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Anxiety sensitivity

Anxiety sensitivity refers to the fear of anxiety-related sensations, such as rapid heartbeat or shortness of breath, stemming from beliefs that these symptoms signal harmful physical, social, or cognitive consequences—a phenomenon often termed "fear of fear."^[1] Introduced in the mid-1980s by psychologist Stewart Reiss and colleagues, it represents a cognitive predisposition that amplifies the interpretation of benign arousal as threatening, distinguishing it from trait anxiety by emphasizing sensitivity to the symptoms themselves rather than external triggers.^[2] This construct is heritable, with genetic factors accounting for about 45% of its variance, alongside environmental influences like parenting styles and exposure to panic episodes.^[1] Anxiety sensitivity is commonly measured using self-report instruments, including the original Anxiety Sensitivity Index (ASI), a 16-item scale developed by Reiss et al. in 1986 that assesses fears across physical (e.g., health threats from bodily symptoms), social (e.g., embarrassment from visible signs), and cognitive (e.g., mental incapacitation) domains.^[2] A revised version, the ASI-3 (18 items), refines these subscales for greater precision in clinical and research settings, with scores above 23 indicating clinically significant levels.^[1] As a transdiagnostic risk factor, anxiety sensitivity prospectively predicts the development, severity, and maintenance of multiple psychiatric disorders, most prominently panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD).^[3] Meta-analytic syntheses confirm its elevation in anxiety disorders relative to nonclinical controls and mood disorders, underscoring its role in fostering avoidance behaviors and escalating symptom chronicity.^[4] Beyond psychopathology, high anxiety sensitivity correlates with poorer health outcomes, including increased healthcare utilization, medication nonadherence in chronic illnesses like asthma, and maladaptive coping such as substance use.^[1] Interventions targeting anxiety sensitivity, such as psychoeducation and interoceptive exposure, have shown efficacy in reducing its impact across these contexts.

Definition and Conceptualization

Definition

Anxiety sensitivity (AS) is defined as the fear of anxiety-related bodily sensations or symptoms, stemming from beliefs that these sensations have harmful physical, social, or psychological consequences.^[1] This construct distinguishes itself from general anxiety by focusing on the secondary fear elicited by the interpretation of anxiety symptoms themselves, rather than the symptoms' mere occurrence. AS exhibits a hierarchical structure, comprising three primary dimensions: physical concerns, involving fears of bodily symptoms leading to medical catastrophes; social concerns, centered on the belief that anxiety symptoms will provoke negative social evaluations; and cognitive concerns, related to fears of losing mental control or experiencing cognitive dyscontrol such as going crazy. These dimensions load onto a higher-order general AS factor, indicating a unified predisposition while allowing for domain-specific variations in fear responses. Common anxiety symptoms misinterpreted through the lens of AS include heart racing, shortness of breath, dizziness, and trembling, which individuals with high AS may catastrophically interpret—for instance, viewing heart palpitations as a sign of an impending heart attack, dizziness as a precursor to fainting and injury, or shortness of breath as suffocation.^[1] Such interpretations heighten the emotional distress associated with these sensations. Conceptually, AS functions as a cognitive predisposition that amplifies normal physiological responses to stress or anxiety into disproportionate fear, thereby perpetuating a cycle of avoidance and heightened vigilance toward bodily cues. This amplification can contribute to the onset and maintenance of anxiety-related conditions, such as serving as a risk factor for panic disorder.^[5] Anxiety sensitivity (AS) is often contrasted with trait anxiety, which represents a stable predisposition to experience anxiety in response to a wide range of stressors and situations. In contrast, AS specifically involves the fear that anxiety symptoms or sensations signal impending harm, such as physical catastrophe, social embarrassment, or mental incapacitation, rather than a broad anxious temperament. This distinction highlights AS as a cognitive vulnerability focused on the interpretation of anxiety itself, whereas trait anxiety encompasses emotional reactivity more generally.^[6] AS also differs from interoceptive awareness, which refers to the objective or subjective perception and attention to internal bodily signals, such as heartbeat or respiration, without necessarily implying fear or negative appraisal. While individuals with high AS may exhibit heightened interoceptive awareness due to vigilance toward bodily cues, the core of AS lies in the maladaptive belief that these sensations are dangerous or uncontrollable, leading to escalated anxiety.^[7] For instance, someone with elevated AS might interpret a racing heart as a sign of imminent heart attack, whereas heightened interoceptive awareness alone involves merely noticing the sensation without catastrophic attribution.^[8] Unlike agoraphobia, which involves avoidance of situations due to fear of panic-like symptoms or helplessness in those settings, or specific phobias centered on avoidance of particular objects or situations, AS functions as a transdiagnostic trait that can intensify fear responses across multiple anxiety conditions without being confined to avoidance behaviors. AS amplifies the perceived threat of anxiety symptoms in various contexts, contributing to the maintenance of disorders like panic but not equivalent to the situational specificity seen in phobias or agoraphobia.^[9] Although AS overlaps with constructs like trait anxiety and neuroticism—sharing variance in emotional distress—empirical studies demonstrate its incremental predictive power. For example, AS accounts for unique variance in anxiety outcomes, such as state anxiety during public speaking, beyond that explained by trait anxiety alone. Similarly, in hierarchical models, AS explains additional variance in psychopathology symptoms after controlling for neuroticism, underscoring its distinct role in fear amplification. These findings affirm AS as an independent risk factor, particularly for the escalation of anxiety symptoms into clinical disorders.^[10]

Theoretical Foundations

Reiss's Theory of Fundamental Fears

In 1991, Steven Reiss proposed the expectancy model of fear, anxiety, and panic, which posits that human fears are driven by three fundamental sensitivities that serve as core mechanisms underlying a wide array of specific fears and phobias.^[11] These sensitivities include injury sensitivity (fear of pain or physical harm), anxiety sensitivity (fear of anxiety-related bodily sensations due to beliefs about their harmful consequences), and negative evaluation sensitivity (fear of social scrutiny or rejection).^[11] According to the model, anxiety sensitivity specifically refers to the tendency to interpret autonomic arousal—such as heart palpitations or shortness of breath—as signals of impending catastrophe, thereby amplifying the intensity of fear responses.^[11] This framework positions anxiety sensitivity not as a peripheral trait but as a foundational fear that interacts with the other sensitivities to escalate everyday anxieties into more severe psychological conditions. The theory emphasizes the interactive role of these sensitivities in fear amplification, where high levels of anxiety sensitivity exacerbate responses to potential threats by heightening the perceived danger of anxiety symptoms themselves.^[11] For instance, an individual with elevated anxiety sensitivity might experience a mild physiological reaction to stress, interpret it catastrophically (e.g., as a heart attack), and thereby trigger a cascade of intensified fear that reinforces avoidance behaviors and perpetuates the cycle.^[12] When combined with injury sensitivity, anxiety sensitivity can transform common somatic concerns into phobic reactions, such as in hypochondriasis or blood-injury phobia, by creating a synergistic effect that overpathologizes normal bodily signals.^[11] Similarly, its interplay with negative evaluation sensitivity may contribute to social anxiety by linking internal arousal to fears of public embarrassment or judgment.^[13] However, in modern contexts, heightened anxiety sensitivity can become maladaptive when it leads to over-interpretation of benign bodily sensations, resulting in chronic hypervigilance and unnecessary fear escalation that disrupts daily functioning.^[12] A core proposition of the theory is that anxiety sensitivity maintains fears through a self-perpetuating feedback loop: the initial anxiety symptoms provoke fear of those symptoms, which in turn generates more intense anxiety, further validating the catastrophic beliefs and sustaining the disorder.^[11] This loop underscores anxiety sensitivity's causal role in the onset and persistence of panic attacks and related conditions, distinguishing it from mere trait anxiety by its specific focus on the expectancy of harm from arousal.^[11]

Learning and Developmental Origins

Retrospective studies have identified key learning experiences in childhood and adolescence as contributors to the development of anxiety sensitivity. Individuals with high anxiety sensitivity often report a history of more frequent somatic symptoms, such as anxiety or cold-related complaints, before age 18 compared to those with low anxiety sensitivity.^[14] These experiences are frequently linked to parental behaviors, including modeling of anxious responses to bodily sensations and reinforcement of sick-role behaviors, such as providing special attention, instructions to rest, or encouragement to avoid activities during illness.^[14] For instance, parents of high anxiety sensitivity individuals were more likely to emphasize the potential harm of symptoms through verbal transmission of information about their dangers, fostering a pattern of catastrophizing interpretations.^[14] The developmental trajectory of anxiety sensitivity typically unfolds during childhood and early adolescence, shaped by multiple learning pathways including classical conditioning, observational learning, and informational influences. Through conditioning, unexpected or intense bodily sensations during stressful events can become associated with fear, while observational learning occurs when children witness parental or peer overreactions to similar symptoms, thereby acquiring fears vicariously.^[15] Verbal information transmission further reinforces this by conveying messages about the threat posed by anxiety symptoms, often from family members, which heightens sensitivity in susceptible youth.^[16] Longitudinal research indicates that elevated anxiety sensitivity in early adolescence predicts persistent high levels of anxiety symptoms over time, underscoring its role as an early-emerging trait.^[17] Biological underpinnings of anxiety sensitivity include partial heritability, as evidenced by twin studies showing genetic influences accounting for approximately 30-50% of variance.^[18] One such study of adult twins estimated broad heritability at 45%, with additive genetic and unique environmental effects predominating, and no evidence of genetic discontinuities at extreme levels.^[18] Heritability appears to vary by sex and dimension, with stronger genetic effects observed in women for physical, cognitive, and social concerns compared to men, where environmental factors dominate.^[19] An interactionist model posits that genetic predispositions interact with environmental learning experiences to determine anxiety sensitivity levels, where inherited vulnerabilities amplify the impact of early adversities like parental modeling or symptom reinforcement.^[20] This interplay suggests that while genetics provide a foundation, developmental learning histories are crucial in manifesting elevated sensitivity.^[20]

Measurement

Anxiety Sensitivity Index

The Anxiety Sensitivity Index (ASI) was developed by Reiss and colleagues in 1986 as a 16-item self-report questionnaire to operationalize anxiety sensitivity, defined as the fear of anxiety-related sensations due to beliefs that these symptoms have harmful consequences.^[21] The scale was created to distinguish anxiety sensitivity from general trait anxiety and to predict fear responses, with initial validation in undergraduate samples demonstrating its utility in forecasting fearfulness beyond anxiety frequency alone.^[21] The ASI consists of items assessing beliefs about the negative implications of anxiety symptoms, rated on a 5-point Likert scale from 0 ("very little") to 4 ("very much"), yielding a total score range of 0 to 64.^[22] It encompasses three primary subscales—physical concerns (e.g., fear of heart palpitations signaling illness), social concerns (e.g., fear of appearing anxious in public), and cognitive concerns (e.g., fear of losing mental control)—though the original factor structure was intended as unifactorial, subsequent analyses revealed a hierarchical multidimensionality.^[22] Higher total scores indicate greater anxiety sensitivity, with subscale scores providing insight into specific dimensions. Psychometric evaluations of the original ASI have established strong internal consistency, with Cronbach's alpha coefficients typically exceeding 0.80 across diverse samples, reflecting reliable item coherence.^[22] Test-retest reliability over intervals of 1 to 3 months ranges from 0.70 to 0.80, indicating temporal stability.^[22] The scale demonstrates robust construct validity, correlating moderately with measures of trait anxiety (r ≈ 0.50) while incrementally predicting panic symptoms and avoidance behaviors in experimental and clinical contexts.^[22] In 2007, Taylor et al. introduced the revised Anxiety Sensitivity Index-3 (ASI-3), an 18-item iteration designed to refine the factor structure and enhance measurement of the three core dimensions: physical, cognitive, and social concerns, with six items per subscale.^[23] Developed through factor analyses of large nonclinical (n=2,361) and clinical (n=390) samples, the ASI-3 uses the same 5-point Likert response format and total score range of 0 to 72, but offers clearer subscale separation and reduced item overlap compared to the original.^[23] The ASI-3 exhibits improved psychometric properties, including subscale internal consistencies of 0.73 to 0.91 and a total alpha of 0.93, alongside test-retest reliabilities of 0.76 to 0.85 over one month.^[23] It shows strong factorial invariance across genders and cultures, with convergent validity evidenced by correlations of 0.41 to 0.70 with related anxiety measures, and superior predictive validity for anxiety outcomes relative to prior versions.^[23]

Other Assessment Tools

The Childhood Anxiety Sensitivity Index (CASI) is an 18-item self-report measure adapted from the adult Anxiety Sensitivity Index to assess anxiety sensitivity in youth, specifically targeting children and adolescents aged 6 to 17 years. Developed by Silverman, Fleisig, and Rabian in 1991, the CASI evaluates fears of anxiety-related somatic, cognitive, and social symptoms through Likert-scale responses, demonstrating strong internal consistency (α = .82–.87) and test-retest reliability in both clinical and nonclinical samples.^[24] Its factor structure supports a hierarchical model with physical, mental, and social concerns subscales, facilitating targeted assessment in pediatric populations where developmental differences may influence symptom expression. Another child-adapted instrument is the Anxiety Sensitivity Index for Children (ASIC), a 20-item scale initially developed by Laurent and colleagues in 1998 as a direct modification of the adult ASI, later refined by eliminating items with poor psychometrics to yield a more parsimonious version.^[25] The ASIC measures similar dimensions of anxiety sensitivity but emphasizes adolescent applicability, with evidence of a hierarchical factor structure comprising physical, psychological, and social concerns, and adequate reliability (α = .90).^[25] Short forms of these youth measures, such as abbreviated versions of the CASI (e.g., 6- or 9-item subsets), have been validated for clinical settings to enhance efficiency while retaining predictive validity for anxiety outcomes, allowing brief screening without sacrificing sensitivity to key facets. Behavioral assessments complement self-report tools by directly evaluating anxiety sensitivity through physiological reactivity to induced bodily sensations. Interoceptive exposure tasks, such as standardized hyperventilation challenges, involve participants engaging in controlled overbreathing for 1–2 minutes to provoke symptoms like dizziness and heart palpitations, followed by ratings of fear and distress to quantify reactivity. These tasks reliably differentiate high- from low-anxiety sensitivity individuals, with higher AS linked to greater subjective anxiety and physiological arousal during the procedure, providing an objective index of intolerance to interoceptive cues beyond retrospective reporting.^[26] Multidimensional scales expand on the core ASI by incorporating broader or revised item sets to capture nuanced facets of anxiety sensitivity. The Anxiety Sensitivity Index-Revised (ASI-R), a 36-item instrument developed by Taylor and Cox in 1998, assesses four lower-order dimensions—physical, social, cognitive, and observable anxiety concerns—under a higher-order AS factor, offering enhanced discriminant validity for distinguishing AS from general anxiety in clinical research.^[27] For momentary fluctuations, state-specific measures adapt AS items for ecological momentary assessment (EMA), prompting real-time ratings of current fears of anxiety symptoms multiple times daily via mobile devices to track dynamic variations in response to situational triggers. These EMA approaches reveal within-person AS instability, correlating with acute anxiety episodes, and support idiographic profiling over trait-like stability.^[28] In recent developments as of 2024, shortened versions of the ASI-3, including 6- and 12-item forms, have been validated using item response theory for rapid screening in clinical and research settings while maintaining strong psychometrics.^[29]

Clinical Significance

Relation to Anxiety Disorders

Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations due to beliefs about their harmful consequences, serves as a primary cognitive risk factor for panic disorder. High levels of AS predispose individuals to interpreting benign physiological arousal as threatening, thereby increasing vulnerability to panic attacks. Prospective studies have consistently shown that elevated AS predicts the onset of first lifetime panic attacks, even after accounting for prior anxiety symptoms or history of panic. For instance, in a landmark prospective evaluation during acute stress, AS uniquely predicted spontaneous panic attacks among young adults, independent of trait anxiety or prior panic experiences. Beyond panic disorder, AS plays a transdiagnostic role across multiple anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). Recent reviews as of 2024 continue to affirm AS's transdiagnostic role across emotional disorders, including emerging applications in health anxiety and critical care contexts.^[30]^[1] In GAD, elevated AS amplifies worry by heightening fears of somatic symptoms, contributing to chronic symptom escalation. Similarly, in social anxiety disorder, AS exacerbates avoidance behaviors through fears of visible anxiety cues, while in PTSD, it intensifies hyperarousal and re-experiencing by linking bodily sensations to trauma reminders. In OCD, elevated AS contributes to overall symptom severity by heightening fears of anxiety-related sensations that can exacerbate obsessions and compulsions.^[7]^[30] Longitudinal research provides robust prospective evidence linking baseline AS to the development of anxiety disorders over short- to medium-term follow-ups of 1 to 12 months. In a 1-year study of community adults, higher initial AS scores predicted new-onset panic attacks and increased Axis I psychopathology, highlighting its role in disorder emergence. Among adolescents, baseline AS has been shown to forecast heightened anxiety symptoms and clinical syndromes over 6 to 12 months, underscoring its predictive utility in early development. These findings from multiple cohorts affirm AS as a precursor rather than merely a correlate of anxiety pathology.^[31]^[32] The mechanisms underlying AS's relation to anxiety disorders center on a self-perpetuating fear-of-fear cycle, where initial anxiety symptoms trigger catastrophic cognitions about their implications, thereby intensifying arousal and maintaining disorder chronicity. This cycle begins with misinterpretation of normal sensations (e.g., heart palpitations as signs of catastrophe), leading to secondary anxiety that mimics or escalates the original threat, fostering avoidance and symptom persistence. In panic disorder, this mechanism directly sustains attacks, while transdiagnostically, it broadens to reinforce maladaptive patterns in GAD, PTSD, and beyond, as evidenced by empirical models of cognitive mediation.^[33]

Heritability and Risk Factors

Twin studies have estimated the heritability of anxiety sensitivity (AS) to range from 30% to 50% of the total variance in AS scores, indicating a moderate genetic contribution. A seminal twin study of 964 individuals found that additive genetic factors accounted for 45% of the variance in total AS as measured by the Anxiety Sensitivity Index (ASI), with the remaining 55% attributed to unique environmental influences. Regarding subscales, heritability was estimated at 35% for physical concerns, 22% for social concerns, and 0% for psychological concerns, suggesting differential genetic influences across AS dimensions.^[34] Environmental risk factors for elevated AS include family history of anxiety disorders, early life adversity, and cultural influences on symptom interpretation. First-degree relatives of individuals with panic disorder exhibit significantly higher AS levels than controls, with family aggregation suggesting both genetic and modeling effects from parental anxiety behaviors. Childhood adversities, such as trauma or maltreatment, prospectively predict increased AS in adolescence, potentially through heightened fear conditioning to bodily sensations. Cultural factors modulate AS expression; for instance, somatic symptoms like dizziness are more prominently associated with AS in some Asian populations compared to Western groups, reflecting varying cultural appraisals of physical anxiety cues.^[35]^[36]^[37] AS demonstrates moderate temporal stability over time, with test-retest correlations typically ranging from 0.50 to 0.70 across years, positioning it as a relatively enduring trait yet responsive to change. In a large longitudinal cohort, AS showed a two-year stability coefficient of r = 0.72, alongside a modest mean-level decline, underscoring its trait-like quality while malleable through interventions. Gene-environment interactions further shape AS vulnerability; for example, polymorphisms in the serotonin transporter gene (5-HTTLPR) interact with childhood maltreatment to amplify AS, particularly in those with the short allele, and genetic liabilities may heighten sensitivity to negative life events via subjective reporting biases. Parental anxiety modeling exemplifies this interplay, where offspring genetic predispositions are exacerbated by observed anxious responses in family environments.^[38]^[39]^[40]

Interventions

Cognitive-Behavioral Interventions

Cognitive-behavioral interventions for anxiety sensitivity (AS) primarily target the cognitive and behavioral processes that maintain fears of anxiety-related sensations, positioning AS as a key modifiable risk factor for anxiety disorders. These interventions typically incorporate psychoeducation to address misconceptions about anxiety symptoms, such as the belief that heart palpitations signal imminent heart attacks, helping individuals understand that these sensations are benign and transient.^[41] Psychoeducation is often delivered early in treatment to normalize experiences and reduce avoidance behaviors.^[42] Core components also include cognitive restructuring to challenge and modify catastrophic interpretations of bodily sensations, such as reframing rapid breathing as a normal response to stress rather than a precursor to loss of control.^[43] This technique involves identifying automatic negative thoughts, evaluating evidence for and against them, and developing balanced alternatives, which directly diminishes the perceived threat of anxiety symptoms. Interoceptive exposure forms another essential element, involving repeated, controlled induction of feared physical sensations—such as spinning in a chair to simulate dizziness or hyperventilating to evoke shortness of breath—to foster habituation and demonstrate the harmlessness of these cues.^[44] These components are integrated to promote experiential learning that anxiety sensations are tolerable and non-dangerous.^[45] Randomized controlled trials demonstrate the efficacy of these CBT protocols in reducing AS, with meta-analytic evidence showing large effect sizes (Hedges' g = 1.40) in treatment-seeking samples and moderate-to-large effects (g = 0.74) in at-risk individuals, corresponding to substantial reductions in AS scores on the Anxiety Sensitivity Index.^[46] Single-session formats, lasting 1-4 hours, have shown feasibility and preliminary efficacy for high-AS individuals, with significant decreases in AS reported in small-scale studies.^[47] These interventions are delivered in various formats, including individual therapy for personalized exposure hierarchies, group sessions to leverage peer support and normalize experiences, and integration into broader panic-focused CBT protocols where AS reduction enhances overall treatment response.^[48] Decreased AS following CBT leads to broader clinical benefits, including reduced severity of anxiety symptoms and lower rates of relapse in panic disorder, with responders maintaining gains at 12-month follow-up and relapse rates of about 14%.^[49] By targeting AS, these interventions not only alleviate immediate distress but also build resilience against future anxiety episodes, underscoring their role in long-term prevention.^[50]

Emerging and Preventive Approaches

Brief interventions targeting anxiety sensitivity (AS) have emerged as efficient strategies for at-risk individuals, often delivered in a single session incorporating psychoeducation, cognitive restructuring, and interoceptive exposure exercises. These programs have demonstrated significant reductions in AS levels, with one randomized trial reporting a 30% decrease in overall AS among young adults in non-clinical samples compared to 17% in controls, alongside prospective associations with lower incidence of mood and anxiety disorders.^[51] Such approaches are particularly valuable for their brevity and scalability, enabling rapid deployment in community settings without requiring extensive therapeutic resources.^[52] Digital and self-help interventions represent another innovative avenue, leveraging online psychoeducation modules and mobile apps to address AS directly. A randomized waitlist-controlled trial of a standalone digital psychoeducation program showed medium-to-large reductions in AS at two-week follow-up, highlighting its potential as a low-cost, accessible tool for broad dissemination.^[53] Meta-analyses of brief AS interventions in at-risk populations further support moderate effects on preventing anxiety onset, with effect sizes indicating sustained improvements in AS and related symptoms up to one year post-intervention.^[54] Preventive applications of AS-focused strategies are gaining traction in high-risk contexts, such as school-based programs for youth. The Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y), a targeted intervention for children aged 10-14 with elevated AS, has shown preliminary efficacy in reducing AS and averting the development of anxiety disorders through school-delivered sessions emphasizing education and exposure.^[55] Similarly, integrating AS management into critical illness care, particularly in intensive care unit (ICU) settings, addresses heightened fears of somatic sensations during procedures like oxygen therapy; non-pharmacologic techniques have been recommended to mitigate AS amplification throughout the illness trajectory.^[56] Looking to future directions, pharmacological adjuncts and mindfulness-based approaches offer promising extensions to existing preventive efforts. Preliminary randomized controlled trial (RCT) evidence suggests that mindfulness training indirectly reduces AS by mediating improvements in anxiety and depression severity, with one study demonstrating significant decreases in AS as a mechanism for symptom relief over eight weeks.^[57] In critical illness contexts, combining pharmacologic agents like selective serotonin reuptake inhibitors with AS-targeted interventions shows early potential for enhancing recovery, though larger RCTs are needed to establish efficacy.^[1]

History

Development of the Concept

Anxiety sensitivity was introduced in the mid-1980s by Steven Reiss, Richard A. Peterson, and their colleagues as a psychological construct to explain why certain individuals exhibit heightened fear toward the somatic, cognitive, and social symptoms of anxiety, beyond mere proneness to experiencing anxiety itself.^[58] This concept arose from observations in clinical populations, particularly those with panic symptoms, where fear appeared to stem not just from the anxiety episode but from catastrophic interpretations of its accompanying sensations, such as heart palpitations or dizziness.^[59] By positing anxiety sensitivity as a predisposition to view these symptoms as harmful or uncontrollable, the theory provided a framework for understanding variability in fear responses across individuals.^[60] A key early publication advancing this idea was the 1986 paper by Reiss, Peterson, Gursky, and McNally, which formally proposed anxiety sensitivity as a stable dispositional factor independent of general anxiety frequency or trait anxiety.^[2] In this work, the authors differentiated anxiety sensitivity as a set of expectancies about the negative consequences of anxiety symptoms—such as beliefs that they signal impending physical harm, mental incapacitation, or social embarrassment—from broader tendencies toward anxiousness.^[61] This distinction was crucial, as it highlighted how anxiety sensitivity could amplify fear even in the absence of frequent anxiety episodes, positioning it as a specific vulnerability rather than a synonym for neuroticism.^[62] The development of anxiety sensitivity marked a significant shift from prevailing models of agoraphobia and panic, which had largely attributed fear to external cues like open spaces or crowds, toward an emphasis on interoceptive fears driven by bodily sensations. Prior frameworks, such as those linking agoraphobia to avoidance of situational triggers, were reframed to incorporate how misinterpretations of internal arousal could initiate and perpetuate panic independently of environmental factors.^[63] This evolution underscored anxiety sensitivity's role in a cognitive-experiential model of fear, where expectancies about symptom implications fueled avoidance and escalation.^[64] Initial validation of anxiety sensitivity's distinction from trait anxiety came through factor-analytic studies in the late 1980s, which empirically separated its underlying dimensions from measures of general anxious disposition.^[62] For instance, Peterson and Reiss's 1987 analysis of the Anxiety Sensitivity Index revealed a coherent factor structure reflecting fears of physical, psychological, and social repercussions of anxiety, uncorrelated with trait anxiety scales like the State-Trait Anxiety Inventory. These findings established anxiety sensitivity as a unique construct, paving the way for its integration into broader theories of fear and anxiety disorders.^[60]

Key Research Milestones

In the 1990s, longitudinal and experimental research solidified anxiety sensitivity (AS) as a key risk factor for anxiety-related outcomes. A one-year prospective study by Ehlers demonstrated that higher AS levels significantly predicted the maintenance and occurrence of panic attacks in individuals with panic disorder, independent of initial symptom severity.^[65] Complementing this, McNally and Eke's experimental investigation using carbon dioxide inhalation challenges showed that AS, alongside suffocation fear, robustly predicted heightened anxiety and fear responses to induced bodily sensations, underscoring its causal role in amplifying AS-related fears.^[66] The 2000s marked expansions in assessment and broader validation of AS. Taylor and colleagues developed the Anxiety Sensitivity Index-3 (ASI-3) in 2007, an 18-item revision that reliably distinguished physical, cognitive, and social concerns subscales, enhancing the tool's psychometric properties and applicability across diverse samples.^[67] Concurrent meta-analyses further established AS as a transdiagnostic risk factor, with syntheses showing moderate to strong associations between AS and the onset or exacerbation of multiple anxiety and mood disorders, beyond just panic.^[30] Entering the 2010s and 2020s, research shifted toward genetic underpinnings and targeted interventions. Jang et al.'s 1999 twin study revealed a heritability estimate of approximately 50% for AS, indicating a substantial genetic component that influences vulnerability to panic and related conditions.^[18] Randomized controlled trials (RCTs) on brief AS interventions gained traction, with refinements in 2012 demonstrating that single-session protocols effectively reduced AS levels and prevented anxiety symptom escalation in at-risk populations. Recent trends in the 2020s have emphasized digital prevention strategies and AS in diverse contexts, including pandemic-related anxiety. Studies during the COVID-19 era highlighted elevated AS as a mediator of heightened mental health burdens, such as increased fatigue and distress from infection fears.^[68] Emerging digital interventions, including app-based cognitive-behavioral modules, have shown promise in reducing AS in underserved and global populations, facilitating scalable prevention amid ongoing public health challenges.^[69] In 2025, studies further explored AS's interactions with intolerance of uncertainty in substance use contexts and its moderating role in digital health anxieties.^[70]^[71]

