Cognitive Therapy and Research

, Volume 39, Issue 6, pp 816–825 | Cite as

Tracing “Fearbola”: Psychological Predictors of Anxious Responding to the Threat of Ebola

  • Shannon M. Blakey
  • Lillian Reuman
  • Ryan J. Jacoby
  • Jonathan S. Abramowitz
Original Article


Serious illnesses such as Ebola are often highly publicized in the mass media and can be associated with varying levels of anxiety and compensatory safety behavior (e.g., avoidance of air travel). The present study investigated psychological processes associated with Ebola-related anxiety and safety behaviors during the outbreak in late 2014. Between October 30 and December 3, 2014, which encompassed the peak of concerns and of the media’s attention to this particular outbreak, 107 university students completed a battery of measures assessing fear of Ebola, performance of safety behaviors, factual knowledge of the virus, and psychological variables hypothesized to predict Ebola-related fear. We found that while our sample was generally not very fearful of contracting Ebola, the fear of this disease was correlated with general distress, contamination cognitions, disgust sensitivity, body vigilance, and anxiety sensitivity-related physical concerns. Regression analyses further indicated that anxiety sensitivity related to physical concerns and the tendency to overestimate the severity of contamination were unique predictors of both Ebola fear and associated safety behaviors. Implications for how concerns over serious illness outbreaks can be conceptualized and clinically managed are discussed.


Ebola Health anxiety Anxiety sensitivity Safety behaviors Anxiety Body vigilance Contamination 


Conflict of Interest

Shannon M. Blakey, Lillian Reuman, Ryan J. Jacoby, and Jonathan S. Abramowitz declare that they have no conflict of interest.

Informed Consent

All procedures performed in this study, which involved human participants, were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board (IRB) approval was obtained and informed consent was obtained from all individual participants included in the study.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.


