Anxiet y Sensitivity and its Unique Relationship with Panic Disorder . Generali zed Anxiet y Disorder. Social Anxiety Disorder. and Depression by

AnxietySensiti vity andits Unique Relationship with Pan icDisorder .GeneralizedAnxiety Disorder.Soc ialAnxietyDisorder. and Depression

by

in pan ialf ulfillmento f the requirementsforthedegree of

(CounsellingPsychology) MemorialUniversity of Newfoundland

August 20 1I

There hasbeensignificant interestin the uniquerelati onshipthatanxietys ensitivity( AS) ho lds with the anxiety disorde rs and depression .Anxiety sensitivity isthe fearof arousal-relatedbodily sensations due tothe personalbelief thatthese symptomswill produceharmfulconsequences suchasthelossofcognitive contr ol,n egati vephysical symptoms,andthefearof publicly obse rvablesymptoms(Re iss,1991).Curre nt researchhas exa mined therelation shipbetweenAS andanxiety disord ers and depressionand has found that highleveIs ofAS are associatedwiththe developmentof panicdisorders,social anxiety,gene ralizedanxietydisorder,and depression (Maller&Reiss,1992;Olatunji&Woitzky-Taylor, 2009;Taylor,Koch,Wood y,&McLean, 1996);howev er,limited researchhas examined the threefacet s ofAS and howthey relate to specific anxietydisord ers and depre ssion .The presentstudy examined three specificanxiety symptom clusters (panic,genera lized anxiety,andsocialanxie ty) and depressiv e symptomsand theirrelat ionship with the threefacets ofAS (fearofphysical symptoms ,socialconcerns,and fear ofcognitiv edyscon trol).It was found thatthe fearofphysicalsymptom s compo nentof AS was corre latedwith panic,aswashypothesized ,butalsocorre lated withsocialanx iety symptoms andgenera lizedanxietysymptoms.Consistentwith hypotheses,fearofpublicly observab le symptoms,orthesocialconcernscomponentofAS, was correlated withonlyone clusterof

symptoms,socia lanxiety.Lastly,fear of cognitivedy scontrol wasunexpectedly foundto corre latewith panic andsymptomsofsocialanxie ty;however,it did not corre late with genera lizedanxietyordepressive symptomsaspredicted in thehypothesis.Theseresult s, although prelimin ary , suggestadegree of specifici tywithrespect to howthevariouscom ponent s of AScorrelate withspecificanxietyand moodsymptoms. Future workin this areamigh t be

ANXIET Y SENSITIVITY.ANXIETY.AND DEPR ESSION

usefulin preventat iveeffortstoaddressaspectsofAS that serveas spec ificrisk factors for these

Acknowledgements

First, I wouldliketothank my supervisors,Sarah FrancisandGregHarris fortheircontinuous guidanceandencouragementduring my Master's thesis.Your knowledge, understanding and suggestionsmade thisthesis possible.

Tomy mentor,and more importantly,my friend,ValerieNoel, Iwould liketo say thank you so much for always beingthere forme.You have wentabove and beyondyour duty as a friendand a colleague,and I hopethat someday Iwill be ableto showyoujust howmuch your help and continuedsupportmeansto me.

Iwouldalso like to thank themembers ofthe MIRIAMlab and Dr.Peter Mezo whohelped me

through the process of writing my thesis andwho graciouslyprovided mewithaccess totheir databaseandsuperior knowledge onanxietyand depression.

Last, butnotleast,Iwouldliketothank my familyfor their undying support. Thisincludesmy momand dad foralways encouraging meto believe in mydreams.my sisterErikawho has been my rock andalwaysseems tohavetimetolisten,and my fianceJohnforhavingfaith in meand always makingme smile. You guysare thebestfamilythata girlcouldaskfor and I would n'tbe where la m todaywithouteac ha ndeveryoneofyou.

,e"nn,"I.~ n.~.nt.

'i.'nfT.h' 'idnfl hh•• "i.tinn.

';d ln~

,et; ,

,n vl "ih'

:..~~.n,

P.t•••nnr...""/&

'e",.II"10 0 '" 17

10 0 0 . ,

OOOh'

""'7'

,n

,n

71

"

"

'n . b 10 m

"

"nn"Ri.11Innrny 71

,no~, 7>

1000' D.

1>. ...

rnoo.l.tinn'nol". i.

!>.n••••inn'n.I".i.

ni.e... . inn

I'.."n.n l••etinn.

Correlations,descriptive statistics,andreliability estimatesof the Depression AnxietyStressScales-21(DASS-21) ,the Penn StateWorry Questionnaire (PSWQ),the SocialInteractionAnxietyScale (SIAS), and theAnxiety Sensitivity

Index (ASI) (N=410) 26

Independent-samplet-teststesting sexdifferencesonthe Depression Anxiety StressSc ales-21 (DASS -2I anxiety scaleandDASS-2Idepression scale)th e Penn StateWorryQuestionnaire (PSWQ), the SocialInteractionAnxiety Scale (SIAS), theAnxiety SensitivityIndex(ASI)·Fear of physical symptoms, the AnxietySensitivityIndex (ASI)-Social concernsand theAnxietySensitivity

Index (ASI)· Fear ofc ognitived yscontrol.. 28

One-wayanalysis of variance testi ng differencesbetw eenmethodsofpr esentation of the questionnaire bauery (paper,o nlinero und l, ando nline round2)on the DepressionAnxietyStressScales-21 (DASS-2 1anxietyscaleand DASS-21 depression scale) the Penn State WorryQuestionnaire (PSWQ), the Social InteractionAn xietyS cale (SIAS), andth eAnxietyS ensitivityIndex (ASI)-Fearof physical symptoms, theAnxietySensitivityIndex (ASI)-Social concernsand the AnxietySensitivityIndex (ASI)- Fear of cognitived yscontrol 30 Regression Analysis predictingDASS-2ld epression 31 RegressionAnalysispredictingPenn-StateWorry Questionnaire RegressionAnalysis predicting theSocial Interaction AnxietyScale Regression Analysis predictingDASS-21 AnxietyScale controllingfor theDASS

-21 DepressionScale 34

ANXIETY SENSITIVITY,ANXIETY,AND DEPRESSION

AnxietySensitivity AnxietySensiti vityIndex

ASI· Phys icaI AnxietySensitivity Index-Ph ysicalConcernsSubscale Anxie ty Sensitiv ityIndex-Soc ial Concerns Subscale ASI-Cogniti ve AnxietySensitivityIndex-Cogn itiveConcern sSubscale

Anxiety Sen sitivityProfile Anxiety SensitivityIndex-J Anxie ty SensitivityIndexRevised GeneralizedAnxietyDisorder PSWQ Penn State WorryQuestionn aire

SocialInteractionAnxietyScale DepressionAnxietyStressS cales-21 DepressionAnxietyStressS cales-21·AnxietySubscale DepressionAnxietyStressScales-21-Depr essionSubscale

ANXIETYSENSITIVITY,ANXIETY,AND DEPRESSION

LislofAppendices Appendix A:Demographic Information Sheet....

AppendixB:UndergraduateInformed ConsentForm....

AppendixC:PennStateWorryQuestionna ire....

AppendixD:DepressionAnxietyandStressS cales-21...

Appendix E:AnxietySensitivity Index .... . Appendix F:SocialInteractionAnxiety Scale....

Appendix G:StatisticalAnalysisthe DifferencesBetweenthe Sexes...

Anx iety Sen sitivity and its Unique Relationship with PanicDisord er , GeneralizedAnxiety Disord er , SocialAnxiety Disorder , and Depr ession Anxiety isdefin ed as a genera lizedmood condition that canresult ina stateofintense apprehe nsio norworry often accompanie dby physical sym ptomssuc has shaki ng,sweatingand intensephysio logica lfeelings in the body(Bar low,2(02).Anx ietycanbea very distress ing experienceandcan ofte noccurwitho Ulan identi fiabl e triggering stimu lus . When anxiety becomesexcessive,and beginsto interfere withanindivid ual's dayto day func tioning,thenitis conside redan anxietydisorde r(Natio nal Inst itute ofMen talHealth,20ll).Inordertodetermine whet he ranxietyis a normal or abno nn alreaction. the intensityandreasoning behi ndit has tobe evaluated(Barker,2(09).Anxietydisorde rsare common psycho logica l probl em s witha prevalenceof25percentinthe genera lpopulation.According tothe National lnsti tuteof Me nta l Health (2011) there are five specifictypes of anxiety disorders:GeneralizedAnxiety Disorder, Obsessive-CompulsiveDisorder(OCD), PanicDisorder,Post-Traumat icStressDisorder (PTSD) andSocial Phobi a (or SocialAnxietyDiso rder).

Anxietydisorders represent a majorconcemin regards to public health. The prevalence, persistence,andrecurrence of anxiety disorders createa socialandeconomicburden that affects not only the suffe rers butsociety as a who le(Smite ta l.,2006).Aspreviouslymentioned, physica lsymp tomscan become severe andpreventanindividu al fromfunctio ning.In addi tionto physica lsymptoms,anxie tydisordershave profoundpsychologicalimplica tio nsforan indi v idual. Someonesuffe ring from an anxiety disordermay experi ence constan t ten s ion s and worry.decreasedconfi dence.increasedse lfconsciolls ness,initability,i nsomnia,andthe inabi lity to concentrate(America n Psych iatric Association, 2000).These ind ivid ua ls may also beginto avoidstressprovokingsituations,distancethemselvesfrom familyand friends,andstop

partakinginactivitiesinwhich theyusedto enjoy(AmericanPsyc hiatricAssocia tion, 2(00).

Because of theimpact thatanxiety disordershave onoursociety,itis ofthe upmostimportance that wegainfurther insightinto their causeandstructure.

