anxiety sensitivity and worry

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Personality and Individual Differences 38 (2005) 1223–1229

Anxiety sensitivity and worry

Mark Floyd *, Amber Garfield, Marcus T. LaSota

Psychology Department, University of Nevada, Box 455030, Las Vegas, NV 89154-5030, United States

Received 10 November 2003; received in revised form 17 May 2004; accepted 4 August 2004

Available online 5 November 2004

Abstract

Anxiety sensitivity (AS), the fear of one�s response to anxiety provoking stimuli, has been correlated with

anxiety disorders and has been theorized to be a risk factor in the development of anxiety disorders. Con-

sistent with prior research (Dugas, Gosselin, & Ladouceur, 2001) it was hypothesized that AS and varying

levels of worry share an underlying feature of anxiety specifically related to a perceived lack of control over

future events, with a resultant emphasis on negative potential outcomes. In this study, the association

between AS, overall distress, pathological worry, and non-pathological worry was investigated in a sample

of 342 undergraduate volunteers. Results indicated that AS was significantly correlated with the Penn StateWorry Questionnaire, the Worry Domain Questionnaire, and the Symptom Checklist 90-Revised. AS was a

significant predictor of worry, even after factoring out overall distress, although the incremental amount of

explained variance was small. Thus, AS and worry have more in common than distress. We speculate that

the common element is a tendency to focus on the uncertainty of the future.

� 2004 Elsevier Ltd. All rights reserved.

Keywords: Anxiety sensitivity; Worry; Anxiety; Fear; Distress

1. Introduction

Over the past two decades, the concept of a sensitivity to become fearful of the sensationsassociated with anxiety (i.e., anxiety sensitivity; Reiss & McNally, 1985) has garnered a great

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* Corresponding author. Tel.: +1 702 895 0109.

E-mail address: [email protected] (M. Floyd).

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1224 M. Floyd et al. / Personality and Individual Differences 38 (2005) 1223–1229

deal of research support as a common factor among persons experiencing anxiety disorders andrelated conditions. Based on the expectancy model of fear (Reiss, 1991; Reiss & McNally, 1985),anxiety sensitivity (AS) is regarded as a unique characteristic of the individual that serves as a‘‘predisposing factor in the development of anxiety-mediated disorders’’ (Reiss & McNally,1985, p. 119). Reiss & McNally�s expectancy model considering ‘‘fear behavior’’ is comprisedof two components: an expectancy that danger will occur (danger expectancy), which leads toavoidance behaviors, and a preemptive ‘‘fear of fear’’ that is comprised of both the expectationthat anxiety will occur following exposure to an anxiety-provoking stimulus (anxiety expectancy)and the belief that the experience of anxiety will bring about feelings of illness, embarrassment,or possibly further anxiety symptoms (anxiety sensitivity). Thus, AS relates strictly towards thepredisposed tendency to fear one�s reactions to an anxiety invoking stimulus and not the stim-ulus per se.

Reiss and Havercamp (1996) posed an argument that, likely due to genetic and predisposi-tional factors, some individuals are especially susceptible (i.e., those with high degrees of AS)to experience anxious symptoms as particularly unpleasant. Persons with high levels of AS willtend to worry that if forced to encounter an anxiety-inducing stressor, something unpredictableand harmful will occur (Reiss & McNally, 1985; Taylor, Koch, McNally, & Crockett, 1992b).To this extent, persons with high AS levels are likely to be highly alert to signals portending anx-iety and to have exaggerated anxiety reactions (Reiss & McNally, 1985) when faced with suchstimuli.

