Learn what causes stress and anxiety and how to manage them. are generally used on a short-term basis due to the risk of addiction. Other factors that can increase your risk of developing an anxiety disorder include: Stress: Everyone encounters stress. This increases the risk of their anxiety or depression going unrecognised and . Coping with Stress and Intro to Mindfulness online courses developed by the.
Increases in Developing Anxiety Stress Risk
The race and ethnicity composition of the sample was as follows: A small percentage of participants, 1. We did not ask the students to report on their family income because the validity of their reports was unlikely to be high.
The community in which the participating middle schools reside is a uniformly lower SES community, with a per capita income of U. School records indicated that There were no differences across the two schools in demographic variables. Participants are asked to indicate which events they had experienced in the prior 6 months. Life events checklists are the instruments most commonly used to assess adolescent stress Grant et al. In addition to examining the effect of total stressful life events, we created two subscales of the Life Events Scale for Children in order to evaluate whether specific facets of stressful life events were uniquely associated with the development of anxiety sensitivity.
The first subscale included seven health-related stressful life events that involved the hospitalization of the participant or a family member for a serious illness or the death of a relative or close friend e.
The second subscale included five stressful life events that reflect family discord, such as parental separation, divorce, or increases in serious family conflict e. Each item on the CASI is rated on a three-point scale ranging from none 1 to a lot 3. Examination of the factor structure across community and clinical samples of children and adolescents supports, in addition to a general factor, the existence of four lower order factors Anxiety Sensitivity—Total; Silverman et al.
The CASI has good test—retest reliability, internal consistency, and convergent validity Silverman et al. The MASC assesses physical symptoms of anxiety, harm avoidance, social anxiety, and separation anxiety and is appropriate for children and adolescents aged 8 years to 19 years. Each item presents a symptom of anxiety, and participants indicate how true each item is for them or how frequently they experience that symptom on a 4-point Likert scale ranging from never true 0 to very true 3.
The Children's Depression Inventory CDI; Kovacs, is the most widely used self-report measure of depressive symptoms in children and adolescents. The CDI is a item self-report measure of depressive symptoms that has been standardized on children and adolescents aged 7 years to 17 years. Each item consists of three statements representing different levels of severity of a specific symptom of depression e.
The CDI has sound psychometric properties, including internal consistency, test—retest reliability, and discriminant validity Kovacs, ; Reynolds, The item pertaining to suicidal ideation was removed from the measure at the request of school officials and the human subjects committee.
Participants completed study questionnaires during their homeroom period on 2 consecutive days at Time 1 and Time 3. The Time 2 assessment consisted of fewer questionnaires and was completed in 1 day. All questionnaires used in the present analyses were administered at Time 1.
Because of our hypothesis that anxiety sensitivity would mediate the longitudinal relation between stressful life events and increases in symptomatology over time, we assessed anxiety sensitivity at Time 2 and the symptomatology questionnaires at Time 3. Four months elapsed between the Time 1 November and Time 2 March assessments, and 3 months elapsed between Time 2 and Time 3 June assessments.
This time frame was chosen to allow the maximum time between assessments and to ensure that all assessments occurred within the same academic year.
Given the transient nature of the school population, data collection within 1 academic year was necessary to avoid high attrition. Homeroom teachers and one member of the research team were present in the classroom during the assessment period. Participants were assured of the confidentiality of their responses and the voluntary nature of their participation. The role of stressful life events in the development of anxiety sensitivity was examined by conducting linear regression analyses examining stressful life events at Time 1 as a predictor of anxiety sensitivity at Time 2, including a covariate for Time 1 anxiety sensitivity.
Separate regression equations were estimated for the four facets of anxiety sensitivity disease concerns, unsteady concerns, fear of mental incapacitation, and fear of publicly observable symptoms.
Next, we examined whether certain types of stressful life events were uniquely predictive of increased anxiety sensitivity. We examined the role of health-related stressful life events and events related to family discord as predictors of anxiety sensitivity. The hypothesis that anxiety sensitivity mediated the longitudinal relation between stressful life events and symptoms of anxiety was evaluated with two mediation approaches.
First, procedures outlined by Baron and Kenny were used: After examining the full mediation model, mediation effects were examined separately for each of the facets of anxiety sensitivity that were found to significantly increase as a result of stressful life events, to determine which facets of anxiety sensitivity were driving mediation effects.
