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ARTICLE IN PRESS

Behaviour Research and Therapy 45 (2007) 1393–1400 www.elsevier.com/locate/brat

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A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance
Anka A. Vujanovica, Michael J. Zvolenskya,Ã, Amit Bernsteina, Matthew T. Feldnerb, Alison C. McLeisha
a

The University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA b University of Arkansas, USA Received 30 November 2005; received in revised form 21 June 2006; accepted 23 June 2006

Abstract The present investigation sought to examine the interactive effects of anxiety sensitivity [AS; Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). San Diego: Academic Press] and mindfulness [Brown, K. W., & Ryan, R. M. (2003). The benefit of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848] in predicting panic-relevant processes. A community sample of 248 individuals participated in the study by completing a battery of self-report instruments. Consistent with prediction, the interaction between AS and mindfulness significantly predicted anxious arousal symptoms and agoraphobic cognitions, above and beyond the individual main effects, and did not significantly predict anhedonic depression symptoms. Contrary to prediction, the AS by mindfulness interaction did not significantly predict body vigilance. Theoretical implications are discussed and future directions are delineated. r 2006 Elsevier Ltd. All rights reserved.
Keywords: Anxiety sensitivity; Mindfulness; Panic vulnerability; Body vigilance; Anxiety

Introduction Anxiety sensitivity (AS) is the fear of anxiety and anxiety-related sensations (Reiss & McNally, 1985). This cognitive factor is theorized to predispose individuals to the development of panic and certain types of other anxiety problems (Reiss & McNally, 1985), a perspective that is empirically supported (Schmidt, Lerew, & Jackson, 1997, 1999). The vast majority of research on AS has focused on demonstrating its role in panic vulnerability (McNally, 2002). A topic that has received significantly less empirical attention is to what extent other theoretically relevant factors interact with AS in terms of predicting panic vulnerability.

ÃCorresponding author. Tel.: +1 802 656 8994; fax: +1 802 656 8783.

E-mail address: Michael.Zvolensky@uvm.edu (M.J. Zvolensky). 0005-7967/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2006.06.002

rather than reacting to it in an excessively anxiety-relevant manner (i. White. mindfulness. what is occurring in the present moment. such as objective self-awareness. 1994. a process that may be important in disengaging individuals from automatic thoughts... denotes conscious ‘‘attention to. 2003. Zvolensky et al. we would theorize that only anxiety/panic processes should be related to this interactive process (cf. however. Moreover. an individual high in AS is likely to fear the negative consequences of aversive stimuli (McNally. 2002). 2003. self-consciousness. Leen-Feldner.’’ According to Brown and Ryan (2003). individuals who engage in catastrophizing or ‘‘what if’’ future-oriented thinking thereby trigger the physiological symptoms of anxiety. depressive symptoms) in the immediate situation. Vujanovic et al. 2005). as attention training is a cognitive technique based on an information processing approach. This construct differs theoretically and empirically from other self-awareness-related constructs. 1999). The MAAS assesses individual differences in the frequency of mindful attention and awareness states over time. catastrophizing). 2005). 2003).e. have been associated with lower mood disturbance and stress symptoms among cancer patients (Carlson & Brown. Here mindfulness may serve to ‘‘dampen’’ the negative effects of an established risk factor like AS. an effect unique to the panic model and not apparent generally for all negative mood states). In addition. Study 4). 824).ARTICLE IN PRESS 1394 A.. it was theorized that mindfulness may interact with established cognitive risk factors. to significantly decrease vulnerability for panic-relevant symptoms and problems. the current study sought to examine the interactive effects of mindfulness and AS in predicting panic-relevant symptoms. This conceptualization of mindfulness also is distinct from the attention training model set forth by Wells.. perceptual—rather than cognitive— display of the current moment. high levels of mindfulness. in press). 1995). Although distinct operationalizations of ‘‘mindfulness’’ have been proposed (e. and awareness of. Smith. 2005) and information processing perspectives for anxiety psychopathology (Wells. it was hypothesized that the AS by mindfulness interaction would not be significantly related to anhedonic depressive symptoms (i. thus leading to panic responses. and other related constructs that define self-awareness (Brown & Ryan. while Brown and Ryan’s (2003) construct of mindfulness is theorized to offer a basic. For example.g. 2004. as indexed by the MAAS.. Other studies have found that the MAAS incrementally predicts affective vulnerability relative to negative and positive affectivity and emotional expression and processing associated with approach-oriented coping (Zvolensky et al. or maladaptive behavioral patterns (Brown & Ryan. 2005). such as AS.. To the extent that a high AS individual can allocate attention to. 2003). to test the specificity of this interactive association with panic-relevant symptoms. & Allen. For example. Feldner. A high AS individual with little ability to allocate attentional resources to the present moment may be more apt to report catastrophic cognitions and hence a greater range of more intense panic-relevant symptoms. this cascade of automatic anxietyrelated processes may be hindered or forestalled altogether. Brown and Ryan (2003) developed a promising theoretically derived self-report measure entitled the Mindful Attention Awareness Scale (MAAS).. and awareness of. Together.A. according to Clark’s (1986) cognitive model of panic. thereby gaining a more objective perception of the level of personal threat. 824). For example. This type of perspective is broadly consistent with models of mindfulness (Zvolensky et al. Here. p. and Carter (1997). It was expected that AS and mindfulness would interact to differentially relate to panic-relevant criterion variables. mindfulness may theoretically permit the high AS individual to attend to the current situation. and thus. Initial work on the MAAS has indicated that it is negatively related to the intensity and frequency of negative affect symptoms over time (Brown & Ryan. research on emotional learning suggests that this type of process unfolds rapidly and in a largely automatic fashion (Bechara et al. Here. Building from previous work. this person would be at a significantly lower risk of experiencing automatic fearful cognitions related to panic symptoms. what is occurring in the present’’ (p. Baer. & Yartz. habits. . 2002) and cope with the corresponding emotional distress through escape/avoidance-oriented tactics (Zvolensky & Forsyth. Specifically. / Behaviour Research and Therapy 45 (2007) 1393–1400 Mindfulness has increasingly been theorized to play an important role in psychological functioning generally and anxiety problems specifically (Zvolensky.e. we will refer to this construct as ‘‘mindfulness. mindfulness refers to open observation of internal and external processes. as this interactive mechanism seems specific to anxiety-related states. as indexed by the MAAS. This perspective was driven by the conceptual model that if an individual can engage in mindfulness. a neutral appraisal or perception of stimuli ‘‘as they are’’’ (Brown & Ryan.