In an effort to empirically assess AS, the Reiss–Epstein–Gursky Anxiety Sensitivity Scale, nowbetter known as the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986),was created. The ASI is a modified version of a scale created by Epstein (1982, as cited in Reisset al., 1986), who demonstrated that AS is a qualitatively distinct construct from anxiety. ASIscores have been found to reliably differentiate anxious from non-anxious individuals (Reiss etal., 1986) and panic disorder from other anxiety disorders (Taylor, Koch, & Crockett, 1991). Con-sistent with AS and expectancy theories (Reiss, 1991; Reiss & McNally, 1985), research on theASI has demonstrated that panic disorder tends to be most strongly associated with the endorse-ment of high ASI scores, and that persons diagnosed with post-traumatic stress disorder(McNally, 1990), generalized anxiety disorder (GAD), obsessive-compulsive disorder, and socialphobia all had ASI scores higher than normal controls (Taylor et al., 1991; Taylor, Koch, &McNally, 1992a).

Other researchers have suggested that the ASI may have applications beyond anxiety disorders.Depression has been speculated to hold a positive correlation to high AS, as two groups ofresearchers (Otto, Pollack, Fava, Uccello, & Rosenbaum, 1995; Taylor, Koch, Woody, &McLean, 1996) found persons with major depression to evidence ASI scores that, with the excep-tion of panic disorder, were comparable to anxiety disorders. It is particularly curious as to whydepression would relate to the construct of AS.

In the current study, the concept of AS was extended to investigate the relationship between ASand worry. Although the primary feature of GAD when in excess, worry is believed to be a com-monplace occurrence in the day-to-day lives of well-adjusted people (Dupuy, Beaudoin, Rhea-ume, Ladouceur, & Dugas, 2001; Joormann & Stober, 1997). The specific content of worry hasnot been shown to differ much between clinical worriers and non-clinical worriers (Hoyer, Becker,& Roth, 2001). However, the quality and degree of worry may be distinct, as those with GAD

M. Floyd et al. / Personality and Individual Differences 38 (2005) 1223–1229 1225

tend to worry more (Craske, Rapee, Jackel, & Barlow, 1989; Dupuy et al., 2001). Furthermore,worry, when in lesser degrees, has been associated with positive attributes such as preparationfor actions, decision-making, and motivation towards accomplishing tasks (Borkovec & Roemer,1995; Davey, Hampton, Farrel, & Davidson, 1992).

While research exists that connects high ASI levels with the severity of GAD worry symptoms(Gross & Eifert, 1990; Taylor et al., 1992a), no known research studies have examined the con-nection between worry in general, overall distress, and AS. Conceptually, the constructs of worryand anxiety sensitivity appear to have similar elements. Worry is conceptualized as a fear or pre-occupation with future outcomes and anxiety sensitivity is conceptualized as a fear of one�s re-sponse to anxiety symptoms, presumably upon exposure to future stimuli. The connectionbetween AS and worry may be prospectively linked to a common experience of distress overuncertain future outcomes and a related intolerance for uncertainty (Dugas et al., 2001). There-fore, we hypothesized that AS would be significantly correlated with overall distress, pathologicalworry, and non-pathological worry. Additionally, we hypothesized that the connection betweenAS and worry was more than just a common experience of distress and that AS would be a sig-nificant predictor of both pathological and non-pathological worry, even after controlling foroverall distress.

2. Methods

2.1. Participants

Participants were 342 undergraduate student volunteers who received a Psychology 101 re-search credit for their participation. The average age of the sample was 19.7 years (SD = 3.3)and there were more women (59%) than men (41%). The self-reported ethnic composition ofthe sample was 60% Caucasian, 19% Asian-American, 10% African-American, 9% Hispanic-American, 1% Native American, and 1% of mixed ethnic backgrounds.

2.2. Instruments

The Anxiety Sensitivity Index (ASI; Reiss et al., 1986) was used as a measure of anxiety sensi-tivity. The ASI is a 16-item self-report questionnaire in which each item is rated on a five-pointLikert scale from 0 (very little) to 4 (very much) endorsement. Each item reflects the belief thatanxious sensations are unpleasantly experienced and potentially lead to harmful consequences.The degree to which one fears the experience of anxiety symptoms is reflected in higher scores.The ASI yields a total score (0–64 range) by adding the calculated responses for all 16 items.Using the total score for the instrument, the ASI has demonstrated sound psychometric proper-ties, which include adequate test–retest reliability (Reiss et al., 1986), high internal consistency andgood validity (see review by Peterson & Plehn, 1999).

