Abstract
This commentary synthesizes research examining cognitive mechanisms underlying the links between anxiety, health behaviors, and illness outcomes. We provide a brief summary of contributions to this special issue and review common themes and methodological limitations. Notably, a number of related constructs emerged as amplification factors, increasing vulnerability to psychopathology and maladaptive health behaviors. These include anxiety sensitivity, distress and discomfort intolerance, emotion regulation, health literacy, and repetitive negative thinking. Finally, we discuss clinical implications, and conclude with suggestions for further research in this area.
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References
Adams, C. E., Tull, M. T., & Gratz, K. L. (2012). The role of emotional nonacceptance in the relation between depression and recent cigarette smoking. The American Journal on Addictions, 21(4), 293–301. https://doi.org/10.1111/j.1521-0391.2012.00238.x.
Andrykowski, M. A., Lykins, E., & Floyd, A. (2008). Psychological health in cancer survivors. Seminars in Oncology Nursing, 24(3), 193–201. https://doi.org/10.1016/j.soncn.2008.05.007.
Baker, R., Holloway, J., Thomas, P. W., Thomas, S., & Owens, M. (2004). Emotional processing and panic. Behaviour Research and Therapy, 42(11), 1271–1287. https://doi.org/10.1016/j.brat.2003.09.002.
Bakhshaie, J., Ditre, J. W., Langdon, K. J., Asmundson, G. J. G., Paulus, D. J., & Zvolensky, M. J. (2016). Pain intensity and smoking behavior among treatment seeking smokers. Psychiatry Research, 237, 67–71. https://doi.org/10.1016/j.psychres.2016.01.073.
Beyenburg, S., Mitchell, A. J., Schmidt, D., Elger, C. E., & Reuber, M. (2005). Anxiety in patients with epilepsy: Systematic review and suggestions for clinical management. Epilepsy & Behavior, 7(2), 161–171. https://doi.org/10.1016/j.yebeh.2005.05.014.
Blackwell, D. L., & Clarke, T. C. (2018). State variation in meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities through leisure-time physical activity among adults aged 18–64: United States, 2010–2015. National Health Statistics Reports, (112), 1–22.
Bonn-Miller, M. O., Harris, A. H., & Trafton, J. A. (2012). Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Psychological Services, 9(4), 404.
Brown, R. A., Kahler, C. W., Zvolensky, M. J., Lejuez, C. W., & Ramsey, S. E. (2001). Anxiety sensitivity: Relationship to negative affect smoking and smoking cessation in smokers with past major depressive disorder. Addictive Behaviors, 26(6), 887–899. https://doi.org/10.1016/S0306-4603(01)00241-6.
Bujarski, S. J., Galang, J. N., Short, N. A., Trafton, J. A., Gifford, E. V., Kimerling, R., & Bonn-Miller, M. O. (2016). Cannabis use disorder treatment barriers and facilitators among veterans with PTSD. Psychology of Addictive Behaviors, 30(1), 73.
Carleton, R. N. (2016). Fear of the unknown: One fear to rule them all? Journal of Anxiety Disorders, 41, 5–21. https://doi.org/10.1016/j.janxdis.2016.03.011.
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176(4), 379–386.
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192.
Ekkekakis, P., Hall, E. E., & Petruzzello, S. J. (2008). The relationship between exercise intensity and affective responses demystified: To crack the 40-year-old nut, replace the 40-year-old nutcracker!. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 35(2), 136–149. https://doi.org/10.1007/s12160-008-9025-z.
Farris, S. G., Metrik, J., Bonn-Miller, M. O., Kahler, C. W., & Zvolensky, M. J. (2016). Anxiety sensitivity and distress intolerance as predictors of cannabis dependence symptoms, problems, and craving: The mediating role of coping motives. Journal of Studies on Alcohol and Drugs, 77(6), 889–897. https://doi.org/10.15288/jsad.2016.77.889.
Farris, S. G., Zvolensky, M. J., & Schmidt, N. B. (2016). Difficulties with emotion regulation and psychopathology interact to predict early smoking cessation lapse. Cognitive Therapy and Research, 40(3), 357–367. https://doi.org/10.1007/s10608-015-9705-5.
Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., & Murray, C. J. L. (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1659–1724. https://doi.org/10.1016/S0140-6736(16)31679-8.
Goldman, M., Suh, J. J., Lynch, K. G., Szucs, R., Ross, J., Xie, H., & Oslin, D. W. (2010). Identifying Risk factors for marijuana use among veterans affairs patients. Journal of Addiction Medicine, 4(1), 47–51. https://doi.org/10.1097/ADM.0b013e3181b18782.
Gratz, K. L., & Roemer, L. (2003). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.
Hearon, B. A., Quatromoni, P. A., Mascoop, J. L., & Otto, M. W. (2014). The role of anxiety sensitivity in daily physical activity and eating behavior. Eating Behaviors, 15(2), 255–258. https://doi.org/10.1016/j.eatbeh.2014.03.007.
Ishikawa, H., Kato, M., & Kiuchi, T. (2016). Associations of health literacy and information sources with health-risk anxiety and protective behaviors. Journal of Communication in Healthcare, 9(1), 33–39. https://doi.org/10.1080/17538068.2015.1133004.
Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. The British Journal of Psychiatry, 177(5), 396–401. https://doi.org/10.1192/bjp.177.5.396.
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health literacy of america’s adults: Results from the 2003 national assessment of adult literacy. NCES 2006-483. National Center for Education Statistics.
Lelorain, S., Bonnaud-Antignac, A., & Florin, A. (2010). Long term posttraumatic growth after breast cancer: Prevalence, predictors and relationships with psychological health. Journal of Clinical Psychology in Medical Settings, 17(1), 14–22. https://doi.org/10.1007/s10880-009-9183-6.
Leventhal, A. M., & Zvolensky, M. J. (2015). Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion–smoking comorbidity. Psychological bulletin, 141(1), 176.
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600. https://doi.org/10.1037/a0019712.
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The pain anxiety symptoms scale: Development and validation of a scale to measure fear of pain. Pain, 50(1), 67–73. https://doi.org/10.1016/0304-3959(92)90113-P.
McGinnis, J. M., Williams-Russo, P., & Knickman, J. R. (2002). The case for more active policy attention to health promotion. Health Affairs, 21(2), 78–93. https://doi.org/10.1377/hlthaff.21.2.78.
McLaughlin, K. A., Mennin, D. S., & Farach, F. J. (2007). The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder. Behaviour Research and Therapy, 45(8), 1735–1752. https://doi.org/10.1016/j.brat.2006.12.004.
McLeish, A. C., Luberto, C. M., & O’Bryan, E. M. (2016). Anxiety sensitivity and reactivity to asthma-like sensations among young adults with asthma. Behavior Modification, 40(1–2), 164–177. https://doi.org/10.1177/0145445515607047.
McLeish, A. C., Zvolensky, M. J., & Luberto, C. M. (2011). The role of anxiety sensitivity in terms of asthma control: A pilot test among young adult asthmatics. Journal of Health Psychology, 16(3), 439–444. https://doi.org/10.1177/1359105310382584.
McLeish, A. C., Zvolensky, M. J., Smits, J. A., Bonn-Miller, M. O., & Gregor, K. L. (2007). Concurrent associations between anxiety sensitivity and perceived health and health disability among young adult daily smokers. Cognitive Behaviour Therapy, 36(1), 1–11.
McWilliams, L. A., & Asmundson, G. J. (2001). Is there a negative association between anxiety sensitivity and arousal-increasing substances and activities? Journal of Anxiety Disorders, 15(3), 161–70.
Mennin, D. S., McLaughlin, K. A., & Flanagan, T. J. (2009). Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. Journal of Anxiety Disorders, 23(7), 866–871. https://doi.org/10.1016/j.janxdis.2009.04.006.
Metrik, J., Jackson, K., Bassett, S. S., Zvolensky, M. J., Seal, K., & Borsari, B. (2016). The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychology of Addictive Behaviors, 30(7), 743–754. https://doi.org/10.1037/adb0000210.
Moshier, S. J., Szuhany, K. L., Hearon, B. A., Smits, J. A. J., & Otto, M. W. (2016). Anxiety sensitivity uniquely predicts exercise behaviors in young adults seeking to increase physical activity. Behavior Modification, 40(1–2), 178–198. https://doi.org/10.1177/0145445515603704.
