The Role of Anxiety Sensitivity in Treatment Outcomes for Patients with Post-Traumatic Stress Disorder in a Collaborative Care Intervention
Most contemporary PTSD models posit that cognitive factors, such as beliefs about one’s symptoms, are integrally involved in the onset, maintenance, and severity of PTSD symptoms. Of the relevant cognitive risk factors involved in PTSD, one of the most promising yet understudied is anxiety sensitivity. Commonly described as “fear of fear,” anxiety sensitivity is thought to be a cognitive trait that gives rise to beliefs that anxiety-related symptoms are dangerous. The present study examined the longitudinal relationship, from baseline to 18-month follow-up, of anxiety sensitivity to PTSD severity in a publicly available NIMH archival dataset of 61 adults in the multicenter Coordinated Learning and Anxiety Management (CALM) study (Hypothesis 1). Differences in anxiety sensitivity as measured by the Anxiety Sensitivity Index (ASI) were analyzed for individuals randomized to either usual care (UC) or collaborative care (CC), which involved options for both CBT and medication management (Hypothesis 2). Finally, change in ASI from baseline to 18-months was investigated as a mediator of the relationship between gender and change in PTSD severity (as measured by the PTSD Checklist – Civilian Version, PCL-C) over the same time period. Linear mixed modeling was used to explore Hypothesis 1. Results indicated that anxiety sensitivity was significantly predictive of PTSD symptom severity over time. That is, as anxiety sensitivity increased or decreased, so too did PTSD symptom severity. Regarding Hypothesis 2, repeated measures ANOVA found no significant differences in ASI score between UC and CC groups at any timepoint. There was a significant effect of time, demonstrating that anxiety sensitivity improved from baseline to 18-month follow-up, regardless of treatment randomization. However, trend-level and effect size differences between UC and CC groups indicated a greater reduction in the CC condition. Finally, mediation analysis was performed to examine Hypothesis 3. Change in anxiety sensitivity was found to partially mediate the relationship between female gender and change in PTSD symptom severity. Change in anxiety sensitivity did not mediate the relationship between male gender and PTSD symptom severity. However, given the very small male sample size, results should be interpreted with caution. In sum, anxiety sensitivity appears to be an important factor related to PTSD severity, particularly for women. Further research could help illuminate not only anxiety sensitivity’s role in the etiology and maintenance of PTSD, but also provide opportunities for treatment optimization.
Clinical psychology|Cognitive psychology|Behavioral psychology
Harrison, Austin Reed, "The Role of Anxiety Sensitivity in Treatment Outcomes for Patients with Post-Traumatic Stress Disorder in a Collaborative Care Intervention" (2021). ETD Collection for Fordham University. AAI28264127.