The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990) wasused as a measure of pathological worry. Items on this measure are believed to reflect the uncon-trollability and excessiveness of general worries. Meyer et al. (1990) reported that this measure hasgood psychometric properties, which include high internal consistency and good test–retest


reliability. This instrument has also been found to reliably distinguish persons diagnosed withGAD from other anxiety disorders (Brown, Antony, & Barlow, 1992), and has been applied inboth clinical and non-clinical populations.

The Worry Domain Questionnaire (WDQ; Tallis, Eysenck, & Mathews, 1992) was used as ameasure of non-pathological worry. This 30-item questionnaire is comprised of six subscales offive items each: (1) relationships, (2) lack of confidence, (3) aimless future, (4) work incompe-tence, (5) financial, and (6) socio-political. The total score is calculated by summing only the firstfive subscale domains (25 items), as the authors of the instrument have found that the socio-political domain may reflect social desirability. Although intended for use as a measure ofnon-clinical levels of worry, the WDQ�s authors suggest that the five ‘‘core’’ worry domainsmay apply generally to assess worry in clinical settings. The WDQ has been found to have ade-quate test–retest reliability, good internal consistency, and adequate validity properties (see re-view by Kelly, 2002).

The Symptom Checklist 90, Revised (SCL-90R; Derogatis, 1983) was used as a measure ofoverall distress and psychopathology. This 90-item self-report instrument measures distress acrossnine symptom subscales, which include Somatization, Obsessive–Compulsive, Interpersonal Sen-sitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism.There are three global indices: Global Severity Index (GSI), Positive Symptom Distress Index(PSDI), and Positive Symptom Total (PST). This scale has been found to have good psychometricproperties, specifically as a measure of general distress (Cyr, McKenna-Foley, & Peacock, 1985).In this study, the GSI was used as the measure of general distress.

2.3. Procedure

The participants entered a large classroom. They were given a packet of questionnaires, andthen the experimenter read aloud the informed consent and instructions for the instruments. Par-ticipants were instructed to complete the instruments and turn them in to the experimenter, whothen gave them a ‘‘receipt’’ indicating they participated in the study.

3. Results

The averages and standard deviations for the instruments were: SCL-90R GSI (M = 0.75,SD = 0.58), ASI (M = 24.59, SD = 5.43), PSWQ (M = 43.52, SD = 10.17), and WDQ(M = 32.47, SD = 21.55). As predicted, the ASI was significantly correlated with the GSI,r = .57, p < .001; the WDQ, r = .55, p < .001; and the PSWQ, r = .41, p < .001. The GSI was alsosignificantly correlated with the WDQ, r = .69, p < .001; and the PSWQ, r = .55, p < .001. TheWDQ and PSWQ were also significantly correlated, r = .507, p < .001. Regression analyses wereused to further test the strength of association of the ASI with worry. In separate regression equa-tions, total scores on the PSWQ and WDQ were used as target variables, with the SCL-90R GSIscores and ASI scores used as predictors. As shown in Tables 1 and 2, the ASI was a significantpredictor for both the WDQ and PSWQ, respectively even after controlling for overall distress (asmeasured by the GSI). The inclusion of the ASI in the model explained an additional 3% of thevariance for the WDQ and an additional 2% of the variance for the PSWQ.

Table 1

Summary of Regression Analyses for Anxiety Sensitivity and Non-pathological Worry

Variable B SE B b p

GSI 20.664 1.757 .564 .000

ASI .850 .186 .220 .000

Note. R2 = .509. The dependent variable is the Worry Domain Questionnaire. GSI is the Global Severity Index of the

Symptom Checklist 90-Revised. ASI is the total score of the Anxiety Sensitivity Index.