. The BVS has adequate internal consistency (a ¼ :75) and it has been . 2003). and 1. & Brown. Lerew. Participants were recruited for participation in a study on ‘‘emotion’’ that involved the completion of theoretically relevant measures and perhaps a laboratory component. on a 5-point Likert-type scale (0 ¼ very little to 4 ¼ very much). The MAAS total score is derived from summing all the items. Mood and Anxiety Symptom Questionnaire (MASQ) The MASQ is a measure of affective symptoms (Watson. 1986) is a 16-item measure on which respondents indicate. which is expected to be nondifferentiating relative to depression. We did not over-sample for high-risk individuals purposefully.. 2005). The ACQ has been shown to have excellent psychometric properties (Kotov. In the present investigation. / Behaviour Research and Therapy 45 (2007) 1393–1400 1395 Method Participants A total of 248 participants (136 females. The General Distress: Anxious Symptoms scale (MASQ: GDA) indexes anxious mood. 1997). Zvolensky et al.4% African-American. The Anxious Arousal scale (MASQ-AA) measures the symptoms of somatic tension and arousal.6% Asian-American. SD ¼ 7. local restaurants. Measures Anxiety Sensitivity Index (ASI) The ASI (Reiss. Barlow. The ASI is made up of one higher-order factor (ASI total score) and three lower-order factors: Physical. and university-based bulletin boards. 1995). Agoraphobic Cognitions Questionnaire (ACQ) The ACQ is a 14-item scale measuring the frequency of frightening or maladaptive thoughts about the consequences of panic and anxiety (Chambless. Vinogradov. the degree to which they agree with a particular statement regarding attentional focus on bodily sensations and related processes. Gursky. 2000): approximately 93. Bright. as it represents the global AS factor and therefore takes into consideration different types of lower-order fears. The racial composition reflected that of the local population (State of Vermont Department of Health. 2003. 1984). we utilized the total ASI score. & Gallagher. & Antipova. written consent. & McNally. The MAAS shows good internal consistency and psychometric properties across a wide range of samples (a ¼ :80 À :87. & Trakowski. on an 11-point Likert-type scale (0 ¼ none to 10 ¼ extreme). their level of attention and awareness to present events and experiences (Brown & Ryan. The BVS is a four-item instrument on which respondents indicate. which is expected to be nondifferentiating relative to anxiety. Only the MASQ-AA and MASQ-AD subscales were used in the present investigation. The General Distress: Depressive Symptoms scale (MASQ: GDD) measures depressed mood. Brown & Ryan. Peterson. 1997). The Anhedonic Depression Scale (MASQ-AD) measures a loss of interest in life.5% of the sample was Caucasian.4 years. Items are rated on a 5point Likert-type scale (1 ¼ thought never occurs to 5 ¼ thought always occurs). Caputo.A. Psychological. Assenheimer.93) were recruited through the general community in Vermont via flyer placement in a local well-traveled marketplace. the degree to which they fear the potential negative consequences of anxiety-related symptoms and sensations.ARTICLE IN PRESS A. Mindful Attention Awareness Scale The MAAS is a 15-item questionnaire on which respondents indicate. as the global aim of the investigation was to gain a broadbased understanding of the risk processes among a community sample. on a 6-point Likert-type scale (1 ¼ almost always to 6 ¼ almost never). 2. Vujanovic et al. Zvolensky. Participants indicate how much they have experienced each symptom on a 5-point Likert-type scale (1 ¼ not at all to 5 ¼ extremely). in press). Mage ¼ 22. Schmidt. Participants were excluded on the basis of limited mental competency or the inability to give informed. Body Vigilance Scale (BVS) The BVS was used to assess attentional focus on somatic symptoms (Schmidt. & Clark. Weber.6% other. and Social Concerns (Zinbarg. 1.8% Hispanic.