Incontrast to anxiety,anxietysensitivity(AS) isthefear of arousal-relatedbodily sensations due tothe personal belief thatthese symptoms will produceharmfulconsequences suchastheloss of cognitive conrrol,n egativephy sical symptoms,and the fear of publicly observa blesymptoms(Reiss,1991).Taylor(1999) describes AS as "atraitlike cognitive characteristic that amplifiestheintensityof specific anxiety symptoms and thusbuildsup the perceptionofanxietyreactions"(Tay lor, 1999,p. 264).Considerablere searchhas gathered support for therelationshipbetweenanxiety disorders and AS.Thereiationship between AS and specificanxiety disordershas beenshownin numerous studies thathavefoundthathighlevels of AS are associated withthedevelopment ofpanicdisorders, socialanxiety,generalizedanxiety disorder, and post-traumatic stress disorder (Maller&Reiss,1992;Olatunji&Woitzky-Taylor, 2(09).Inaddition totheanxietydisorders, eJevated levels of AShavealsobeen observedamong patients with majordepression relative to controls(Tay lor,Koch,Woody,&McLean,1996).

Thisfindingled Taylorandcolleagues(1996) toquestionthestructure ofAS and howit relates to notonly the anxietydisorders,butalso depression.Taylorand colleaguesarguedthattwo facets of AS(fearofpubliclyobservablesymptomsandfear of physicalsymptoms)arespecific to anxiety while the thirdfacet (fearofcognitive dyscontrol)is specific todepression.Although more recent researchhas shown thatthefear of cognitived yscontroIpredictedbothdepressive andanxioussymptoms(Schmidt,Lerew&Joiner,1998) andsuggested thatdepressionmay also belinkedtothefear ofpubliclyobservable symptoms(Viana&Rabian,in press), the specific mechanism of these relationshipsstillremains unclear (Olatunj i&Woitzky-Taylor,2009).

This studyseeks todete nn ine if the comorbiditybetweenanxietyand depression is accounting for thecorrelationsobserved betweendepressive symptoms and facetsofASor whether aunique relationship exists between depressivesymptomsand facets of AS.

Specifically, this studywillexamine threespecific anxietysymptomcl usters (panic,generalized anxiety,andsocialanxiety)and depressive symptomsand theirreiationship with the facetsof AS. Althoughanxiety related bodily sensationsoccur in a number0fcontextsand all five of the anxiety disorders may be associated with these symptoms tovaryingd egrees,th ep resentstudy hasdecidedto concentrateononly three oftheanxietysymptom clusters(panic,g eneralized anxiety,andsocial anxiety).Posttraumatic stressand obsessive compulsive symptomswere not includedin thepresentstudybecause research hasnot shown a clearcasualv iewof thero leof specific dimensions of AS in thedevelopment ofthese symptoms, instead showi ngthatwithin these symptomconstellations, differentASfacets may serve differentpredicti ve functions, whichisoutside of thescopeof the present study(Ozer, Best,Lipsey,& Weiss,2003;Taylor et aI., 1992;Vuja novic, Zvolensky, & Bernstein,2 (08 ).Tos tudy the uniquerelationship that AS haswith thesethree areasof anxiety and with depressive symptoms,thehierarchical structureof AS thatwas suggestedby Olatunji & Woitzky-Taylor(2009)will beused.Thismodelproposes that the threefacets ofASare nested beneaththehigher order factorsofnegative affectand trait anxiety.More specifically, this studywill investigateif AS-fearofc ognitived yscontrolis independently associated with both anxietyand depressivesymptoms.Consistentwith the theory thatwasproposed by Olatunji &Wolizky-Taylor (2009)it waspredictedthat afteran investigationintothethreelowerfactors of AS(AS Physical Concerns,ASCognitiveConcerns and AS Social Concerns) this studywouldshowa correlationofeachfactorwithaparticular anxietysymptomcluster. Itwaspredictedthattherewouldbeacorrelationbetween fear of

physical concem s andPanic,fear ofpublicly observablesymptoms andS ocialAnxiety,and fear ofcognitive dyscontroland both Depressive symptoms and GeneralizedAnxiety sep arately.If it isfoundthatdistinct AS dime nsionscorre spondto specifi c anxietyord epressivesymptoms,this inform ationmight subsequently inform effortstodevelop specifi c intervent ionsto targeteachof thesedimen sion stotreat and prevent specificanxietyand depressivesymptom cluster s.

AnxietySensilivily

The constru ct ofASoriginated fromReiss and McNally ' s(1985) elaborationof Goldstein andChambless'(1978) conceptof the fear of fear (Reiss,1991;Reiss& McNall y, 1985 ).In theirarticle,theyproposedthat the fear offearcan beseparatedinto two compo nent processes called anxiety expectancyandanxie tysensitivity(Reiss &McNall y,1985 ).ASh as beendefined asan individualdifferen cevariablebased on the belief thatanxietyrelated symptoms( increased heartrate.s weating.dizziness) have harmful,if notca tastrophic conse quences(Reiss&McNally,1985).Reiss and McNall y (1985) reportedthat theybel ieved that an individualdifferencevariable cons istedof thebeliefthatthe experienceofanxietyand fearcauses illness,embarrassment , oradditionalanxiety (Reiss,Peterson,Gursky, &McNall y., 1986).For example,a personwithhighASmight perceive aracing heartb eatasan indicationof an impendin gheart attack, mayfear sweating bec auseit will lead to humiliation.or mayfear

worry ingbecause itwillvalida te the beliefthattheindividual is10singcognitivecontrol (O latunj i& Wolizky-Tay lor,2009).

Following theintroduct ion ofAS,adebatebegan in theIiteraturediscussi ng whether AS andtraitanxiety areindepend ent construc ts. Reiss,Peter son ,Gursky, and McNally (1986) used thenewly constructed Anxiety Sensitivity Index (ASI: Reiss,Peterson,Gursky , & McNally, 1986)toarguethatbecauseAS only mode rately correlates withtrait anxiety,AS and trait

anxie tyaredistinct constructs.To stre ngthenthis argume nt,researchers demonstratedthat AS pred icted certa incond itions that are com pletelyindependent from traitanxiety,suchas panic attacksandanxietyreactions toproc edur es thatanindividua lfindschallen gin g (Brown & C ash, 1990 ;R eiss et al.,1986). In contr ast,Lilienfe ld,T urner , andJ acob (1993) argued that AS and trait anx ietymay notbe distinc tconstructs. They statedthat many0ftheearlyfindings tha trelate AS to anxietydisorders couldpossibly bedue to the effectsoftrait anxietyandsimilar unmeasured variables.As suc h,theycontendedthat AS sho uld be viewed as a lowerorderfacet of trait anxietyandnot as a complete lyindepen dentconstruc t(Li lienfeld,Tu rner,&Jacob, 1998). Afterman y years ofdiscu ssion,Lilienfie ldandcolleag ues(199 8) summarize dthe debate in theirreviewof AS in the ad ultpopu lationin199 8.They stated thatthere isnow a consensus intheliterature thatalthoughAS and trait anxiety are moderatelycorre lated,ASdoescontrib ute to thepred ictionof certa inanxie tyand mood disordersabove andbeyondtraitanxiety, thereby making ita nindependentconstruct. The debateconcerning the cons tructofAShasleadto extensive researchintohow the anxiety disorders are associatedwithAS andhas encouraged further research into thisun ique relations hip .

AS is theorized to manifest from the comb ina tionof gene ticpredispos itions (Stein, Jan g,

& Livesley,1999) andlearn ing experiences that result intheacqu isition of beli efs aboul potentialharrnful effects ofautonomicarousal(St ewart,eta l.,2ool).To studytherelationship betwee n heri tabili ty andAS, researchers have usedthe strong predictiverelatio nshipofASand panicdisorder.There is anabunda nceof empirica lsupport forthe roleofASinpanic disorder (e.g.. Parker & Swanson,1996 ; Maller&Re iss,1992; Eke &McNally,1996;Schmid t,Lerew,

& Jackson, 1997; Schmidt, Zvolensky,&Maner, 2006; Taylor,1995) andresearche rs have used twin studiestodemon strate thatpanic disorderrunsin families.Specifically,ithas been

proposedthat patient swith pan icdisorderinherita phys iologicalor biolog ical riskfactor for panic (Fyer, Mannuzza, Chapman , Martin,&Klein,1995 ;Weissman,1988;Vieland,Goodm an, Chapman,&Fyer,1996).Otherstudies(e.g.,Stein,lang,&Livesly,1999)have shownsimilar results reportin gthat aherit abl e compo nent account ed for 45%of the varian cein AS levels of twins.Ad diti onall y,intheir study ontheh eritab ility of AS intwins,Steinandcolleag ues (1999) concluded that AShasastrong heritabl e compone ntand thatitaccountedfornearlyhalf ofthe variancein totalASscores.They cautio ned that even thoughASseemstomanifest fromgenetic predi spos ition s,uniquelearningandenviro nmentalfactorsalso need tobe takeninto consideration(Ste in,et al., 1999).

It hasbeenproposedthatinstrum entallearning (direct learnin gwherebehaviouris acquiredoreliminatedbyits consequences.e.g.•positiv eornegativereinforcement )and vicariouslearnin g(learningbyimitating orwatching) mayinfluencethe development ofAS (Bandura ,1986).Research in this area has suggested thatwhencompared toindividualswithlow levels of AS,thosewithhigherlevels of ASreportedmoreinstrum ental andvicarious conditioningexperiences that involve parent alreinforcem ent and modeling ofboth anxiety- related and non-anxiety somaticsymptoms(Watt,Stewa rt,&Cox, 1998 ;Watt&Stewa rt,2000).

TherelationshipbetweenAS,earlychildhood learn ing experiences,andpan icdi sord erwas studied byStew artetal.,(2001) who used structuralequation mode lingtotest if the frequencyof panic attacks(whic hare correlatedwith AS)was affected by childhood learningexperiences.

Their resultsprovide additiona lsupportfor the theorytha t ASis reiated to early learning experiences; they found thatlearninghistoryfor arousa landre active somaticsymptoms directl y influencedboth AS and pan icfrequen cy.Theresearchintoth em anif estation and development of

ASis extremely import anttonotebecauseitsheds light on the relationships betweenASand speci ficanxiety disordersand hasledtoextensiveresearchin this area.

Therelationshipbetween AS and anxietyhas beenvery wellestabli shed inadult popul ations over the past fewdecades.Recentresearchhasshownthatadults withanxietyand certain mooddisorder shavehigherlevels ofASwhen compared to individuals withother mood disord ers (Ta ylor, 1995;Lillenfield,Turner&Jacob,1998 ).Furtherm ore,AS was originally propose das aspecific vulnerability traitfor panicdisord erbecauseelevated levels of AS have been showntobe associated withpani c attacksamongnon-clinical ind ividuals (Ta ylor,1995;

Taylor, 1999).Thereisa large amountofresearchto support thistheory.Specificall y, studies have show n thatAS ispredictive ofafearfulrespon setobiological challenge procedur esin non- clinical individuals and inducespan ic attacksamo ng thosewith panicdisord er (Zvolensky, Feldn er, Eifert,&Stewart , 200 1;Rassovsky,Kushner,Schw arze,&Wangen steen , 2(00).In Maller and Reiss' s (1992) researc h theyfoundthat stude nts with elevatedlevels ofAS werefive timesmorelikely tohave an anx ietydi sord erin 3year s.A morerecents tudy reportedthat elevatedlevelsof AS in non-clinic alpatientspredicted aclinicalanx iety disorderdiagnosis 24 month s after theinitial assessment (Schmidt,Zvolensky,&Maner,2(06). Otherresearch showed that elevatedlevels of AS havebeen show n in depression. genera lized anxietydisorder, post-traum at ic stressdisorder, socia lanxiety disord er, ando bsessiv e compul sivedisord er and that AS predictstheonsetof certain mood andanxie tydisorders(e.g.,Arnir, Coles,&Foa,2002;

Calama ri,Rector,Woodard , Cohen,&Chik,2008;Hazen ,Walker,&Stein,1995;Maller&

Reiss,1992;Rodri guez,Bruce,Pagano,Spencer,&Keller,2004;Viana&Rabian,2008; Wald

&Taylor,2(0 7).

Knowledge of the rel ationshiphetweenAS and thespeci fic anxietyd isorders is extremely important becau seifdistinctAS dimensionsarefound to correlatewithspec ific anxietydisordersor depression,thenspec ific hehaviour alinterventionsa nd treatmentscan be deve!opedto treatand prevent spec ificanxiety relateddisorders(01atunj i & Wo lizky-Taylor, 2009).The benefit sof treatment and prevention ofAS in panicdisorderpalientshasbeen shown in recent studies.These stud ies havereportedthat theuse ofcognitivebehavi ouralth erap y (CBT) hasbeen successf ulin reducin gthe symptomsof AS andin tum,loweringtherisk and severityof panicattacks(Smits, Powers, Cho, &Teich,2004 ; Smits,Berry,Tart,&Powers, 2(08) . To furthe r theresearchin this area,Schm idt, andcolleagues(2007) conducteda longitudin al study totargetAS reduct ionusingparticipantswhohad highlevels of AS.Intheir study,theyrandoml y assigned parti cipant s into two groups,one which receiv ed anintervention designed toreduceAS and theotherwho recei vednointervention.Theirresultsind icated a greater redu ction ofAS in thegroupwho receivedtheintervention whencomparedwith the group whorece ivedno interventionaftera 24month period.Althoughthis research shows how hehaviouraltreatment s and interventions can helplowerASin pat ientswhosuffer from pani c disorder,literature on howitcan helptheothe ranxietydisordersislimited.The limitedamount ofliteratu re ava ilableexamini nghowCBTco uld benefitallofthe anxietydi sorder si st roublin g becau se ofthe high prevalenceand persistence ofanxiety disordersin our society.Thepresent studyaims toaddress these conce rnsbylearningmore abo ut theunique relation ofASto each individualanxiety symptomclusterand depressive symptoms.

Inorder tounderstandthe relationship sbetween ASand the anxiety disorder s and depression, one mustfirstunde rstandtheunderlying structure of AS.ln the past few deca des,

therehas beenan ongoi ngdebate concerning the structureof AS.Itwas initiallyarguedthat AS is one dimen sional , consisting ofasing lefacto r(McNa lly,1996 ;Reiss,Peterson,Gursky,&

McNally,1986). This argument , however, is nolonger the consensusamo ngthose whostudy AS.Morerecentl y,the struc tureof AS has been suggestedto be multidimensio na l,cons istingof separateanddistinctfactors that appearto be hierarchical in natu re(Lilienfe ld,1996;Lilienfeld et aI.,199 3).Olatunj i&Wolizky-Tay lor(2009) have suggested that ASis composed of a unifactorialstruc tureat the higherorder level and a multidimens ionalstructureat thelowerlevel.

They goonto sugges ttha tthe threemost replicable lower orde r Afl di mensionsloadontoa single higherorder factor (i.e .,a genera lAS factor) and consist0fthefollowi ng:(I)fearof physicalsymptoms,(2) fear of publiclyobservablesymptoms, and(3) fearof cognitive dyscontrol.This model of AS contends that an individualcan be fearfu I of anxiety related sensationsingeneral,specificaspectsoftheanxietysensations( Le.,profusesweating),orboth (Deacon& Abramowi tz,2(06). Studies have shownthat a multi-dimens ionalandhierarc h ica l modelofAS provides a much better fitto the existingdata (e.g., Rodriguez,Bruce, Pagano, Spencer,&Keller,2004).Since thepresent studyislook ing at thenature of the relat ionship betwee nanxie tyanddepressive symp tomsand thelo wer facets of AS, this is the modelthatwill be used to examinehoweach symptomclusteris relatedto each of the three subscalesofthe AnxietySens itivity Index (ASI)(i.e.,fear of physica lsymptoms,fearofpubliclyobservable symptoms,andfearofcognitivedyscontrol).

Anxietyand Depression

Wheninves tiga tingspecific anxietydisordersand theirunique relationsh ips withAS, the inclusionof depression isnecessary.Althoughdepression is categorizedas a mood disorde r,its comorbid itywithanxiety makes itsignificantwheninvestigatingthe multi-facetedstructureof

AS.The close knit relation ship ofanxietyand depressionhasbeen repeatedlydemonstrated over the pastfew decades.Through studiesof patientsin primary care and the co mmunity.researcher s havefoundthat of theindividua ls whomeet the criteria formajor depr ession ,50%in the communityand75%in primarycarecenters alsomeet the diagnosticcriteriaforananxiety

disord er (Hirschfeld.200 1). Numerous other studieshave supported thesedata. show ingthat comorbidity between anxietyand depressionisnot the excepti on,but therule (Brown & Barlow.

1992;Brown,Campbell.Lehman.Grisham,& Mancill,200 1; Maser&Cloninger , 1990).

Majordepressionisdescribed asamooddisord erin whichfeelin gs ofsadness.Ioss.

angeror frustrati onimpedeaperson's functioningin theirday-to-daylife forlong stretchesof time (Americ an Psychi atricAssociat ion, 2000). Symptoms ofdepressionincludeconsistent irritable mood.recurring thoughtso fs uicide or dea th,feelingsof hopeless ness, we ight lossor gain,slowedoragitated physicalmovements,se lf-hateand feeli ngs ofworthlessnes s,lack of energy,difficultyconcentrating. and trouble sleeping orexcess ivesleepin g (American Psychiatricassociation,2(00). Not unlike anxiety, depressionistheorized tooccur throu gh a combin ation ofgeneticsand learnedbehav iou r and ismost often triggered by a stressfulor unhappylifeevent (Fava, Rafanelli,Tossani,&Grandi.200 8).

The comorbidit y of anxietyand depressioncreatesmajor barriersinthediagno sisan d treatment ofboth disord ers.It hasbeen reporte d thatindividual swho suffer frombothdepression andananxiety disorder have ahigher severityofillness.reducedfunctionin gatwork,and decreased socia l functionin g (Brown,eta l.,2 oo 1).Comorbidityo f thesedisorder shasbeen show n toincre asethe severityofeachdisorde r, slow recoverytime,andincreasethelikelihood ofarelapse onceanindividual has recovered(Kess ler, Stein,& Berglund,1 998;Sherboum e.et al., 1992). Beca use these diso rders are frequen tly found to coex istwi thothe r medical conditions

such asdiabetes andcardiovasc ulardisease. they are sometimes hardto recog nizeand increase anindividual'srisk ofh ospitalization and suicide (Olfson, et aI.,l 997 ). Acco rding toanational survey, co morbidity wasassociated witha2.5 foldi ncrease in the likelihoodof hospitalization with individualss ufferingfrom ananxiety disorder( Kess ler,eta I., 1998).

Thereisevidence to supporta relationship betweenASand depre ssion.Studieshave showneleva ted levels of ASinpatient s sufferingfrom depressionwhen compared to contro ls (Taylor,Koch ,Woody,&McLean ,(996). Furthermore,depressionhasbeenfoundto specifically relatetothe fear of cognitivedyscontrol facet of AS.Schimidt,Lerew,and Joiner (1998)foundthatthe fearof cognitivedyscontrol predicted not onlysympto msof anxiety but alsoof depression.Thisfindinghas beensuppo rted by Grant, Beck, and Davila (2007)andraises thequestion of whethe r depressionis specifica llyassociatedwithAS and thefear ofcognitive dyscontrol orwhether the relationship is accountedfor by anxiety.Alternatively,the AS facet of fearof cog nitive dysco ntrolco uld bei nstrume ntali n thedevelopmentof depressio n because it couldleadto the avoidanceofsocialsituations(removi nga potential source ofp osi tive reinforce ment)and inhibit an indiv idua l'sday-to-dayfunctio ning.Thepresent studypredicted that AS fearofcognitive dyscontrol wouldcorre latewith depressive symptomswhereas the otherfacets of AS, socialconcerns andfear of physical symptoms,wouldbepredictive of the otheranxietysymptomclusters .

Generalized Anxiety Disorder

Generalize dAnxiety Disorder (GAD)is describedas constantworry andanxietyover manydifferent activ itiesand events(Nationa l Institut e ofMentalHealth,20 10).An individual withGAD isdescribedto be inthe presenceof constantworry andtension,evenwhen thereis no rationa l cause. GAD causes anindiv idualto worry about many different things, even though

theyareaware thattheir worriesorfears are stronge r than necessary.According toKessler,Chiu, Demle r,and Walters (2005)the usualage of onset for GADis variable.They go on to state that althoug hGADcanbeginanywherefromearlychild hood tolate adu lthood,onsetisusuall ymore gradua l than with the otheranxietydisorders.Somecommonsympto msofGADaredifficult y concentrati ng,fatigue,irritability, difficult ies sleeping,headaches,shaki ness,and the constant feeling ofbein g"on edge" (AmericanPsychi atric Association,2000;Taylore ta l.,2(08).It is believed that genes may playarolein the developmentof GAD andit has alsobeen saidthat learnedbehav iourwhenpresentedwith stressful life situations may aIso contribute tothe developmentof GAD, whichcan star! at any given timein anindividual ' slife (Tayloret al., 2(08).

Recentresearch has shownthe thereisa unique relat ionship betweenASand GAD.

Studies(e.g.,Cox, Borger,&Enos, 1999;Rector,Szacun-Shimizu,&Leybman,2(07)have shownthehighcorrelationbetween AS andGAD and howthisunique relations hip interactswith both worry and depression .PatientswithGAD have shownelevatedlevels of AS when comparedtoindividuals who didnotsuffer from an anxietydisorde r(Zinbarg,Barlow&Brown, 1997).Empi ricalevidencehasshownthatthere is a unique relat ionshipbetween AS andGAD (Borkovec, Aleaine&Behar,2004; Carleton,Sharpe,&Asmundson,2007; Viana&Rabian, 2(08).Upon furtheranalysis,it has been proposed that worry andGAD have adistinct relationshipwith the fearofcognitiv edyscontrolfacet of the ASI. Rectorandcolleagues(2007) founde lev3ted levels offearofcognitivedyscontrolinindividualswhowerediagnosedwith GAD whencompared to individua lswithotheranxiety disorders ,and Leen-Fe ldner,Feldner, Tull,Roemer,&Zvolensky(2006) foundasimilar pattern in a non clinicalsample.

Panicdisorderis a typeof anxiety disord erin whichan individual hasrepeateda ttacksof intensefearthatsomething badwilloccurwhe n notexpected.Some onewho experiencespanic disorderlives inconstant fearthat anotherattack willoccur (Daitch,201 t) . A panicattack is reportedto begin suddenl y andi ast anywherefromlOt020minutes andtheage ofonsetis usuall yearly adulthood (Bandelowetal.,2000).During apan icattackthe person may think that they are having aheart attac k,goingcrazy,orabout to die.Theymay experience anyofthe followin g symptoms:ches t pain;dizzine ss;fearoflosing control;feelin gsof choking;feelings of detachm ent;naus ea; numbnessofthehand s, face, orfeet;heartpalpitation s;shortn ess ofbr eath;

tremblin g;sweating; orchills(Americ an Psychi atric Association,2000;Taylor etaI.,2008).

Studieshaveshown that genetics mayplayarole inthe development0fpanicdisorder.Ithas beenshow n that ifone twinhaspan icdisorderthentheothe r twinhasa 40%chanceof developing thedisorder (Taylore taI.,2008).NishimuraandColleag ues(2008)analyzed this gene tic componentfurthe r and foundthat theinstan ce ofpanicdisord er infirst-deg ree relat ives issignificantlyhigherwhen compared tounrelatedindividuals.

Pan icdisord eristheanxietydisorde r thatismost commonly linkedtoAS.Accordin gto Schm idt, Lere w, and Jack son (1999) ASishighly correlatedwith panicdisorder symptoms, precedesthe devel op ment of panicdisordersymptoms ,and theassociation betwe en AS and panicdisord erisnotdueto athird variable.In theirresearch on therelationshipbetween panic disord er andAS, Taylor,Koch,and McNally (1992)foundthat individuals whowerediagnosed withpanicdisordershowedgreater AScompared toindividualsdiagnosedwithan anxiety disord er otherthan PTSD.ln addition,S chmidt,Z volensky, andManer (2oo6 )reportedthat heightenedAS predicte d increas ed pan icsymptoms aftera carbon dioxide cha llenge in both clinical and non-cl inicalsamples.It has also been sugges ted by Lilienfeld, Tu m er, andJ acob

(1998) thatAS may play a role in the fonnation and seve rity of panic d isorder.Afterreviewing the literature on AS in the adult population,they concluded that strong empiricalevidence existedthatdemonstratedthatASuniquelypredictspanic atta ck s.Furtheringthe eviden ce ofthe clear assoc iation betweenAS and pan icdisorder ,resear chhasshown that AS is apredictor of spontane ou spani c attacks (Maller& Reiss,1992;Plehn &Peterson,2(02).

The undisput ableevidencethat exists to support thecorrela tionbetweenpanicdisorder and AS may give usan insightintothe development and natureof the underlying stru cture of AS.It hasbeenpropo sedthatpanicdisord erhas adistin ctrelat ion ship with thefearof physical sympto ms facetoftheASI(Zinba rg & Schmidt,2(02). Evidence for this theoryhasbeen accumulating,with many resear cher sfinding adirect correlation0nlyb etweenpani cdi sorder and thefearof physical sympto mssubsca leand not theothe r two subscales(Z vo lenskyet al

Social Anxiety Disorder

SocialPhobi aor SocialAnxietyDisord eris apersistent and irrationalfear of situ ation s thatmayinvol ve scrutinyor judgem entbyothers(Stein, Stein,Pitts,Kumar & Hunter,2(02 ).

Individualswhosuffer fromsocialanxiety becom eoverwh elmin gly anx iousandself-co nscio us ineverydaysocialsituationsand havean inten se,chronic fear of being watchedand judgedby

individu al' sday-to-daylife caus ing themto avoid publicplaces such aswork, sch ool ,and activiti esthatinvolve friendsand famil ymembers.The age ofon set for thisdisorderis earlyin childho odor adole scence and it rarelybegin s after the age of 25 (Beid el&Turner,1998).Soci al anxiety can be limitedto onesituat ion(suc has speak ing in front of a group)or it maybeso broadthattheindividual experien cesanxie tyaroundalmos te very onethey enco unter.Although

people with socialanxiety realizethatthesefears maybeunfound ed orexcessive.theycannot alleviate th is anxie ty without interven tion.Someofthephysica lsy mptoms of socialanxiety disorde r are blushing , sweating, difficult y speaking,trembling,and nausea (American Psychiatric Associat ion,2000;Stein etal., 2oo2).Th ese sympt om shave also been show n in indiv idualswho have eleva ted levels onthe AS-socia lconcernssubscaleofthe ASIsugges tinga unique relationshipbetweenthis facet of AS andsocialanxiety disorder(Belcher& Peters , 2009).

Studiesconductedinthepastdecadehave foundarelationship between AS and social anxietydisorder(e.g.Mattick&Clark,1998;Rectoretal.,2oo7;Zinbargetal.,1997).

Unfortuna tely,litera tureon the relationship betweenAS andsocialanxietydisorderislimited.

Drawing fromthe studiesthatdo exist,anindividual withsocialanxietymay fear thattheywill benegat ively evaluated ifthey present withpubliclyobservab lesy mptomsof anxie tyandthese socialconcernsmaybe attributab le to AS (Asmundso n& Ste in, 1994 ; Ball,Otto, Pollack, Uccello,& Rosenbaum, 1995; Norton,Cox, Hewitt, & Mcleod,1997). Furthermo re,AShas beenshown to be involved in the development andmaintenanceofsocialanxiety disorder (Rapee&Heimberg,1997).The correlationbetween AS andsocialanxiety disorder was also found byresearchers during hyperventilation challengesthatwere aimeda t lookingi mothe unique relationship between panic disorder and AS-phys icalconcerns(Brow n,Smits,Powers,&

Teich, 2oo3;Zinbarg,Barlow &Rapee,2oo!).Afteritwas discove redthatAS-physica l concernspredictedfear in panic disorderpatientsinpanic provokingsituat ions.J twas alsonoted thatparticipantswithelevatedAS-socialconcerns were the first to withdrawfrom the cha llenges.

The authors theorizedthat withdrawingfrom the challengesearlier than the other participants showed aunique relationshipbetween AS and socialanxiety.They stated thatbeca use having

elevated levels of AS-socialconcerns led to earlywithdrawa lfromthechallenge these participan ts werepreventedfro mhavingthe chancetoleam thata potentially threaten ing situatio nmaynot be asthreatening asthey perceived (Brownetal.,2003;ZinbargetaI.,2(01).

Thiscorrelationwasfurther analyzedbyRodri guez and colleag ues(2004) in their studyabout the discriminantvalidityoftheASIandsubjects that have beendiagnosedwithsocialanxiety disorder.The resultsof thisstudyshowedthat socialanxietydisorder predicted elevatedl evels on the AS-socialconcerns subscale.Althoughlimited,theresearch thathas beenconducted has pointedtoa uniquere lationshipbe tweenAS -socialco ncemsan dsocia la nxiety disorder.

Summary

Researchers have recently cometo the consensusthattheunderlying structure of AS is hierarchicalin nature, withallofthe facets of ASloading ont o a singleh igher order factor

(Blais,Otto&Zucker,2001; Hayward, Killen, Kraemer,&Taylor, 2000; Zinbarget aI.,2(01).

This conclusionhas lead tothe explorationof therelationship between AS and the spec ific anxietydisorders.It has beenproposed thatthethreefacets of AS (physicalconcems,social concerns,andfearofcognitivedyscontrol) relate bothdifferentiallyanduniquelyto each specificanxietydisorder (Abramowitz,2006; McKayet aI.,2004;Rachm an&Taylor,1993).

More specifica lly,AS-physica lconcerns has been linked to panic disorder,AS-socialconcerns has been linkedto socialanxiety,and AS-fear of cognitivedyscontroI has been linkedto both GAD anddepression.The presentstudyaims to expandthe understanding oftheunique relationshipsbetween the facets of AS and thesymptomcluste rsof anxietyby measuring the

Psychom etricpropertiesof measure sof Anxiety Sensitivity

Therehavebeenanumber of scalesthat have been developedtomeasure ASin the adult population.The firstindexthatwas created wasthe AnxietySensitivity Index (ASI; Reiss, Peterson, Gursky,&McNally,1986); although therehavebeenmodifications and revisionsto

this scale(reviewed below ),itis still the mostcommonlyused inventory andconsidered to capturetheAS construct initsentirety.

The Anxiety SensitivityIndex (ASI; Reiss,Peterson,Gursky,& McNally ,1986) The ASI is aI 6-item self-report scaleth at measures anxiety about possible negative consequencesof arousalsymptoms. Itisthemost commonly usedmeasure of AS(Reiss, Peterson, Taylor Schmidt&Weems, 2(08).Thedevelopment ofthe ASIwas based onanearlier scale that aimed to measureAScalled the AnxietySensitivity Scalethatwasdevelopedby Epstein(1982). TheASI is madeupofthree subscales:ASPhysical Concerns,AS Fear of Cognitive Dyscontrol, andAS SocialConcerns. ASphysical concerns involve afear of sensations:e.g.Itscares me when my heart beatsrapidly; AS CognitiveConcerns are fears of negative psychologicalconsequencesofanxiety-relatedcog nitive experiences:e.g. It is importanttometo stayin controla/my emotions;and AS SocialConcernsare fearsof possible

negative social ramifications of publiclyobservab leanxietysensations:e.g.Other peoplenotice whenljee lshaky(Reissetal., 1986). Respondentsareas ked to rate thedegree to which they agree with the listedthoughts and feelings ona 5-point Likert scalefrom0(very little) to 4 (very much) yield ingt otal scores ranging from Oto 64wh erehi gher scores indicatehigherlevels of

Inthe article that introduced the ASI,Reiss and colleagues(1986)reportedm oderate two-weektest-retestreliability estimatesfor all three samplesanalyzed: men(r=.70), women(r

=.74),and the fullsampleof collegestudents(r =.75).Maller andR eiss (1992)reporteda

satisfactory test-retest reliabilityofr=.710ve rt hreeyears. lntema lconsistencyhasbeen reportedas mode rate tohighby multiplestudies,ranging from.76to.90for bothclinicaland non-clinicalstudies(Ginsburg&Drake, 2002;Maller &Reiss,1992; Schmidt&Joiner, 2002;

Zinbarg,Barlow and Brown,1997).

TheAnxiety Sen sitivityProfile (ASP; Taylor&Cox, 1998a)

The ASP is a 60-itemmeasure of ASthat was createdusing the16-item ASIas a basis (Reissetal., 1986).Taylorand Cox (l998a) created the ASP in an attempttot heore tically improvethe availableassessmentsofthe multifacetednatureofthe AS construct.Althoughthe ASI has beenthemostcommonly usedmeasure ofAS,there were concernsthatsinceitwas not createdto measuremultiplefactors it may contain aninsufficient number of itemsto adequately

captureeac hof thelowe rfac torso fA S(Tay lor&Cox,1998b).Thetestbattery consistsofa 60·

item self-reportscaleonwhichrespondentsratethe extent to which theyagree witheachitemon

a 7·pointLikertscale(l-vNo tatall likely" to 7· "Extremelylikely").The inventoryis comprised ofsixsubscales:(l)Fearofcardiovascularsym ptoms(e.g.Yollr hear/ispollnding ); (2) fear o f respiratorysym ptoms(e.g.Yolljee/ /ikeyollcan'//akeadeepbreath);(3) fear of gastrointestinal

symptoms(e.g.YOllr stoma ch is making /olld noises); (4) fear ofpu blicly observable anxiety reactions (e.g.Hot jl ashes sweep overyoll);(5) fearofdissociative and neurological symptoms (e.g.YOIl havetingling sensationsin yourhands);(6) fear ofcognirivedyscontrcl Ie.g.Tonr /hollghtsseemss/ower/hanllsllal)(Tay lor&Cox, 1998a).

In the articlethat introduced theASP,Taylor andCox (1998a) reported thattheir study showedsupportforthehierarchical structureofASbut yieldedsupportforonly four of the six lowerfactors: (I)fear ofrespitory symptoms,(2) fearofcognitivedysco ntrol,(3)fear of gastrointestinalsymptoms,and(4) fear of cardiacsymptoms.Thesefactors loaded ona single

higher order factor and they concluded thatthe results lend support tothe theorythat ASisthe productof a gener alfactor, withindepe ndentcontributionsfrom four specificfactors. Olatunji Sawchuk ,Arrindell,&Lohr (2005)conducted twostudiestoexaminethe factor structure and psychometri cpropertie s ofthe ASP in non-cl inical samplesand foundthatintern al consistency tobe highforthe full inventory withallitemscorrelating modera telY tohighly with thetotal score. They reported moderate tohightest-retestreliabilit yfor fourofth e six scales(fearof respitory sympt om s,fear ofc ognitived yscontrol,fear of cognitiv ed issoci ation , andfear of gastrointes tinalsymptom).

The Anxiety SensitivityIndex-Revised(ASI-R; Taylor&Cox,1998b) TheASI-Rwasdevelo pedbyTaylor&Cox (1998b)as anextensio nofthe ASI,whic h they felt didnot contain enough ite ms to deterrnine the underly ingsubscalesofAS.Taylor and

Cox(I998 b)believed that becauseof this, the ASIwas notspeci ficenough torevealthetype and

orderof lowerfactors in the hierarc hicstruct ureof AS. The ASI-R is comprisedof36 items with subsca lesassessingsix major do mainsofASthat havebeens uggeste d inp reviouss tudies:(l) fear of respitory sympto ms,(2) fear ofpublicly observable anxietyreactions,(3) fear of cardiovascularsymptoms,(4)fear of cognitive dyscontrol,(5)fear ofcardiovasc ularsymptoms, and(6) fear ofdissociat ive and neuro logicalsymptoms(Taylor&Cox,1998b ). The ASI-R uses the sameinstructions and format as theASI andthe assessment battery consistsof10items from the ASIand26newly constructed itemsthat were aimed to provideamore comprehensive measure ofthefirst orde ranxietysensitivity dimensions.Theitemsa reratedo n afiv e-point Likert scale,ranging from 0 (verylittle)to4(verymuch). Constructvalidity for theA SI-R has been established based on significa ntcorrelations with theoriginal vers ionofthe ASI(r=.94;

TaylorandCox,1998a).The ASI-R has alsobeenshow n to displayadequate criterion validity,

inthatpatientswith an anxietydisorderdiagnosistend to score higherthanind ividua lswith no history of anxiety disorders(Beck&Wolf,2(01).Deacon,Abramowi tz,Woods,&Tolin(2003) alsoreported thatthe ASI-R has excellentinternalconsis tency(r=.95) withallitemsshowi ng adequateitem-totalcorrelations ran g ing from.40-.71.

Anx ietySens it ivity Index-3 (ASI-3 ; Ta yl or et. al.,2007).

The ASI-3is an 18-itemversion of the originalASI(Reiss et al., 1986 ) that was developed by empiricallyselectingitems from the ASIand ASI-R that measured either physical, social,orcognitivedomainsofanxietysensi tivi ty.Respondents are askedto indicatetheir agreementwitheachitem on a five-pointLikert scale from 0 (verylittle)to 4 (very much); the total scores range fromOto72,wherehigherscores indicate higherlevel s of AS. Taylorand Colleagues(2007) reported thatthey crea tedthis scaleto tryto stab ilizethe factorstructureof AS, whichwas anissue with other AS measures.Ofthe 18 itemson the ASI-3,five overlap with the originalASl,with one or two overlapping items on each of the ASI-3's 6-itemsubscales (PhysicalConcerns,CognitiveConcerns,and Social Concerns) (Tayloretal.,2(07).The ASI-3 has demonstra tedgood psychome tricpropertiesthatinclude astable3 factorstructu re,strong reliabiIityaswellashigh factorial.convergentdiscriminateand criterionrelated validity(Taylor

Summary

Forthepresentstudy,theoriginaIAS l(Reissetal.,1996)willbeem ployedg ive nthat it is the most commonlyused measure of AS. The originalASI ismade up ofthe threefacets of AS that are included in the present study(AS-physica lconcerns, AS-social concerns and AS-fear of cognitivedyscontrol),andthusallowi ngfor analysisof the relat ionships of these facets with panic, socialanxie ty,generalized anxiety,and depressivesymptams.

Present St ud y

Theaimoftheprese nt study isto exam ine the unique relationsh ipbetween three anx iety symptomclusters(panic,genera lizedanx iety,andsocialanxie ty)anddepress ivesympto msand the facetsof AS,which are physical conce rns,socialconce rns,andfearofment al dyscontro l.

Thepresent studypred icts thatfear of physica lconcerns will predictpani c,fear of pub licly observablesymptomswillpredictsocialanxie ty,andfear of cognitivedyscontr olwillpredi ct bothdepr essive symptomsandgene ralizedanx ietysepara tely.Ifit is found thatdistinc t AS dime ns ionscorrespondto specificanxietyor depr essiv esym ptomsthen specific interv ent ion s tha t target eachof thesedimension s canbecreated to treatandpreventeach specificanxiety

Participants

Thecurrent study utilizedundergraduate studentswho were recruitedfrom Memorial Univers ityof Newfoundl and wh ichislocated in SI. John's,Newfou ndl and andLabrador.

Part icip an ts wererecruit edfrom introduct oryPsych ology classesdu ringthe 2008/2009and 2009120lOacademicyears.Thesample ran gedinagefrom18-45 years(mea nage=20) and was comprisedof 410 unde rgra duate studen ts(301womenand 109men) who pred omi nately ide ntifiedasWhite (96%).UsingG*Powe r3.0.10(Fa ul,Erdfelde r, Lan g&Buchn er, 2(07)as a guide line,an aprior ipo wer analys isformultipl eregre ssion,withana lphaset3t.05andpower setat.80.was conducted toprovide aminimumsample sizetodetect an effectin the analysesin thestudy.Having usedtheresult sfromG*Power 3.0.10(wh ichsuggeste daminimumN =89 to detect amediumeffec tandminim u mN =40 to detect alarge effect]a samp leof 410was

eons ide redsuffi cie nt to confide nt lyexami ne therel ationship sbetween the pertinen tcons tructsof this study .

To eva luateif the different facetsof ASdist ingui shbetwee nthe anxiety symptom clustersand depr essive sym ptoms,fourself-reportinstrumentswereemploye d. The self-repo rt instrum ents in this studyincluded:a measureof AS, socialanx iety,worry,and dep ression.A demograph icinfo rmatio nform was alsoincl ude dinthebattery.

DemographicInformationFor m .The Demog rap hicInforma tionForm (AppendixA) was develope dspecifica llyfor this studyto capturethe distributio nofd em ographi c characteris tics in the studysample. Participants were asked toprov ide info rmatio nincludi ng their age, sex,ethnic ity,maritalstatus ,number of children,edueation,religious affili ation, employme ntstatus. and annual income.

Penn StateWorry Questionnaire (P SW Q ; Meyer,Miller, Metzger,&Dorkovee, 1990).Th e PSWQ(Appendix D) is a16-item measure of chronicworry.Parti cipants are require d to rate each ite mon a one to five point Likert scalethatranges from 'notatall typica lofme' to 'very typicalof me'A sample itemincludes'My worries overwhe lm me ' . As an individual's score on thePSWQ increases,itindicates increasinglevels of worry.When a score reaches or is greaterthan40,pathologicalworryisindieated(Meyeretal., 1990).Studiessupport the good reliabil ityandvalidityofthePSWQ with a reportedhigh level ofbothintem al co ns istency (ranging from.80to .95 )andgoodtest-retest reliab ility(correiationsrangingfrom .74to.93) (Molina&Boko vec,1994 ).

TheDepress ion Anx ietyStressSca les 21-itemver s ion(DASS -21;An tony, Dieling, Cox,En ns,&Swinson ,1998).Th e DASS-21 assesses the core symptoms of depression,anxiety,

and tension/stre ss,andconsistsof2 1self-report item sthat aregrouped into three7- item subscales(i.e.•Depres sion,Anxiety.and Stress).Participants areaskedtoreportthe frequency and severityof anynegative emotions theyhad experiencedover the previous week ona one to threepointLikert scale,rangingfrom zero (didnotapplytomeat all)tothree (Applied tom e verymuch.or most ofthe time).Scores rangebetween0 and 42 oneachsubscaleand higher ratingsindicatehigherlevels ofdepression.anxiety,andstress. TheDASS -21 is wide ly used andshowsgoodoverallvalid ityas wellas high internal consistencyandreliabilit y.Inparticular, the Depress ionscalecorrelatesstrong lywiththeBeck Depression Inventory (Beck,W ard, Mendelson.Mock&Erbaugh,1961) andthe Anxietysubsca lecorrelatesstrongly with theBeck Anxiety Invent ory (Beck&Stee r. 1990).Lovibonda ndLovibond(1995) state thatthe authorsof the DASS-21aimed to cover the fullrangeof coreanxie tyand depression symptoms inthe DASS-21 and thereforeitcan be assumedthat onceyoucontrolfordepressio n,the onlyvariance thatremain s isthat due to physicalarousa l.whichisusedto assesspani c (Lovi bond&Lovibond, 1995). For the purposes ofthe presentstudy.only data fromthe Anxiety andDepression

The Anxiety Sensitivity Index(ASI ; Reiss,Peterson,Gursky&McNally,1986).The ASIisa I6-itemself-reportscale thatmeasuresbeliefsabou t possiblenegat ive consequencesof arousa lsymptomsassociatedwithanxie ty.The ASI ismade upofthreesubscales: AS Physical Concerns (fear of sensations);AS CognitiveConcerns(fear ofnegative psychological conseq uencesof anxiety-relatedcognitiveexperiences);and.ASSocialCo nce ms(fearof possiblenegativesocial ramificat ions ofpublicly observableanxiety sensat ion s) (Reiss etal..

1986).The participantsareasked to rate thedegree to whic htheyagreewithlisted thoughtsand feelingson a 5-point Likert scale from0(verylittle) to 4 (verymuch).The ASI hasgoodi nterna l

consis tency(range = .82 to.91)andacceptable test-ret est reliab ilityof.75over2week s (Re isset al.,1986 )and.710ver 3 years (M alle r&Reiss.1992).

The Social Interaction Anxiety Scale (SIAS; Mattick&Clarke,1998).The SIA Sis a 19-itemmeasur ethat isusedto assess level s of anxietyexperienced befo reand during situations

of socialinteracti on.The partici pan tsare asked to rateeach item (e.g.,'Iamtensemixingina group')ona 5po intLikert scalefrom0(not at all)to 5 (extre me ly)(Ma ttick &Clarke, 199 8).

The SIA Shasbeen foundto have highinternal consistency(a= .93)andahighI-month test- retestreliabilitycorrelationcoefficie ntabove.90(Hofma nn,2007).

The currentstudy receivedethicalapprovalfrom theInterd isciplin ary Committeeon EthicsinHumanResearch at MemorialUniversityof Newfoundland.To recruit participants. a researche rvisited introductory psycho logyclasses(Psycho logy1000andPsycho logy 1001 ) at MemorialUn ivers ityandverballyinforrned the studen tsoftheopport un ity to be involved in research thatinvestigates'howpeopl ethink aboutthings' . Part icipan tswere advised thattheir partici pat ion was comp lete lyvoluntaryand thattheir names or privateinform ationwould not appear onany forrnsor inany reports.Each classwas alsopresented withanince nt ive to part icip ate inthisstudy.Insome classes,theseincentivesincluded the chanceto enteradrawto win one $50 giftcertificateor oneof five $10 gift certifica tesfora locaImall.whereasin other classesstudentswere offered atwopercentbonusmarktowards their finalgradefor participating in thisstudy. Participantswerethen info rmedthatthey maintained therightto withdraw fromthe study at any time withou tpenaltyandinforrned thatiftheyhad any concerns relatedt othe currentstudy,they couldaska researche rwhowouldbe availab lefor clarificat ion prior tothe startofthestudy.Fina lly ,each classwasinforrned of a roo m an dsched uledtimetocompletethe

study.Participants weregiven twooptions toc ompietethequestionnairebattery:online through asecured website or by completing paper copies of thequestionnairesby hand.Participantswho completed papercopies weregiven an envelopecontainingtwo numbered forms.One wasfor theparticipant to keep as an informationletter and theother wasthe batteryof questionnairesfor completion.In ordertocontrol for carryover effects, theorder of the questionnaire swere randomi zed.However,the demographicinformationsheetalwaysappeared at thefrontof the batteryandshould nothavebiasedparticipantresponsesdueto thefact that the questions contained onitdid notrelate to any itemsin the questionnairebattery.T o maintaina no nymity.

all participant swereinstructedto complete aconsentform beforethe startof the studyand hand ittotheresearcher.Consent formswerethencollected andstored separately from the questionnaires,bothinalocked filingcabinet. Beforethe participan tsb eganth ete stbatt erythey wereinstructedthat theywereunder noobligation tocontinuethestudyiftheye xperienced discomfortor anxietyduringthestudy.Aftertheyhadcompletedthe battery.they were given the opportunity toask theresearcherany questions.All participantswerethanked for their contribution tothe studyandadvised to contact the University Counselling Centerin the event theyfelt any psychological distressaftercompleting thequestionnaires.l fthe yfelte xtreme distress,they wereadv ised to call theHe alth and Community Service s Crises line wherea counsellor would be able to speak with them immediately.Also,all participants were provided with a websitetoviewa synopsis of the study's results.Participants whochose to fill out the batterythrougha securedwebsite went through the same procedure asthose who filled out hard copiesand were alsopresented with the above mentioned resourcesvia the website.