Table 2

Summary of Regression Analyses for Anxiety Sensitivity and Pathological Worry

Variable B SE B b p

GSI 8.123 1.005 .460 .000

ASI .294 .107 .157 .006

Note. R2 = .318. The dependent variable is the Penn State Worry Questionnaire. GSI is the Global Severity Index of the

Symptom Checklist 90-Revised. ASI is the total score of the Anxiety Sensitivity Index.


4. Discussion

As expected, the ASI was significantly correlated with both pathological (PSWQ) and non-pathological worry (WDQ). Furthermore, the ASI was significantly correlated with overall dis-tress (GSI). The effect sizes of the associations, using typical values for effect size magnitude(Cohen & Cohen, 1983), were large for non-pathological worry and overall distress, and mediumto large for pathological worry. In fact, the correlation between the ASI and the GSI was actuallyhigher than the correlations between the ASI and either of the worry measures. Since the GSImeasures overall distress, perhaps the ASI is tapping an element of general distress. Alternatively,it is possible the GSI is such a broad instrument that it includes items measuring AS and worryand the strong correlations are due in part to shared items. Another explanation is, given theinherent distress element common in depression and anxiety (Katon & Roy-Byrne, 1991), thatdepression and AS share a common feature of stress related to the unsettling perception of unpre-dictable, unknown, and possibly frightening future events (Dugas et al., 2001).

The correlation between the ASI and the WDQ was considerably higher than the correlationbetween the ASI and the PSWQ. This could be due to using a sample of college students (insteadof a clinical population) and their perception of the distress associated with worry. In comparingthe items on the WDQ and PSWQ, it appears that the PSWQ focuses more on the out-of-controlaspect of (pathological) worry whereas the WDQ focuses on type of worry and frequency ofworry. Since the GSI and WDQ had the highest correlation of all the variables, it indicates thatmost participants in this study perceived worry to be somewhat distressing, even if their worry wasnot excessive, out of control, or functional. It also suggests the WDQ is a better measure of worryfor this population, although additional research would be necessary to confirm this.

The correlations clearly supported the theoretical association between AS, worry, and distress.The purpose of the regression analyses was to further examine the association between AS andworry, and test if there was something to the relationship in addition to the shared experienceof distress. As hypothesized, AS was a significant predictor for both the WDQ and the PSWQ


even after controlling for overall distress. However, the AS did not explain much additional var-iance. Considering the large correlation between the GSI and the two worry measures, this was avery strict test of the AS. As mentioned above, the GSI is such a broad instrument that it could beincluding items that are measures of both AS and worry. If this is not the case, then it suggests themajority of the association between worry and AS is general distress (or some other associatedvariable), and there is a relatively small element of worry that is accounted for specifically byAS. AS and worry both involve the tendency to focus on the uncertainty of the future and thiscould be the incremental contribution of AS to worry. Thus, it could be that AS, as a tendencyto focus on the future, is one of the trait characteristics that predispose people to become worriers,even at the level of non-pathological worry. Longitudinal research would be necessary to examinethe risk associated with high levels of AS.

This study is limited by the lack of a clinical sample for comparison with the normal collegestudent population. Having questions specific to GAD or other anxiety disorders would have beenhelpful in identifying participants within this sample that could have served as clinical analogs.Another limitation is that the survey method used in this study does not permit firm conclusionsregarding the relation between anxiety sensitivity and worry. It would also be interesting to followthe participants in time to see if high levels of AS lead to pathological levels of worry.

In conclusion, anxiety sensitivity has long been considered to be one of the basic fears and priorresearch has demonstrated its association with a number of anxiety disorders. This study demon-strated that AS is associated with worry, however the vast majority of the association appears tobe due to shared elements of distress. The additional amount of worry variance explained by AS ismost likely due to the tendency to focus on the uncertainty of the future.

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