there was a significant interaction between AS and mindfulness at step two in the model. As expected. All correlations are significant and in the expected direction with the exception of the non-significant association between mindfulness and body vigilance. Upon completion of the study. & Trakowski. As hypothesized. participants were debriefed regarding the aims of the study and compensated for their efforts. Analytic approach To address the current hypotheses. 15% of the overall variance in body vigilance was accounted for at step one in the model. 1 . step one of the model accounted for 41% of variance. step one of the model accounted for 25% of the variance in this criterion variable. Finally. after controlling for the variance accounted for by step one of the model. Here. there was no effect for mindfulness. 419). anhedonic depressive symptoms. 1983). however. Thus. This model tests whether mindfulness interacts with AS and ensures that any observed effects for the interaction term are unique and not attributable to the main effect terms in steps 1 or 2 (Cohen & Cohen. agoraphobic cognitions. The criterion variables were: anxious arousal symptoms. AS was a significant predictor of body vigilance. In terms of anxious arousal. At this appointment. / Behaviour Research and Therapy 45 (2007) 1393–1400 used successfully among clinical (Schmidt. there was no significant interaction between AS and mindfulness in relation to body vigilance. As hypothesized. Lerew. there was no effect for mindfulness. Regression analyses Please see Table 2 for a summary of the regression analyses. AS and mindfulness were both significant predictors. upon receiving a description of the study. and body vigilance.A. 1983. step one of the model accounted for 35% of variance. Lerew. Examining the form of the significant interactions Forms of the significant interactions were examined by inserting specific values for each predictor variable into the regression equations associated with the described analysis (Cohen & Cohen.1 Results Descriptive data and zero-order correlations among theoretically relevant variables Please see Table 1 for zero-order correlations. 1997. there was not a significant interaction between AS and mindfulness for anhedonic depressive symptoms. Schmidt. As hypothesized. participants provided verbal and written consent and then completed a self-report battery assessing mindfulness and affect-related variables. 323. Inconsistent with prediction. 2002). hierarchical multiple regression analyses were performed. Procedure Participants responding to community-based advertisements for the study were scheduled for an individual appointment by a trained research assistant. Vujanovic et al. As Tests of mediation were performed and found to be nonsignificant. & Jackson. AS was a significant predictor of anxious arousal symptoms. The main effects of AS and mindfulness were simultaneously entered at step 1 and their interaction was entered at step 2 in the model.ARTICLE IN PRESS 1396 A. In terms of body vigilance. pp. Concerning agoraphobic cognitions. 1997) and nonclinical populations (Zvolensky & Forsyth. AS and mindfulness were both significant predictors. these analyses are not reported in the paper. Mindfulness did not mediate the association between AS and any of the criterion variables. there was a significant interaction between AS and mindfulness at step two in the model. in regard to anhedonic depressive symptoms.