Mullane, J. C., Stewart, S. H., Rhyno, E., Steeves, D., Watt, M., & Eisner, A. (2008). Anxiety, sensitivity and difficulties with smoking cessation. In Advances in psychology research, Vol. 54 (pp. 141–155). Hauppauge, NY, US: Nova Science Publishers.
Norr, A. M., Albanese, B. J., Oglesby, M. E., Allan, N. P., & Schmidt, N. B. (2015). Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria. Journal of Affective Disorders, 174, 64–69. https://doi.org/10.1016/j.jad.2014.11.023.
O’Bryan, E. M., & McLeish, A. C. (2017). An examination of the indirect effect of intolerance of uncertainty on health anxiety through anxiety sensitivity physical concerns. Journal of Psychopathology and Behavioral Assessment, 39(4), 715–722. https://doi.org/10.1007/s10862-017-9613-y.
Ocañez, K. L. S., McHugh, R. K., & Otto, M. W. (2010). A meta-analytic review of the association between anxiety sensitivity and pain. Depression and Anxiety, 27(8), 760–767. https://doi.org/10.1002/da.20681.
Otto, M. W., Eastman, A., Lo, S., Hearon, B. A., Bickel, W. K., Zvolensky, M., & Doan, S. N. (2016). Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion. Clinical Psychology Review, 49, 67–78. https://doi.org/10.1016/j.cpr.2016.07.003.
Otto, M. W., & Smits, J. A. (2018). Anxiety sensitivity, health behaviors, and the prevention and treatment of medical illness. Clinical Psychology: Science and Practice, 25(3), e12253.
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19(1), 2–21. https://doi.org/10.2307/2136319.
Pham, T., Sauro, K. M., Patten, S. B., Wiebe, S., Fiest, K. M., Bulloch, A. G. M., & Jetté, N. (2017). The prevalence of anxiety and associated factors in persons with epilepsy. Epilepsia, 58(8), e107–e110. https://doi.org/10.1111/epi.13817.
Picardi, A., Amerio, P., Baliva, G., Barbieri, C., Teofoli, P., Bolli, S., & Abeni, D. (2004). Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Dermato-Venereologica, 84(3):213–217.
Prather, A. A., Gottlieb, L. M., Giuse, N. B., Koonce, T. Y., Kusnoor, S. V., Stead, W. W., & Adler, N. E. (2017). National academy of medicine social and behavioral measures: Associations with self-reported health. American Journal of Preventive Medicine, 53(4), 449–456. https://doi.org/10.1016/j.amepre.2017.02.010.
Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11(2), 141–153.
Reitzel, L. R., Short, N. A., Schmidt, N. B., Garey, L., Zvolensky, M. J., Moisiuc, A., & Businelle, M. S. (2017). Distress tolerance links sleep problems with stress and health in homeless. American Journal of Health Behavior, 41(6), 760–774. https://doi.org/10.5993/AJHB.41.6.10.
Sabourin, B., Hilchey, C., Lefaivre, M.-J., Watt, M., & Stewart, S. (2011). Why do they exercise less? Barriersto exercise in high- anxiety-sensitive women. Cognitive Behaviour Therapy, 40(3), 206–215. https://doi.org/10.1080/16506073.2011.573572.
Scheier, M. F., & Carver, C. S. (1992). Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cognitive Therapy and Research, 16(2), 201–228. https://doi.org/10.1007/BF01173489.
Schmidt, N. B., Richey, J. A., & Fitzpatrick, K. K. (2006). Discomfort intolerance: Development of a construct and measure relevant to panic disorder. Journal of Anxiety Disorders, 20(3), 263–280. https://doi.org/10.1016/j.janxdis.2005.02.002.
Schroeder, S. A. (2007). We can do better—Improving the health of the american people. New England Journal of Medicine, 357(12), 1221–1228. https://doi.org/10.1056/NEJMsa073350.
Short, N. A., Babson, K. A., Schmidt, N. B., Knight, C. B., Johnson, J., & Bonn-Miller, M. O. (2016). Sleep and affective functioning: Examining the association between sleep quality and distress tolerance among veterans. Personality and Individual Differences, 90, 247–253. https://doi.org/10.1016/j.paid.2015.10.054.
Smits, J. A., Tart, C. D., Presnell, K., Rosenfield, D., & Otto, M. W. (2010). Identifying potential barriers to physical activity adherence: Anxiety sensitivity and body mass as predictors of fear during exercise. Cognitive Behaviour Therapy, 39(1), 28–36.
Smits, J. A. J., Otto, M. W., Powers, M. B., & Baird, S. O. (2018). Anxiety sensitivity as a transdiagnostic treatment target. In J. A. J. Smits, M. W. Otto, M. B. Powers & S. O. Baird (Eds.), Anxiety sensitivity: A clinical guide to assessment and treatment (pp. 1–5). San Diego: Academic Press.
Smits, J. A. J., Zvolenksy, M. J., Davis, M. L., Rosenfield, D., Marcus, B. H., Church, T. S., & Baird, S. O. (2016). The efficacy of vigorous-intensity exercise as an aid to smoking cessation in adults with high anxiety sensitivity: A randomized controlled trial. Psychosomatic Medicine, 78(3), 354–364.
Szasz, P. L., Szentagotai, A., & Hofmann, S. G. (2012). Effects of emotion regulation strategies on smoking craving, attentional bias, and task persistence. Behaviour Research and Therapy, 50(5), 333–340. https://doi.org/10.1016/j.brat.2012.02.010.
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188. https://doi.org/10.1037/1040-3590.19.2.176.
Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378–391. https://doi.org/10.1016/j.beth.2006.10.006.
Wiglusz, M. S., Landowski, J., & Cubała, W. J. (2018). Prevalence of anxiety disorders in epilepsy. Epilepsy & Behavior, 79, 1–3. https://doi.org/10.1016/j.yebeh.2017.11.025.
Woodruff, P. W. R., Higgins, E. M., du Vivier, A. W., & Wessely, S. (1997). Psychiatric illness in patients referred to a dermatology-psychiatry clinic. General Hospital Psychiatry, 19(1), 29–35.
Yamaoka, K., & Tango, T. (2005). Efficacy of lifestyle education to prevent type 2 diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 28(11), 2780–2786. https://doi.org/10.2337/diacare.28.11.2780.
Zale, E. L., & Ditre, J. W. (2015). Pain-related fear, disability, and the fear-avoidance model of chronic pain. Current Opinion in Psychology, 5, 24–30. https://doi.org/10.1016/j.copsyc.2015.03.014.
Zvolensky, M. J., Bogiaizian, D., Salazar, P. L., Farris, S. G., & Bakhshaie, J. (2014). An anxiety sensitivity reduction smoking-cessation program for Spanish-speaking smokers (Argentina). Cognitive and Behavioral Practice, 21(3), 350–363. https://doi.org/10.1016/j.cbpra.2013.10.005.
Zvolensky, M. J., Garey, L., Allan, N. P., Farris, S. G., Raines, A. M., Smits, J. A. J., & Schmidt, N. B. (2018). Effects of anxiety sensitivity reduction on smoking abstinence: An analysis from a panic prevention program. Journal of Consulting and Clinical Psychology, 86(5), 474–485. https://doi.org/10.1037/ccp0000288.
Zvolensky, M. J., Marshall, E. C., Johnson, K., Hogan, J., Bernstein, A., & Bonn-Miller, M. O. (2009). Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users. Experimental and Clinical Psychopharmacology, 17(1), 31–42. https://doi.org/10.1037/a0014961.
Zvolensky, M. J., Stewart, S. H., Vujanovic, A. A., Gavric, D., & Steeves, D. (2009). Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine & Tobacco Research, 11(3), 323–331. https://doi.org/10.1093/ntr/ntn037.
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Jasper Smits receives funding from the NIH and has received monetary compensation for his work as consultant to Microtransponder, Inc. and Aptinyx, Inc. He also received royalties from various book publishers.
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Stein, A.T., Freeman, S.Z. & Smits, J.A.J. Cognitive Mechanisms Underlying the Link Between Anxiety, Health Behaviors, and Illness Outcomes: Commentary on a Special Issue. Cogn Ther Res 43, 131–138 (2019). https://doi.org/10.1007/s10608-019-09999-6
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DOI: https://doi.org/10.1007/s10608-019-09999-6