Cognitive Processes during Acute Psychosis: The Role of Heightened Responsibility and Catastrophic Misinterpretations. Behavioural and Cognitive Psychotherapy, 37, 357-377.

Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Donati, D., Namia, C., Novella, L., & Petrachi, M. (1997). Interrater reliability and internal consistency of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), version 2.0. Journal of Personality Disorders, 11, 279–284. DOI: https://doi.org/10.1521/pedi.1997.11.3.279

Masillo, A., Day, F., Laing, J., Howes, O., Fusar-Poli, P., Byrne, M., ... & Valmaggia, L. R. (2012). Interpersonal sensitivity in the at-risk mental state for psychosis. Psychological Medicine, 42, 1835-1845. DOI: https://doi.org/10.1017/S0033291711002996

Masillo, A., Valmaggia, L. R., Saba, R., Brandizzi, M., Lindau, J. F., Solfanelli, A., ... & Di Pietro, D. (2016). Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis. European Child & Adolescent Psychiatry, 25, 7-16. DOI: https://doi.org/10.1007/s00787-015-0692-6

Mazzi, F., Morosini, P., De Girolamo, G., Lussetti, M., & Guaraldi, G. P. (2000). SCID-I– Structured Clinical Interview for DSM-IV Axis I Disorders (Italian edition). Firenze: Giunti OS.

Meneghelli, A., Alpi, A., Cascio, M. T., Häfner, H., Maurer, K., Preti, A., Raballo, A., & Cocchi, A. (2014). Italian validation of the “Early Recognition Inventory for the retrospective assessment of the Onset of Schizophrenia Checklist”: reliability, validity and instructions for use. Journal of Psychopathology, 20, 186-198.

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495. DOI: https://doi.org/10.1016/0005-7967(90)90135-6

Mian, L., Lattanzi, G. M., & Tognin, S. (2018). Coping strategies in individuals at ultra‐high risk of psychosis: A systematic review. Early Intervention in Psychiatry, 12, 525-534. DOI: https://doi.org/10.1111/eip.12492

Modai, I., & Cygielman, G. (1986). Conversion Hallucinations–A Possible Mental Mechanism. Psychopathology, 19, 324-326. DOI: https://doi.org/10.1159/000284456

Morani, S., Pricci, D., & Sanavio, E. (1999). Penn State Worry Questionnaire e Worry Domains Questionnaire. Presentazione delle versioni italiane ed analisi della fedeltà. Psicoterapia Cognitiva e Comportamentale, 5, 13–34.

Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136, 128-150. DOI: https://doi.org/10.1037/a0018055

Norr, A. M., Albanese, B. J., Allan, N. P., & Schmidt, N. B. (2015). Anxiety sensitivity as a mechanism for gender discrepancies in anxiety and mood symptoms. Journal of Psychiatric Research, 62, 101-107. DOI: https://doi.org/10.1016/j.jpsychires.2015.01.014

Olejnik S, Algina J. (2003). Generalized eta and omega squared statistics: measures of effect size for some common research designs. Psychological Methods, 8, 434-447. DOI: https://doi.org/10.1037/1082-989X.8.4.434

Olthuis, J. V., Watt, M. C., & Stewart, S. H. (2014). Anxiety Sensitivity Index (ASI-3) subscales predict unique variance in anxiety and depressive symptoms. Journal of Anxiety Disorders, 28, 115-124. DOI: https://doi.org/10.1016/j.janxdis.2013.04.009

Pozza, A. (2019). The role of aberrant salience and alexithymia in psychotic experiences of non-treatment-seeking adolescent immigrants compared with natives. Neuropsychiatric Disease and Treatment, 15, 2057. DOI: https://doi.org/10.2147/NDT.S213393

Pozza, A., Coluccia, A., Kato, T., Gaetani, M., & Ferretti, F. (2019). The ‘Hikikomori’ syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and meta-analysis protocol. BMJ Open, 9, e025213. DOI: https://doi.org/10.1136/bmjopen-2018-025213

Pozza, A., Coradeschi, D., & Dèttore, D. (2013). Do dysfunctional beliefs moderate the negative influence of comorbid severe depression on outcome of residential treatment for refractory OCD? A pilot study. Clinical Neuropsychiatry, 10, 72-83.

Pozza, A., & Dèttore, D. (2015). Psychometric Evidence of the Italian Anxiety Sensitivity Index-3 (ASI-3) in Patients with Anxiety Disorders and Psychosis. Research in Psychology and Behavioral Sciences, 3, 7-17. DOI: https://doi.org/10.12691/rpbs-3-1-3

Pozza, A., & Dèttore, D. (2017). The CBQ-p: a confirmatory study on factor structure and convergent validity with psychotic like experiences and cognitions in adolescents and young adults. BPA-Applied Psychology Bulletin, 65, 58–69.