  1. Abramowitz, J. S., & Braddock, A. E. (2010). Hypochondriasis and health anxiety. Cambridge, MA: Hogrefe & Huber.Google Scholar
  2. Abramowitz, J. S., Deacon, B. J., & Whiteside, S. H. (2011). Exposure therapy for anxiety: Principles and practice. New York, NY, US: Guilford Press.Google Scholar
  3. Abramowitz, J. S., & Moore, E. L. (2007). An experimental analyses of hypochondriasis. Behaviour Research and Therapy, 45, 413–424.CrossRefPubMedGoogle Scholar
  4. American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Google Scholar
  5. American Psychological Association [APA]. (2014). Managing your fear about Ebola. Retrieved from
  6. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  7. Bish, A., & Michie, S. (2010). Demographic and attitudinal determinants of protective behaviors during a pandemic: A review. British Journal of Health Psychology, 15, 797–824.CrossRefPubMedGoogle Scholar
  8. CDC. (2014). Outbreaks chronology: Ebola virus disease. Retrieved from
  9. CDC Health Alert Network. (2014). HAN 366: CDC Ebola update #2. CDC Media. Retrieved from
  10. Cisler, J. M., Brady, R. E., Olatunji, B. O., & Lohr, J. M. (2010). Disgust and obsessive beliefs in contamination-related OCD. Cognitive Therapy and Research, 34, 439–448.PubMedCentralCrossRefPubMedGoogle Scholar
  11. Cisler, J. M., Olatunji, B. O., & Lohr, J. M. (2009). Disgust, fear, and the anxiety disorders: A critical review. Clinical Psychology Review, 29, 34–46.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. doi: 10.1016/0005-7967(86)90011-2.CrossRefPubMedGoogle Scholar
  13. C-SPAN2. (2014). Dr. Anthony Fauci on Ebola [Video file]. Retrieved from
  14. Deacon, B., & Maack, D. J. (2008). The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy, 46, 537–547. doi: 10.1016/j.brat.2008.01.010.CrossRefPubMedGoogle Scholar
  15. Dennis, B., & Craighill, P. M. (2014). Ebola poll: Two-thirds of Americans worried about possible widespread epidemic in U.S. Washington Post. Retrieved from
  16. DeVellis, R. F. (1991). Scale development: Theory and applications. Newbury Park: Sage.Google Scholar
  17. Fergus, T. A. (2014). Health-related dysfunctional beliefs and health anxiety: Further evidence of cognitive specificity. Journal of Clinical Psychology, 70, 248–259.CrossRefPubMedGoogle Scholar
  18. Fox, M. (2014). Ebola fear factor: Why America needs a viral reality check. NBC News. Retrieved from
  19. Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences, 16, 701–713.CrossRefGoogle Scholar
  20. Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17, 218–233.Google Scholar
  21. Henry, J. D., & Crawford, J. R. (2005). The 21-item version of the Depression Anxiety Stress Scales (DASS–21): Normative data and psychometric evaluation in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.CrossRefPubMedGoogle Scholar
  22. Lau, J. T. F., Kim, J. H., Tsui, H. Y., & Griffiths, S. (2008). Perceptions related to bird-to-human avian influenza, influenza vaccination, and use of face mask. Infection, 36, 434–443.CrossRefPubMedGoogle Scholar
  23. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  24. Meade, A. W., & Craig, S. B. (2012). Identifying careless responses in survey data. Psychological Methods, 17, 437–455.CrossRefPubMedGoogle Scholar
  25. Moritz, S., & Pohl, R. F. (2009). Biased processing of threat-related information rather than knowledge deficits contributes to overestimation of threat in obsessive-compulsive disorder. Behavior Modification, 33, 763–777. doi: 10.1177/0145445509344217.CrossRefPubMedGoogle Scholar
  26. Niles, A. N., Dour, H. J., Stanton, A. L., Roy-Byrne, P. P., Stein, M. B., Sullivan, G et al. (2014). Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. Journal of Psychosomatic Research, 78, 109–115.CrossRefPubMedGoogle Scholar
  27. Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
  28. Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681.CrossRefGoogle Scholar
  29. Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory: Part I. Behaviour Research and Therapy, 41, 863–878.CrossRefGoogle Scholar
  30. Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory—Part II: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.CrossRefGoogle Scholar
  31. Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007a). Body vigilance in nonclinical and anxiety disorder samples: Structure, correlates, and prediction of health concerns. Behavior Therapy, 38, 392–401.CrossRefPubMedGoogle Scholar
  32. Olatunji, B. O., Etzel, E. N., Tomarken, A. J., Ciesielski, B. G., & Deacon, B. (2011). The effects of safety behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy, 49, 719–728. doi: 10.1016/j.brat.2011.07.008.CrossRefPubMedGoogle Scholar
  33. Olatunji, B. O., & Sawchuk, C. N. (2005). Disgust: Characteristic features, social implications, and clinical manifestations. Journal of Social and Clinical Psychology, 24, 932–962.CrossRefGoogle Scholar
  34. Olatunji, B. O., Williams, N. L., Tolin, D. F., Sawchuk, C. N., Abramowitz, J. S., Lohr, J. M., et al. (2007b). The Disgust Scale: Item analysis, factor structure, and suggestions for refinement. Psychological Assessment, 19, 281–297.CrossRefPubMedGoogle Scholar
  35. Reif, W., Hiller, W., & Margraf, J. (1998). Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology, 107, 587–595.CrossRefGoogle Scholar
  36. Reiss, S., Peterson, R., Taylor, S., Schmidt, N., & Weems, C. F. (2008). Anxiety sensitivity index consolidated user manual: ASI, ASI-3, and CASI. Columbus, OH: IDS Publishing Corporation.Google Scholar
  37. Robbins, M. (2014). ‘Fear-bola’ hits epidemic proportions. CNN. Retrieved from
  38. Salkovskis, P. M., & Warwick, H. C. (2001). Making sense of hypochondriasis: A cognitive model of health anxiety. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related disorders (pp. 46–64). New York: Wiley.Google Scholar
  39. Sandman, P. M. (2009). Pandemics: Good hygiene is not enough. Nature, 459, 322–323.CrossRefPubMedGoogle Scholar
  40. Schmidt, N. B., Lerew, D. R., & Trakowski, J. H. (1997). Body vigilance in panic disorder: Evaluating attention to bodily perturbations. Journal of Consulting and Clinical Psychology, 65(2), 214–220.CrossRefPubMedGoogle Scholar
  41. Scott, K. M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M. C., et al. (2007). Depression–anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. Journal of Affective Disorders, 103, 113–120.CrossRefPubMedGoogle Scholar
  42. Shrestha, S. S., Swerdlow, D. L., Borse, R. H., Prabhu, V. S., Finelli, L., Atkins, C. Y., et al. (2011). Estimating the burden of 2009 pandemic influence A (N1N1) in the United States (April 2009–April 2010). Clinical Infections Diseases, 52, S75–S82.CrossRefGoogle Scholar
  43. Taylor, S., & Asmundson, G. J. G. (2004). Treating health anxiety: A cognitive behavioral approach. New york: Guilford Press.Google Scholar
  44. Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176–188.CrossRefPubMedGoogle Scholar
  45. Van den Bulck, J., & Custers, K. (2009). Television exposure is related to fear of avian flu, an ecological study across 23 member states of the European Union. European Journal of Public Health, 19, 370–374.CrossRefPubMedGoogle Scholar
  46. Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Fabricant, L. E., & Olatunji, B. O. (2012). Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognitive Therapy and Research, 36, 210–218.CrossRefGoogle Scholar
  47. WHO Ebola Response Team. (2014). Ebola virus disease in West Africa—The first nine months of the epidemic and forward projections. The New England Journal of Medicine, 371, 1481–1495. doi: 10.1056/NEJMoa1411100.PubMedCentralCrossRefGoogle Scholar
  48. Wong, T. W., Gao, Y., & Tam, W. S. (2007). Anxiety among university students during the SARS epidemic in Hong Kong. Stress and Health: Journal of the International Society for the Investigation of Stress, 23, 31–35.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shannon M. Blakey
    • 1
  • Lillian Reuman
    • 1
  • Ryan J. Jacoby
    • 1
  • Jonathan S. Abramowitz
    • 1
  1. 1.University of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations