Academic journal article International Journal of Clinical and Health Psychology

Experiential Avoidance and Anxiety Sensitivity in Patients with Panic Disorder and Agoraphobia: Do Both Constructs Measure the Same?

Academic journal article International Journal of Clinical and Health Psychology

Experiential Avoidance and Anxiety Sensitivity in Patients with Panic Disorder and Agoraphobia: Do Both Constructs Measure the Same?

Article excerpt

ABSTRACT. We examined whether Anxiety Sensitivity (AS) and Experiential Avoidance (EA), two potentially relevant constructs in the evolution of anxiety and related disorders with significant implications for cognitive-behavioral treatments, differentially relate to symptom expressions of patients with panic disorder and agoraphobia. Within a multi-center study 369 patients meeting the DSM-IV-TR criteria for panic disorder with agoraphobia (PD/AG) completed the multidimensional Panic and Agoraphobia Scale (PAS), the Anxiety Sensitivity Index (ASI), the Acceptance and Action Questionnaire- II (AAQ-II) and the Beck Depression Inventory-II (BDI-II). Overlap, distinctiveness, and predictive validity of AS and EA were examined using explorative item analyses and multiple hierarchical regression analyses. AS and EA moderately correlated with each other (r=-.50, p<.01). EA explained additional variance in PAS-subscales Anticipatory Anxiety and Panic-Related Disability, but not in Panic Attacks, Agoraphobic Avoidance and Health Worries. ASI, AAQ-II and BDI-II explained a low to moderate amount of variation in the five PAS-subscales (R2 =.04-.29; p<.005). AS and EA are overlapping, yet distinct constructs. Results suggest that EA contributes to a significantly improved understanding of vulnerability, at least in patients with PD/AG.

KEYWORDS. Experiential avoidance. Anxiety sensitivity. Panic disorder. Agoraphobia. Ex post facto study.

RESUMEN. Se examinó si la sensibilidad a la ansiedad (SA) y la evitación experiencial (EE), dos constructos potencialmente relevantes en la evolución de los trastornos de ansiedad relacionadas con importantes consecuencias de los tratamientos cognitivoconductuales, se relacionan de forma diferencial con la expresión de síntomas en pacientes con trastorno de pánico y agorafobia. Dentro de un estudio multicentro, 369 pacientes que cumplían con los criterios DSM-IV-TR para el trastorno de pánico con agorafobia (TP/AG) completaron la Panic and Agoraphobia Scale (PAS), el Anxiety Sensitivity Index (ASI), el Acceptance and Action Questionnaire-II (AAQ-II) y el Beck Depression Inventory-II (BDI-II). Paralelamente se examina la validez predictiva de la SA y la EE mediante análisis exploratorio de los ítems y análisis de regresión múltiple. SA y EE correlacionaron de forma moderada entre sí (r = 0,50, p < 0,01). SA explicó un porcentaje de la varianza de las subescalas Ansiedad anticipatoria y Pánico relacionado con la incapacidad, pero no de Ataques de pánico, Evitación agorafóbica y Preocupaciones por la salud. ASI, AAQ-II y BDI-II explicaron un porcentaje de varianza entre bajo y moderado de las cinco subescalas PAS (R2 = 0,04-0,29, p < 0,005). SA y EE se superponen en constructos distintos. Los resultados sugieren que SA contribuye a una comprensión mucho mejor de la vulnerabilidad, al menos en pacientes con TP/AG.

PALABRA CLAVE. Evitación experiencial. Sensibilidad a la ansiedad. Trastorno de pánico. Agorafobia. Estudio ex post facto.

Despite the fact that CBT for PD/AG is considered one of the most efficacious treatments currently available (e.g. McHugh, Smits, and Otto, 2009; McIntosh et al., 2004; Otto, Pollack, and Maki, 2000) current treatment approaches, including Cognitive Behavioral Therapy (CBT), are limited by the fact that still about one third of patients do not respond to therapy (Johansson and Høglend, 2007). Therefore, the examination of concepts which aim to expand the current understanding of the psychopathology of PD/AG and its implications for treatment are warranted.

One established construct that has been associated most frequently with the development of panic attacks and PD is Anxiety Sensitivity (AS; Reiss and McNally, 1985). AS, a trait-variable, is defined as the tendency to respond fearfully to bodily sensations (e.g. sweating, increased heart rate) due to the belief that these sensations could result in harmful somatic, cognitive, or social consequences (Reiss, Peterson, Gursky, and McNally, 1986). …

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