Descriptive Statistics and Reliability of Study Instruments

Themeans. standard devi ations.and internal consiste nciesoftheDASS-21a nxiet ysca le.

the DASS-21depression scale. thePSWQ .theSIAS.and the ASI and its subsca les(phys ical concerns.socia lconcerns.and fear ofcognitive dyscontr ol) are report ed in Tabl e1.All part icipant swereincluded inallana lyses in thisstudy.

The internalconsistenciesofallof themeasureswere good ranging froma=.88 to. 75. except forthe ASI-social concernsscalewhichwas very low(a=.48).

Correlation Analysis

Correlationa nalyseswereconducted using the measureso fa nxiety.depress ion,a nd anx ietysensitivity.Thecorrelationsbetwee n theDASS-21 anxietyscale.theDASS-21 depression sca le, thePSWQ.the SIAS.and theASI anditssubscales(physica lconcerns.social concerosan dfearofcognitive dysco ntrol)ar ere portedin Table l.Allof the correlationswere significantwith themajorit y being medium tohighinsize(Cohen&Cohen,1983).Corre lations that weresmall insizewere betweendepression and theASIand its subscales, between social anxietyand anxiety and worry. and betweentheASI_Soc ial subscalea ndanx ietyand worry.

Correlations, descriptive statistics,and reliability estimatesofthe Depression Anxiety Stress Sca/es-21(DASS-21), thePenn Sta teWorry Questionnaire(PSWQ).theSocialInteraction AnxierySca/e(SIAS),andtheAnxierySensitiviry Index(ASl)(N=410)

3.PSWQ 4.SIAS

6.ASI (Social)

7.ASI (Physical) .24*

8.ASI(Menta1) '.29 *

Coefficientalpha .77

Nole.DASS-21-A;DepressionAnxiety and StressScales -Anxiety Subscale;DASS-21-D- DepressionAnxietyand StressScales -DepressionSubscale(Antony et al., 1998) .PSWQ:Penn State Worry Questionn aire(Meyeretal., 1990).SIAS:Social InteractionAnxietyScale (Ma ttick eta l., 1998). ASI: Anx iety Sensitivity Index ; ASI (Soc ial) ; Anxiety Sensiti vityIndex - Soci al ConcernsSubscale;ASI(Mental) ; Anxiety Sensitivit yIndex-Ment al Concerns Subscale;ASI (Physica l) ; AnxietySen sitivit yIndex-PhysicalConcernsSubseaIe (Reiss etal.,1986).

*p<.OI

Independent-sampl esI-testswereusedtomeasurewhetherthemeans of the DASS-21 anxiety scale,DASS-2ldepre ssion scale,SIAS, PSWQ, ASI: fear ofphysical symptoms,ASI:

social concernsand ASI: fearo fcog nitivedyscontrol differe d based on the partici pants'sex.It was found thatwomenhad significa ntly higherscoreson theASI-fearof physical symptoms scale,the SIAS,and the PSWQ than men(see table2).Therewere no significant differences found betweenmen and women on any of the otherscales.Giventhatunexpected gender

differences wereobserve d,subsequent analysesinvolvin gtheA SI-fear ofphy sical sympt oms scale, the SIAS, and the PSWQ were conducted sepa ratelyfor men and women, aswell asforthe sample as awhole.

Independ ent -samplet-teststestin g sexdifferences on theDepr ession AnxietyStress Scales-2/

(DASS-2J aruiety scal ean dDASS-2J depressionscale) thePennStateworryQuestionnaire

(PSWQ),theSocial lnteractionAnxietySca/e(S IAS),theAnxietySensitivity Index (ASI)-Fearof physica/ symptoms. the Anxiety Sensitivitylndex (ASI)-Socia/ concem s and the Anxiety Sensitivity lndex(A SI)-Fea rofcognitivedyscon troi.

MaleMean (SD)Female mean (SD)r-value dfp-value ASISocial 7.08 (2.90) 7.68(2.86)

ASI Physica l8.08(5.86) 11.63 (6.70) 3.01(3.32) 3.59(3.42) 23.90(14 .18) 27.78(14.31)

4.62(4.13) DASS-21 -D4.71 (4.43) 4.68(4.42) PSWQ 42.87 (15.54 ) 55.54(15.09)

Note.DASS-2 1-A-Depression Anxietyand Stress Scales- AnxietySubscale;DASS-21-D= Depression Anxietyand StressScales-Depression Subscale(Antony et al., 1998). PSWQ:Penn StateWorry Questionnaire(MeyeretaI.,1990). SIAS:Social InteractionAnxiety Scale(Mattick

&Clarke,1998). ASI(Social)=Anxiety Sensitivity Index-SocialConcerns Subscale;ASI

(Mental)

=

=

*p<.05,**p<.01

One-way analysesof variance (ANOVAs) wereused tomeasure whetherthe means of theDASS-21 anxietyscale,DASS-2 1 depression scale,SIAS, PSWQ and ASI:fear of physica l symptoms,ASI:socialconcerns and ASI:fear of cognitivedyscontrol differedbased on the methodof presentationofthequestionnaire battery(paper,o nlinero undl,and online round 2).

Therewereno significantdifferencesamongthose whowrote the firstroundon line,the second

ANXIETY SENSITIVITY,ANXIETY AND DEPRESSION

round online,and the paper questionnaire son any of the inventoriesexcept for in theSIAS (see Table 3). Using contrast coefficients,it wasfound that participants in the second round of the online questionnaire shad higherscoreson the SIAS than thosewho filled out the paper questionnaire ,t(408)=-2 .25,p=.03.Althoughthere is a significant difference between participants in thesecondround onlineand participantswho filled out their questionnairesby paper,it can bearguedthat this differenceisnota concemforthe purposeof thisstudy.This can beargued because whenyou dividetheanalysis thisway,the results cannot be usedto generate conclusionsastowhetherthereisan effectof method of responsebeeausetherewas no differenceb etweenp aperandonlineround onere sponses.ltcanbe assumedthatany differences foundwouldbeattributed to extraneousfactors independent from the method of response.

Moreover,the effectsize of this differencewas small(,,'=.02),suggesting that time ormethod ofdatacollection did notaccount fora meaningfulproportionofvariance inSIASscores. This

smalleffect size also suggests that the significant differenceobserved between groupswith respecttoSIASscores mighthave beenattributable tothe larges ample size ratherthantoan actual effect.Accord ingly, forallsubsequenta nalyses,participantswere examined asagroup withrespecttomethod and time of datacollection.

One-way ana lysisof variancetesting differencesbetweenmethod sofpresentation of/he questionnaireb attery(p aper,onliner oundl,and onliner ound2 ) ontheDepr essionAnxiety SrressScaIes-2 l (DASS-2l anx iety scaIe andDASS- 2I dep ression sca Ie)thePennStateWorry Questionn air e(PSWQ).theSociallnteractionAnxiety Scale (SlAS)•and theAnxiety Sensi tivity Index(AS1)-Fear of phys icalsymptoms ,the Anxiety Sensitivity lndex (AS1)-Soci aIconce rns and theAnxietySensitivitylndex (ASI)- Fear ofcognitiv edyscontrol.

Source df F p-value

ASI-SocialBetween 2 .51

I Error 407

ASI·PhysicalBetween 2

Error 407

ASI·Mental Betwee n 2

Error 407

SIASB etwe en 2

Error 407

DASS-2 1AnxietyBetween 2

Error 407

DASS -21DepressionBetw een 2

Error 407

PSWQBetween 2

Error 407

Nore.DASS-21-A

=

=

Depre ssionAnxiety and StressScales -Depre ssion Subscale(Antony et al.,1998).PSWQ : Penn StateWorryQuestionnai re (MeyeretaI.,1990).SIAS : Soc ialInteractionAnxiety Scale (Ma ttick etal.,1998 ).ASI(Social)=Anxiety Sen sitivityIndex-SocialConcernsSubscale ;ASI(Mental)

=AnxietySensitiv ity Index-Mental ConcernsSubscale: ASI(Phys ical)=AnxietySen sitivity Index-Physical Concerns Subscale (Re issetal.,1986).

*p<.05

RegressionAnalysis using the ASIsu bsca les to predictdepression,panic,socialanxiety,

Regression ana lyseswere usedtodeterrnine which ASIsubsca les, that is socialconcerns, fear of physical symptoms,and fear of mentaldyscont rol,were specifica lly predictiveo f depressive symptoms, panic,socialanxie ty,andgeneralized anxiety.ln predicting depressive symptoms,aftercontrollingfo r anxiety( panic,social,a ndworry)all threeof theA Sls ubsca les (socialconcerns,fear ofphysical symptoms,andfearof mentaldyscontrol) wereenteredas predict orstogether.Thethreepredictor saccounted for 0.2%ofthevariancein depressive

ANXIETYSENSITIVITY,ANXIETY AND DEPRESSION

symptoms[F(3,403) =.56,p =.65].Inconsistentwith hypotheses,mentaldyscontrolwasnot found tobea significant predictor of the DASS-2I depression scale (seeTable4).When this regressionanalysiswasconducted separately formenand women,parallel resultswereobserved for bothsexes (seeAppendix G).

Regression Ana/ysisp redictingDA SS-2/depression

DASS-2lAnxiety

PSWQ ASCSocial ASCPhysical ASCMental

Note.ASCSocial=Anxiety Sensitivity Index -SocialConcernsSubscale;ASI_Mental = AnxietySensitivityIndex-MentalConcernsSubscale; ASCPhy sical= AnxietySensitivity Index-Physical Concerns Subscale(ReissetaI., 1986);DASS-21-A=DepressionAnxiety and StressSc ales-Anxiety Subscale(Antonyet al.,1998).

