Academic journal article Journal of Cognitive Psychotherapy

Specificity of Childhood Learning Experiences in Relation to Anxiety Sensitivity and Illness/Injury Sensitivity: Implications for Health Anxiety and Pain

Academic journal article Journal of Cognitive Psychotherapy

Specificity of Childhood Learning Experiences in Relation to Anxiety Sensitivity and Illness/Injury Sensitivity: Implications for Health Anxiety and Pain

Article excerpt

Health anxiety refers to the preoccupation with and fear of bodily sensations arising from catastrophic misinterpretations about the significance of these sensations (Hadjistavropoulos, Asmundson, & Kowalyk, 2004). Constructs theoretically relevant to the development of both health anxiety and chronic pain are two of the putative "fundamental fears" identified by Reiss (1991)-anxiety sensitivity (AS) and illness/injury sensitivity (IS) (Cox, Borger, & Enns, 1999; Vancleef, Peters, Roelofs, & Asmundson, 2006). The learning history origins of AS have been examined in a series of studies (Stewart et al., 2001; Watt & Stewart, 2000; Watt, Stewart, & Cox, 1998); however, no studies have examined the learning history antecedents of IS. The present retrospective study compared the relative specificity of learning experiences related to the development of AS and IS in a sample of 192 undergraduates (143 women and 49 men). Structural equation modeling supported nonspecific paths from both anxiety-related and aches/pains-related childhood learning experiences to AS and a more specific path from aches/pain-related childhood learning experiences to IS. Results suggest that the developmental antecedents of IS are more specific to learning experiences around aches and pains, whereas the developmental origins of AS are more broadly related to learning experiences around bodily sensations.

Keywords: anxiety sensitivity; illness/injury sensitivity; health anxiety; pain; learning experiences

Health anxiety refers to a continuum of health-related fears and beliefs ranging from no concern about bodily sensations at one end to extreme fear of and preoccupation with bodily sensations at the other (Hadjistavropoulos, Asmundson, & Kowalyk, 2004). The cognitive-behavioral model of health anxiety purports that the key maintaining factor is catastrophic misinterpretation of health-relevant information. According to this hypothesis, certain individuals experience persistent health anxiety because of an enduring tendency to misinterpret bodily sensations, medical information, and other information regarded as relevant to their health as evidence that they currently have or are at risk of developing a serious physical illness (Rode, Salkovskis, & Jack, 2001).

Some researchers have suggested a role for health anxiety in chronic pain (e.g., Rode et al., 2001); however, the prevalence of health anxiety among chronic pain patients remains in need of further investigation (Hadjistavropoulos, Owens, Hadjistavropoulos, & Asmundson, 2001). One recent study of 161 chronic pain patients reported conservative estimates of current prevalence rates as being 51% for significant health anxiety, including 37% for full-blown hypochondriasis (Rode, Salkovskis, Dowd, & Hanna, 2006). A cognitive-behavioral model, similar to that proposed for health anxiety, has been proposed for chronic pain. Specifically, this model proposes that chronic pain patients have an enduring tendency to misinterpret pain sensations as a sign that they may be vulnerable to or have already sustained serious physical damage (Rode et al., 2001). Rode et al. suggested that three types of catastrophizing appraisals may be especially important in chronic pain that has a prominent health anxiety component: (a) pain-focused consequences ("This pain will come to dominate my life"), (b) damage-focused consequences ("This pain is nature's way of telling me to be extremely careful"), and (c) disease-focused causes ("This pain is a sign of something really serious").

To better understand the relationship between health anxiety and chronic pain, it may be useful to consider their potential common derivation from the three fundamental sensitivities outlined by Reiss and McNally (1985): anxiety sensitivity (AS), illness/injury sensitivity (IS), and negative evaluation sensitivity (NES). These three dimensions are considered fundamental because they represent the potential to fear inherently aversive stimuli or events and because other common fears are believed to result from these sensitivities (Reiss, 1991). …

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