The predictive specificity of anxiety sensitivity was examined with a covariance analysis strategy, consistent with previous investigations of the specificity of anxiety sensitivity to anxiety symptom development among adults Schmidt et al.
Separate regression equations were examined for symptoms of anxiety and depression. In the first regression analysis, anxiety symptoms were examined at Time 3 as the dependent variable. Time 1 anxiety symptoms were added at Step 1 to create residualized change scores, followed at Step 2 by symptoms of depression at Time 1 and Time 3 to account for changes in depression.
Each of the four facets of Time 1 anxiety sensitivity was added at Step 3. This analysis strategy identified the impact of each facet of anxiety sensitivity on symptoms of anxiety after accounting for changes in depression over time Schmidt et al.
The second set of regression equations examined depressive symptoms at Time 3 as the dependent variable and followed the same stepped approach as the anxiety analysis. Analyses were first conducted to determine whether participants who did not complete all three assessments differed from those who did complete the baseline and two follow-up assessments.
Univariate analyses of variance were conducted for continuous outcomes, with attrition as a between-subjects factor and with demographic factors, each of the psychopathology outcomes, stressful life events, and anxiety sensitivity as dependent variables.
Chi-square analyses were performed for dichotomous outcomes. This analysis was conducted with AMOS 6. We conducted a confirmatory factor analysis on the continuously scored CASI, using the four previously identified lower order factors Silverman et al. We then constrained the factor loadings from Time 1 to be equal to the factor loadings at Time 2 and compared this model with the unconstrained model.
Table 1 displays the mean and standard deviation of Time 1 stressful life events, anxiety sensitivity at Time 1 and Time 2, and anxiety and depression symptoms at the Time 1 and Time 3 assessments, along with the zero-order correlations among variables.
As expected, anxiety sensitivity demonstrated significant concurrent associations with symptoms of anxiety and depression both at Time 1 and at Time 3 see Table 1.
The four facets of anxiety sensitivity were then examined in separate regression analyses. Next, we examined whether certain types of stressful life events were differentially predictive of increases in each of the facets of anxiety sensitivity. The impact of health-related stressful life events, involving serious illness or death, was examined first. To ensure that the longitudinal association between stressful life events and anxiety is not an artifact of the association between anxiety sensitivity and anxiety, we added a covariate for Time 1 anxiety sensitivity to the model.
Disease concerns and mental incapacitation concerns, the two facets of anxiety sensitivity that increased as a result of stressful life events, were examined separately as mediators of the relation between stressful life events and increases in anxiety symptoms. Mediation was also supported for the mental incapacitation facet of anxiety sensitivity.
The general factor Anxiety Sensitivity—Total accounted for 1. Thus, the association between anxiety sensitivity and anxiety symptoms was driven largely by the general anxiety sensitivity factor and, to a lesser degree, the facet reflecting concerns about feeling unsteady.
See Table 2 for all beta weights and step statistics. Of the variability in depression that was accounted for by anxiety sensitivity, less than.
In sum, anxiety sensitivity was prospectively associated with symptoms of anxiety but not with depression. In the current investigation, we sought to address several gaps in the literature on anxiety sensitivity among adolescents.
The first goal was to examine stressful life events as a contributor to increased anxiety sensitivity. As hypothesized, the experience of stressful life events was longitudinally associated with increases in anxiety sensitivity. To our knowledge, this study is the first to identify stressful life events as a factor associated with the development of anxiety sensitivity in adolescents.
Although previous studies have identified uncued panic attacks as a factor predicting increased anxiety sensitivity among adults Schmidt et al. As such, these findings provide novel information regarding the development of anxiety sensitivity among adolescents, providing evidence for the role of environmental factors. What are the pathways that explain the association between stressful life events and the formation of negative beliefs about the consequences of anxiety symptoms?
A similar process may lead to the development of elevated anxiety sensitivity, wherein stressful life events increase attention to bodily cues of anxiety and anxiety-related cognitions. This increased attention, paired with greater focus on the causes and consequences of anxiety symptoms, may lead to the development of negative beliefs about the consequence of anxiety symptoms.
Anxiety sensitivity, in fact, shares many features with certain types of repetitive self-focused thought Watkins, These processes each may lead to similar cognitions and self-statements during periods of self-focus e.