Pozza, A., & Dèttore, D. (2019). Modular cognitive‐behavioral therapy for affective symptoms in young individuals at ultra‐high risk of first episode of psychosis: Randomized controlled trial. Journal of Clinical Psychology, 1-14. Doi:10.1002/jclp.22901 DOI: https://doi.org/10.1002/jclp.22901

Pozza, A., Domenichetti, S., & Dèttore, D. (2019). Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation. The Cognitive Behaviour Therapist, 12, e36. DOI: https://doi.org/10.1017/S1754470X19000229

Rausch, F., Eifler, S., Esser, A., Esslinger, C., Schirmbeck, F., Meyer-Lindenberg, A., & Zink, M. (2013). The Early Recognition Inventory ERIraos detects at risk mental states of psychosis with high sensitivity. Comprehensive Psychiatry, 54, 1068-1076. DOI: https://doi.org/10.1016/j.comppsych.2013.04.016

Reiss, S., McNally, R. J. (1985). Expectancy model of fear. In S. Reiss & R.R. Botzin (Eds.), Theoretical issues in behavior therapy (pp. 107-121). San Diego, CA: Academic Press, 1985.

Rietdijk, J., Ising, H. K., Dragt, S., Klaassen, R., Nieman, D., Wunderink, L., ... & van der Gaag, M. (2013). Depression and social anxiety in help-seeking patients with an ultra-high risk for developing psychosis. Psychiatry Research, 209, 309-313. DOI: https://doi.org/10.1016/j.psychres.2013.01.012

Rietschel, L., Lambert, M., Karow, A., Zink, M., Müller, H., Heinz, A., ... & Naber, D. (2017). Clinical high risk for psychosis: gender differences in symptoms and social functioning. Early Intervention in Psychiatry, 11, 306-313. DOI: https://doi.org/10.1111/eip.12240

Schmidt, N. B., Eggleston, A. M., Woolaway-Bickel, K., Fitzpatrick, K. K., Vasey, M. W., & Richey, J. A. (2007). Anxiety Sensitivity Amelioration Training (ASAT): A longitudinal primary prevention program targeting cognitive vulnerability. Journal of Anxiety Disorders, 21, 302-319. DOI: https://doi.org/10.1016/j.janxdis.2006.06.002

Schultze-Lutter, F. (2009). Subjective symptoms of schizophrenia in research and the clinic: the basic symptom concept. Schizophrenia Bulletin, 35, 5-8. DOI: https://doi.org/10.1093/schbul/sbn139

Schultze-Lutter, F., Ruhrmann, S., Berning, J., Maier, W., & Klosterkötter, J. (2008). Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophrenia Bulletin, 36, 182-191. DOI: https://doi.org/10.1093/schbul/sbn072

Smits, J. A., Berry, A. C., Tart, C. D., & Powers, M. B. (2008). The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: A meta-analytic review. Behaviour Research and Therapy, 46, 1047-1054. DOI: https://doi.org/10.1016/j.brat.2008.06.010

Startup, H., Freeman, D., & Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523-537. DOI: https://doi.org/10.1016/j.brat.2006.04.006

Taylor, S. E. (1999). Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. Lawrence Erlbaum Associates Publishers: Mahwah, NJ.

Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., ... & Coles, M. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176-188. DOI: https://doi.org/10.1037/1040-3590.19.2.176

Van der Gaag, M., Nieman, D., Van den Berg, D. (2013). CBT for Those at Risk of a First Episode Psychosis: Evidence-based Psychotherapy for People with an “at Risk Mental State”. New York, NY: Routledge. DOI: https://doi.org/10.4324/9780203503478

Yung, A. R., & McGorry, P. D. (1996). The initial prodrome in psychosis: descriptive and qualitative aspects. Australian and New Zealand Journal of Psychiatry, 30, 587-599. DOI: https://doi.org/10.3109/00048679609062654

Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., ... & Godfrey, K. (2005). Mapping the onset of psychosis: the comprehensive assessment of at‐risk mental states. Australian and New Zealand Journal of Psychiatry, 39, 964-971. DOI: https://doi.org/10.1080/j.1440-1614.2005.01714.x

Wheaton, M. G., Deacon, B. J., McGrath, P. B., Berman, N. C., & Abramowitz, J. S. (2012). Dimensions of anxiety sensitivity in the anxiety disorders: Evaluation of the ASI-3. Journal of Anxiety Disorders, 26, 401-408. DOI: https://doi.org/10.1016/j.janxdis.2012.01.002

Published
2020-05-20
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Special Section: Clinical high risk for mental illness
Keywords:
At-risk mental states, psychosis, anxiety sensitivity, cognitive bias, ultra-high risk of psychosis
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How to Cite
Pozza, A., Meneghelli, A., Meliante, M., Amato, L., & Dèttore, D. (2020). Anxiety sensitivity dimensions in young individuals with at-risk-mental states. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1). https://doi.org/10.4081/ripppo.2020.431