·p<.OI

The secondanalysisexaminedwhich ASIsubscalewas predictive ofgeneralized anxiety/worry whencontrollingfor depressive symptoms. After controlling fordepression,all three oftheASIsubscales,social concern s,fear of physical symptoms,and fear of mental dyscontrol, were enteredaspredictorstogether. The three predictors accounted for 4.7%ofth e variance ingeneralizedanxiety/worrysymptoms[F(3,405)= 10.84, p< .0 1].Inconsistent with hypotheses,the fear of mentaldyscontrolwasnotfound tobe asignificant predictorof generalizedanxiety/worry.Unexpectedly,fear of physical symptoms wastheonly facetthat was

found tobe a significa ntpredictorofgeneralizedanxiety/worry(seeTable 5). Whenthese analyses were conduc tedseparate lyby gender,it was observedthat only the AS-menta lsubsca le significa ntly pred ictedworry in males;amongst females,noneofthe ASfacets significan tly predictedworry after controllingfor depression (see Appen dixG).

Regression Analysispredic/ingPenn·S/QteWorryQues/ionnaire

Dass-2 l Depressio n

Note.ASCSocial-AnxietySensitivity Index-SocialConcernsSubscale;ASCMental- AnxietySensitivity Index-Mental ConcernsSubscale;ASI_Phys ical=Anxiety Sensitivity Index - Physica lConcernsSubsca le(Reisset aI.,1986);PennState WorryQuestionnaire (Meyer

·p<.OI

The thirdanalysisexaminedwhichASIs ubsca lewas predictive ofsocialanxietyafter controllingfor depressivesymptoms.All three of the ASIsubsca les,socialconcerns,fear of physical sympto ms,and fear ofmental dyscontrol were enteredas predictorstogether.Thethree predictorsaccountedforI2.6%ofthevarianceinsocialanxiety[ F(3, 405) = 22.00.90, p < .OI].

Consistentwithhypotheses, socialconcems were foundto be a significant predictorofsocial anxiety(see Table6). Unexpectedly,fear of physica lsymptoms andfearofcognitivedyscontrol were also foundto be significantpredictorsof socialanxiety. Whenthisregressionanalys iswas conductedfor men and women separately,itwas foundthatonlyAS-phys icalconcerns predicted

social anxietyin men andonlyAS-fear of cognitive dyscon trolpredi ctedsocialanxi ety in women(see AppendixG); among neither sex did AS-soc ial concernssignificantly predict social anxiety.

Regr ession Analysispredicti ng the Social lnteraction AnxietyScale

DASS-2lDepression

ASI ]hys ical

ASI_M ental <.0 1'

Note.ASCSoc ial-AnxietySensitivity Index - SocialConcerns Subscale;ASCMen tal=

AnxietySensitivity Index -Mental ConcernsSubscale; ASI_Ph ysical =Anxiety Sensitivity Index -Physical ConcernsSubsca le(Reisset al.,1986);PennState Worry Questionna ire(Meye r

'p< .OI

Thefinal ana lysisexaminedwhich ASI subsca lewaspredictiveofpan icafterco ntrolling for depressivesymptoms.All three ofthe ASIsubsca les,socialconcerns,fear ofphysical symptomsandfear of mental dyscontrol, were entered as predictors together.The three predictorsaccountedfor7%ofthevarianceinpanicsymptoms [F(3,405)=11.95,p<.01].

Consistentw ith hypo theses,fearof physica lsym ptomswas found to beasignificant pred ictotof panic(seeTable 7).Unexpectedly,mentaldyscontro lwas also foundtobe a significa nt predictor of panic. When thisanalysiswas conducted separately for men andwomenit was observedthat theAS-fear of cognitivedyscontro lfacetpredictedpanic inmales,whereast heAS-fearof

physical sym ptomsfacet predictedpanic in females(see AppendixG),sugg es ting thatthe initial hypothesiswith respectto panic was suppo rted for womenbut not for men.

RegressionAna/ysispr edictingDASS-2JAnxietyScale controllingfiortheDASS -2JD epression

DASS-21Depression

·.03 .06

ASI]hysical .08 .0 3

Note.ASCSocial; AnxietySensitivityIndex-SocialConcerns Subscale ;ASCMental;

Anxiety Sensiti vityIndex - MentalConcernsSubscale ;ASCPhysical; Anxiety Sensiti vity Index -PhysicalConcern sSubscal e(Reiss etaI.,1986 );SIAS:SocialIntera ct ionAnxietyScale (Mattick etal.,1998) .

*p<.01

The purposeof thisstudy wasto examinethreespecific anxietysy mptomcIustersIpanic, genera lizedanxiety,andsocial anxiety ) and depressive symptomsandtheirrelationshipwiththe threefacetsof AS (physic alconcern s,social concern s,and fearofcognitivedyscontrol).Itwas predictedthat AS· fear of physical conce rns would predictpanic,AS·socialconcerns would predictsocialanx iety,and AS-fe ar ofcognitiv edyscont rolwoul d predi ctboth depr essi ve sym pto msandgenera lized anxietyindep endentl y.Itwasfoundthatthefearofphy sic al sym pto ms predictedpani csymptoms, as washypothes ized,butalso predi cted soc ialanxiety sym pto msand generali zed anxietysym pto ms , thussugges ting that,in this sample,the fearof physical sym ptoms component of AS had littlespeci ficity.Consistentwith hypotheses,fear of

publiclyobserva blesymptoms or socialconcernspredicted onlyonetypeofanxious symptomatology,socialanxiely.Lastly, fear of cognitivedyscontrolwasfoundto pred ictpanic andsocialanxiety,butnot generalizedanxiet y and depressive symptomsashypothesized.

The presentstudy used the hierarchica lmode lthat was proposed by Olatunjiand Wolitzky-Taylor(2009) to predictthe relationshipbetweenthe three facetsof AS, whicharefear of physicalsymptoms,socialconcerns,and the fearofcognitivedyscontro land three specific anxiety symptomcl usters( panic,socialanxiety,and generalizedanxiety)anddepressive symptoms.Theirmodel proposed thatthethree facetsof AS arenestedbeneatht he highero rde r factorsof negative affect and traitanxietyand that AS-fearofphys ical symptomswouldpredict panicdisorder.AS-socialconcerns wouldpredictsocialanxiety disorder,an dAS-fearor cognitivedyscontrolwouldpredictGAD and depression separate ly(see FigureI).Resultsfrom the presentstudysuggestthatOlatunjiandWolitzky-Taylor's (2009) modelmay be over- simplified.Althoughthe present study'sresultssupport two of the fourhypothesessuggestedby OlatunjiandWolitzky-Tay lor's(2009) model,(AS-fearof physicalsymptomspredicted panic and AS-socialconcerns predicted socialanxiety) it alsofoundadditional relationships between AS-fear of physicalsymptoms andsoc ialanxiety,AS-fear of phys icalsymptomsand generalized anxiety, AS-fear of cognitive dyscontrolandpanicsymptoms andAS-fear of cognitive dyscontrol and socialanxiety symptoms (see Figure 2).Although theseadditio nalrelationships didnotappearinOlatunjiandWolitzky-Taylor's(2oo9)model,i two uldbe beneficialfor future researchto examine eachrelationsh ipthorough ly.Since the present studyhas provided a preliminarylook athow AS and its low er-order facets interactwiththeanxietysymptomclusters and depressive symptoms, itmay behelpful to replicatethis study using the new modelproposed baseduponthepresent findings(see figure2).

Aspreviouslymentioned ,thecurrent study also found unexpectedandunhypothesized significantdifferencesbetween thesexes whenexaminin gthe relationship between AS and panic,socia l anxiety, generalized anxiety, and depressive symptoms.S pecifi cally ,itwasfound that in males,AS-fear of cogniti ved yscontrol wasa significant predictoro f generalizedanxiety (consistentwithhypothe ses).How ever,inconsistent with hypotheses,for males,panicwas significantly predi ctedby AS-fear ofcognitiv ed yscontroland AS-f earof physical symptoms was a significant predictor ofsocialanxie ty.Converse ly, infernales,AS-fear of physical symptoms was a significant predictor of panic. ashypothesized.However,inconsistentwith

hypotheses, amon gstfem alesAS-fear of cognitivedyscontrol wa s a signifi cantpredictorof social anxietyand none of the AS facet s significantly predi cted generalized anxiety.

Imerestingly,and consistentwithfi nings observedinthe full sampie,for neither sexwas depre ssion significa ntly predi ctedby any oftheindividual facets of AS aftercontrollingfor anxiety(seeAppendixG).How ever, since the currentstudy did not hypothesize sex differenc es andsuch differenceswerenot sugges ted byOlatunj i andWolitzky-Taylor' s(2009)model,th e findings reportedherefor men andwomenshould be treatedwith caution.Noneth eless,the differences withrespecttorelationshipsbet weenthefacetsof AS andanxiety and depre ssion that wereobse rved heredo sugges t that sexdifferences in this area warrantfurther investigation.

Specifica lly, investigation intosexdifferences will allowusto get a betterunderstandin g of how therelationshipbetweenAS, anxietyand depression affects thesexesdiffer entl y.

Pastresearchhasfound acloserelationshipbetween anxietyand depression (H irch feld, 200 1).It has beenshow n that of the individualswhomeetthecriteria for majordepression,50%

of theindividualsin the communit y and75%in primary carecent ers also meetthediagnostic criteriaforananx iety disorder (Brown&Barlow,1992).Itisbecauseof the high co mor bidity