As such, it is likely that similar environmental events i. We also examined the association between specific types of stressful life events—including those related to physical health and family discord—and the subsequent development of anxiety sensitivity.
The results documented that these two types of stressors were differentially associated with certain facets of anxiety sensitivity. In particular, health-related stressors were predictive of fears of disease and mental incapacitation, whereas stressors associated with family discord predicted fears of unsteadiness, mental incapacitation, and social concerns.
To our knowledge, this is the first study to document associations between specific stressors and unique facets of anxiety sensitivity. Given the novelty of these results, little is known regarding the reasons underlying the differential associations between types of stress and anxiety sensitivity. However, existing research on stressful life events points to several possibilities.
For example, the perception that stressors portend danger is uniquely associated with the development of anxiety disorders Brown, Health-related stressors may be particularly likely to elicit feelings of impending danger, which could in turn lead to greater attention to, and fears surrounding, the anxiety symptoms that result from these stressors. These types of stressors may be particularly likely to increase attention to symptoms that appear to portend disease or health problems.
Moreover, stress associated with dysfunctional family relationships can disrupt the normative development of social competence Repetti et al. These hypotheses should be pursued in future studies examining relations between the type and meaning of stress and the development of anxiety sensitivity during adolescence. These findings extend the literature on stress and adolescent psychopathology in several important ways.
Adolescence represents an important period in which to examine mechanisms linking stress to the development of psychopathology. Adolescence is characterized by higher risk for the development of psychopathology Hankin et al. The relation between stress and psychopathology among children and adolescents is well-established Grant et al. Our findings suggest one intrapersonal mechanism linking stress to anxiety symptomatology.
Specifically, elevated perceptions of anxiety symptoms as dangerous and portending negative physiological consequences served as a mechanism underlying the relation between stressful life events and anxiety symptoms.
The global anxiety sensitivity factor, as well as concerns about disease and mental incapacitation, mediated the association between stress and the development of anxiety symptoms. These results have potentially important treatment implications. In particular, they suggest that preventive interventions that focus on attenuating anxiety sensitivity may help to reduce stress-related psychiatric morbidity in adolescents.
Evidence-based treatments such as cognitive-behavioral Barlow, and emotion regulation Mennin, interventions may be particularly effective in enabling adolescents to more adaptively challenge and manage their negative beliefs about the harmfulness of anxiety symptoms following stressful experiences. Stress inoculation training Meichenbaum, represents an additional evidence-based intervention that may prove effective in decreasing adolescents' anxiety sensitivity following stress.
This training teaches a variety of coping skills that are applied and practiced with target fears, which could include beliefs about the deleterious consequences of anxiety symptoms subsequent to life stressors. A final contribution of this study was the examination of differential relations between anxiety sensitivity and depressive and anxious symptoms in adolescents.
Prior research examining the predictive specificity of anxiety sensitivity has been inconsistent, with some research documenting that the association between anxiety sensitivity and depressive symptoms disappears after anxiety symptoms are added to the model Pollock et al. Existing studies among adolescents have relied exclusively on cross-sectional data Weems et al.
Anxiety sensitivity was associated longitudinally with the development of anxiety symptoms in our sample, and this association was explained largely by the general anxiety sensitivity factor. Concerns about feeling unsteady also contributed to the longitudinal relation between anxiety sensitivity and anxiety symptoms. In contrast, anxiety sensitivity was not associated longitudinally with symptoms of depression when covariates for anxiety were included in the model.
These findings indicate that anxiety sensitivity serves as a unique vulnerability factor for anxiety, but not depressive symptoms, among adolescents. This study had a number of important methodological strengths that contribute to our understanding of anxiety sensitivity among adolescents and that expand on the literature examining mechanisms linking stressful life events and adolescent psychopathology.
A large sample with substantial racial and ethnic diversity participated. However, limitations of the current study must also be acknowledged. The first is our use of self-reported symptomatology.
Our use of a self-report checklist of stressful life events represents an additional limitation. It is important to note that the questionnaire in our study is among the most widely used self-report measures of stressful life events in adolescence Hammen, Additionally, the stressors measured are predominantly external, environmental changes or conditions and, consequently, are not confounded with subjective appraisals of the stressor Grant et al.
Further, stress checklists represent the most reliable methodology for assessing stress in large community samples in which stressor interviews are prohibitive in time and cost Grant et al.
Nevertheless, stressor interviews, which capture more objective indices of stressors as well as the level of threat associated with these stressors, would represent a methodological improvement and should therefore be used in future studies Hammen, In particular, stressor interviews could establish timing of stressor onset and duration of stressors in relation to the development of anxiety sensitivity and anxiety disorders, an important avenue for further study. In addition, the stress measure we used did not allow us to examine trajectories of stressful life events over time, given that it asked about stressful life events in the preceding 6 months, and our assessment intervals were spaced at shorter intervals.
Future research examining trajectories of stressful life events may help us to further elucidate the relation between stress and anxiety sensitivity to determine whether chronic versus episodic stress is more strongly related to the development of anxiety sensitivity. Finally, these results warrant replication. We identified a sample on the basis of the willingness of the school district to participate and the diversity of the student body.
Replication is necessary to ensure that these findings generalize to other samples of adolescents. In sum, the current study identified stressful life events as a factor related to the development of elevated anxiety sensitivity among adolescents. Specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety.
In addition, anxiety sensitivity was uniquely related to prospective increases in anxiety symptoms but not symptoms of depression, confirming previously reported cross-sectional associations in a longitudinal design. Finally, this study identified anxiety sensitivity as a mechanism linking stressful life events to increases in anxiety symptoms among adolescents, suggesting important avenues for intervention research targeting stress-related symptomatology among adolescents.
National Center for Biotechnology Information , U. Author manuscript; available in PMC Jun 7. McLaughlin and Mark L. Author information Copyright and License information Disclaimer. Department of Psychology, Yale University. Correspondence concerning this article should be addressed to Katie A. The publisher's final edited version of this article is available at J Abnorm Psychol. See other articles in PMC that cite the published article. Abstract Anxiety sensitivity represents a robust risk factor for the development of anxiety symptoms among both adolescents and adults.
Method Participants The sample for this study was recruited from the total enrollment approximately students of two middle schools Grades 6—8 from a school district in central Connecticut that agreed to participate in the study students in self-contained special education classrooms and students in technical programs who did not attend school for the majority of the school day were excluded. Depressive symptoms The Children's Depression Inventory CDI; Kovacs, is the most widely used self-report measure of depressive symptoms in children and adolescents.
Procedure Participants completed study questionnaires during their homeroom period on 2 consecutive days at Time 1 and Time 3. Data Analysis The role of stressful life events in the development of anxiety sensitivity was examined by conducting linear regression analyses examining stressful life events at Time 1 as a predictor of anxiety sensitivity at Time 2, including a covariate for Time 1 anxiety sensitivity.
Results Preliminary Analyses Analyses were first conducted to determine whether participants who did not complete all three assessments differed from those who did complete the baseline and two follow-up assessments. Stressful life events Time 1 — 2. CASI anxiety sensitivity Time 1. MASC anxiety Time 1. CDI depression Time 1.
CASI anxiety sensitivity Time 2. MASC anxiety Time 3. CDI depression Time 3. Open in a separate window. Discussion In the current investigation, we sought to address several gaps in the literature on anxiety sensitivity among adolescents.
Footnotes 1 We tested two alternative models in which Time 1 anxiety sensitivity a moderates the effect of stressful life events on anxiety sensitivity at Time 2 and b moderates the effect of stressful life events on Time 3 anxiety symptoms.
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Cognitive Therapy and Research. Child Anxiety Sensitivity Index: Considerations for children with anxiety disorders. This content does not have an English version. This content does not have an Arabic version. Overview Experiencing occasional anxiety is a normal part of life. Request an Appointment at Mayo Clinic. American Psychiatric Association; National Institute of Mental Health. Mayo Clinic, Rochester, Minn.
National Alliance on Mental Illness. Help with anxiety disorders. Reinhold JA, et al. Pharmacological treatment for generalized anxiety disorder in adults: Expert Opinion in Pharmacotherapy. Bandelow B, et al. Efficacy of treatments for anxiety disorders: Bazzan AJ, et al.
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Complementary and alternative treatments for anxiety symptoms and disorders: Pharmacotherapy for generalized anxiety disorder in adults. Sawchuk CN expert opinion. Related Mental health providers:
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