ASI: Anxiety Sensitivity Index.58 . Table 2 Anxiety sensitivity (AS) and mindfulness in relation to the anxiety criterion variables DR2 Dependent variable: anxious arousal Step 1 . It should be noted that individuals reporting both high AS and high mindfulness were almost nonexistent.53 À2. .43** À.63 .64** À.59 À.ARTICLE IN PRESS A. but not with high levels of mindfulness.07 59.20** 1 4 .12 .00 AS Â mindfulness Dependent variable: agoraphobic cognitions Step 1 .35 AS Mindfulness Step 2 . in regard to anxious arousal.001 ns ns 5. 3. **po.03 À.42) 1397 Note: *po.37** 1 6 .001 o.32 29. 2.01 o.001 ns o. in other words.61 .05.06 .47 25.25 AS Mindfulness Step 2 .02 .34** 1 M (SD) 20. 1. in the present sample. ACQ: Agoraphobic Cognitions Questionnaire.01 ns 9. BVS: Body Vigilance Scale. / Behaviour Research and Therapy 45 (2007) 1393–1400 Table 1 Descriptive data and zero-order relations among theoretically relevant variables Variable name 1.12 À.00 Note: b ¼ standardized beta weight.41 À.02 À. 5.61** .63 .04 .32 À.21 . ASI: Total MAAS: Total MASQ: Anxious arousal MASQ: Anhedonic depression ACQ: Total BVS: Total 1 1 2 À.09 À.4%) endorsed both levels of AS and mindfulness higher than one standard deviation above the mean.49** À.07 .71 20.04 o. .15 AS Mindfulness Step 2 .99 À2.28** 1 3 .01. the form of the interaction indicates that co-occurring low levels of AS and low or high mindfulness yield the lowest levels of anxious arousal. 4.31** .31** .40 54.64 . sr2 ¼ squared semi-partial correlation.01 5.08) (5. can be seen in Fig.9) (1. as only one individual (n ¼ 1.63** À.47 À1. Furthermore.20 . An identical pattern of findings was evident for agoraphobic cognitions (see Fig.31** 1 5 .41** .19) (14.16* .34 .00 o.00 AS Â mindfulness t (each predictor) b sr2 p 9. co-occurring high levels of AS and low levels of mindfulness yield the highest levels of anxious arousal. no significant differences were found between the low AS-low mindfulness and low AS-high mindfulness groups as relevant to levels of anxious arousal.05 o.33 .14 .00 .25 . Therefore.90 À2. 6.35) (8. MASQ: Mood and Anxiety Symptom Questionnaire.02 AS Â mindfulness Dependent variable: anhedonic depression Step 1 . 1).00 À.04 o.70) (24.001 o.39 À.00 . MAAS: Mindful Attention Awareness Scale.02 AS Â mindfulness Dependent variable: body vigilance Step 1 .86 .41 AS Mindfulness Step 2 .A.16 . Vujanovic et al. high levels of AS co-occurred primarily with low levels of mindfulness.43 (12.

uniformly. or unambiguously mean that moderation was fully operative. Discussion Consistent with prediction. 2002). Evidence was found for the interactive role of mindfulness in strengthening the associations between high levels of AS and panic-related symptoms (i. inconsistent with prediction. replication of the . no significant differences were found between low mindfulness-low AS and high mindfulness-low AS groups yielded the lowest levels of anxious arousal and agoraphobic cognitions. / Behaviour Research and Therapy 45 (2007) 1393–1400 35 30 Anxious Arousal 25 20 15 10 5 0 Low AS High AS Low Mindfulness High Mindfulness 30 Agoraphobic Cognitions 25 20 15 10 5 0 Low AS High AS Low Mindfulness High Mindfulness Fig. 2003). it should be noted that. does not significantly and specifically tap into somatic experience or physically based attention. thus yielding support for the predictive specificity of the interaction. but not all panic-relevant processes. Specifically.. evidence of a statistical interaction was obtained. derived from a general measure of present-centered attention and awareness. 1. but this interaction does not necessarily. when mindfulness is low) and decreasing the strength of the association between high levels of AS and panic-related symptoms (i. when mindfulness is high). Furthermore. Although this significant interactive effect is broadly in line with moderation. from a conservative viewpoint. Taken together. Anxious arousal scores as a function of the interaction of AS and mindfulness among participants one standard deviation above and/or below the mean.ARTICLE IN PRESS 1398 A.e.. Agoraphobic cognition scores as a function of the interaction of AS and mindfulness among participants one standard deviation above and/or below the mean. this pattern was observed in terms of both anxious arousal and agoraphobic cognitions. However. the AS by mindfulness interaction significantly predicted anxious arousal and agoraphobic cognitions in the expected direction.A.e. Thus. these findings collectively suggest that the AS by mindfulness interaction seems most evident for anxiety symptoms and body-oriented catastrophic thinking. the AS by mindfulness interaction did not significantly predict body vigilance. Given the early stage of work in this domain. co-occurring low levels of mindfulness and high levels of AS yielded the highest levels of anxious arousal and agoraphobic cognitions. 1. The cooccurrence of low or high levels of mindfulness with low levels of AS (i. As shown in Fig. One possible reason for this unexpected finding is that the mindfulness construct (Brown & Ryan.. Vujanovic et al. technically (Holmbeck. AS may not be a ‘‘true moderator’’ since individuals who endorsed both high AS and high mindfulness were almost nonexistent in the current sample.e. the AS by mindfulness interaction did not significantly predict anhedonic depression.

A.g. it is noteworthy that mindfulness may actually maintain a number of relations with AS and thereby via multiple processes influence risk for panic problems. Here.g. Vujanovic and a National Research Service Award (F31 MH073205-01) granted to Amit Bernstein. and 1 R21 DA016227-01) awarded to Dr. it would be important to examine the interactive effects of mindfulness and AS in select clinical samples and among ethnically diverse individuals. . 2003). other than AS and mindfulness in relation to anxiety as well as other outcomes of interest. as developed by Brown and Ryan (2003). the current study tested the associations between AS and mindfulness. Double dissociation of conditioning and declarative knowledge relative to the amygdala and hippocampus in humans. R. the present cross-sectional design cannot definitively address the nature of these questions. it may be promising for future investigations to explore the nature of the interactive relationship between multiple affect-tolerance-related factors (e. Smith. the current findings were based on a relatively homogenous community sample. Acknowledgements This paper was supported by National Institute on Drug Abuse research grants (1 R01 DA018734-01A1. Future work might build upon the present findings and incorporate multimethod approaches to indexing the variables of interest. 2004). elevated levels of mindfulness may decrease levels of AS. & Allen. A. a specific mindfulness-based construct (Brown & Ryan. It may therefore be prudent to examine the interplay between AS and other mindfulness-based constructs. T. As next steps in this program of research. it also is possible that elevated levels of AS may contribute to panic problems when mindfulness is low but not when mindfulness is high. Alternatively. bodily sensations).. Rockland. 1994) of mindfulness in terms of panic problems. Vujanovic et al...g. the present investigation utilized established self-report instruments as the principal assessment strategy. Mindfulness. One important next step in this line of inquiry would therefore be to use prospective longitudinal research methodologies to evaluate the consistency of the present findings over time or to experimentally manipulate mindfulness in the laboratory and test singular and interactive effects with AS in terms of anxious and fearful responding to theoretically relevant stressors (e. 269. but rather.. Though promising. R. A. Adolphs. high levels of AS may hinder an individual’s capacity for high levels of mindfulness. the observed findings underscore the importance of considering AS within multi-factor or multidimensional models of panic vulnerability. Fifth. A. it is not possible to make causal statements concerning any of the relevant constructs. The current results are broadly theoretically consistent with traditional resilience models (Masten. Assessment of mindfulness by self-report: The Kentucky inventory of mindfulness skills. and low levels of AS are not expected to lead to panicrelated problems regardless of mindfulness level. There are several limitations that warrant consideration. C.. Results of the present study provide an important empirical basis for further evaluating AS by mindfulness interactions in future work of panic vulnerability. 11. provides a basis for exploring such questions in future work. Baer et al. G. Finally. Overall. R. 1115–1118... 191–206.. Zvolensky.ARTICLE IN PRESS A.. distress tolerance). due to the cross-sectional and correlational nature of the present research design. since AS is only one of many risk factors for panic problems. D. B. It also is noteworthy that the mechanisms underlying the observed AS by mindfulness interaction may ultimately have translational implications for the clinical intervention and prevention of panic and related anxiety problems by offering an additional therapeutic means by which to clinically target panic-vulnerability factors such as AS. Future intervention studies targeting mindfulness could help to elucidate such issues by measuring changes in levels of AS as a function of changes in mindfulness as well as the corresponding changes in panic-related outcomes that result. Bechara. Fourth. First. Second. References Baer. is only one type of mindfulness construct and others have postulated different conceptualizations of mindfulness (e. (2004). (1995). Science... & Damasio. H. R03 DA16307-01. Damasio. Third. K. This work also was supported by a National Research Award (F31 DA021006-01) and University of Vermont McNeil Fund Award granted to Anka A. Assessment. In the case of true moderation. / Behaviour Research and Therapy 45 (2007) 1393–1400 1399 current findings would be important to further examine the nature of the identified interactive process. Tranel. For example. future work directed at isolating the types of risk factors with which mindfulness may interact would be important in terms of systematically shaping the potential explanatory parameters of this construct.

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