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Refinement of a Brief Anxiety Sensitivity Reduction Intervention - PMC
Method. This one-session intervention utilized psychoeducation and interoceptive exposure to target AS and was compared to a health-focused control intervention ...Abstract · Assessments · Self-Report Measures
[35]
Targeting Anxiety Sensitivity With Evidence-Based Psychoeducation
Recent work demonstrated that single-session digital psychoeducation interventions delivered on computers in a lab setting can effectively reduce anxiety ...
[36]
Cognitive-Behavioral Treatments for Anxiety and Stress-Related ...
Jun 17, 2021 · CBT is an effective, gold-standard treatment for anxiety and stress-related disorders. CBT uses specific techniques to target unhelpful thoughts, feelings, and ...
[37]
Interoceptive hypersensitivity and interoceptive exposure in patients ...
Aug 16, 2006 · Interoceptive exposure has been validated as an effective component of cognitive behavioral therapy (CBT) for the treatment of panic disorder.
[38]
Interoceptive Exposure - Psychology Tools
Interoceptive exposure is a powerful technique for treating panic and anxiety by confronting and reducing fear responses to bodily sensations.Missing: hyperventilation | Show results with:hyperventilation
[39]
The efficacy of cognitive-behavioral interventions for reducing ...
Our review indicates that CBT is efficacious in reducing anxiety sensitivity. However, more research is needed to determine the mechanisms by which CBT exert ...
[40]
Single-session anxiety sensitivity reduction program for trauma ...
The present case series examined a single-session, cognitive-behavioral anxiety sensitivity (AS) reduction program among five trauma-exposed adults.
[41]
CBT treatment delivery formats for panic disorder - PubMed Central
Findings from this NMA show that group, guided self-help and individual CBT delivery formats are all superior to treatment as usual having similar effect sizes, ...
[42]
Twelve-Month Outcomes Following Successful Panic-Focused ...
Sep 11, 2018 · Results: Patients with panic disorder who responded to 1 of 3 treatments maintained their gains on the PDSS, SDS, and HDRS with no differences ...
[43]
A meta-analysis of relapse rates in cognitive-behavioral therapy for ...
We used meta-analysis to determine relapse rates in CBT for anxiety disorders. We found a 14 % overall relapse rate, which did not differ based on diagnosis.Missing: decreased | Show results with:decreased
[44]
Full article: Is it possible to prevent relapse in panic disorder?
In conclusion, the best treatments to prevent relapse in PD are roughly the same ones recommended by the guidelines for acute treatment: SSRI, SNRI, TCA, ...
[45]
Effects of a Brief Anxiety Sensitivity Reduction Intervention on ... - NIH
Anxiety sensitivity (AS) has been identified as a transdiagnostic cognitive risk factor for a wide range of affective disorders, including conditions within the ...Self-Report Measures · Figure 1 · Mediation Effects Of Changes...
[46]
Reductions in anxiety sensitivity cognitive concerns prospectively ...
In an initial study, a brief intervention produced a 30% decrease in overall AS and was prospectively associated with lower incidence of mood and anxiety ...
[47]
Targeting Anxiety Sensitivity With Evidence-Based Psychoeducation
We tested a standalone brief digital psychoeducation intervention vs. waitlist. There were medium-to-large reductions in anxiety sensitivity at two-week follow ...
[48]
Anxiety sensitivity as a malleable mechanistic target for prevention ...
Is computerized psychoeducation sufficient to reduce anxiety sensitivity in an at-risk sample?: A randomized trial. Journal of Affective Disorders, 212, 48 ...Missing: online | Show results with:online
[49]
Test of an Anxiety Sensitivity Amelioration Program for at-risk youth ...
The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10–14 years ...
[50]
Understanding and Managing Anxiety Sensitivity During Critical ...
Nov 1, 2023 · A “fear of fear” can amplify anxiety during all stages of the critical illness trajectory, from ICU admission through long-term recovery.
[51]
The potential mediating role of anxiety sensitivity in the impact of ...
Jul 19, 2022 · This study investigated whether anxiety sensitivity was a potential mechanism for the impact of mindfulness training on anxiety and depression.
[52]
The sensitivity theory of aberrant motivation. - APA PsycNet
In 1985, R. J. McNally and I introduced the concept of anxiety sensitivity to explain data pertaining to the treatment of anxiety disorders.
[53]
Anxiety sensitivity in 1984 and panic attacks in 1987 - ScienceDirect
Subjects with high 1984 ASI scores were five times more likely to have an anxiety disorder during the period 1984 to 1987.Missing: original paper
[54]
[PDF] ANXIETY SENSITIVITY: AN EXAMINATION OF THEORETICAL AND ...
“injury sensitivity” and “social evaluation sensitivity” hypothesized by. Reiss (1991) to play an important role in the development of fears. Although these ...
[55]
Anxiety sensitivity, anxiety frequency and the prediction of fearfulness
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative ...Missing: original | Show results with:original
[56]
The Anxiety Sensitivity Index: Construct validity and factor analytic ...
Results suggest that the ASI is a reliable measure that is factorially independent of other anxiety measures.
[57]
An examination of reiss and McNally's expectancy model and ...
This paper reports on two studies that examined predictions derived from Reiss and McNally's (1985) expectancy model of fear behavior and Bandura's.Missing: details | Show results with:details
[58]
Anxiety sensitivity, trait anxiety, and the anxiety disorders
The recent debates and commentaries about the construct validity of the Anxiety Sensitivity Index (ASI) suggest several issues that remain to be resolved.
[59]
Anxiety sensitivity, suffocation fear, and breath-holding duration as ...
McNally, 1986) predicted anxiety and self-reported bodily sensations, whereas a behavioral measure of carbon dioxide sensitivity (i.e., maximum breath-holding ...
[60]
development and initial validation of the Anxiety Sensitivity Index-3
The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the ...
[61]
Anxiety Sensitivity and COVID-19 Mental Health, Fatigue, and Well ...
Jun 3, 2024 · Research has applied anxiety sensitivity theory to the COVID-19 pandemic based in the idea that it can exacerbate the severity of interoceptive ...Missing: 2020s | Show results with:2020s
[62]
Digital mental health interventions for anxiety and depressive ...
Jun 20, 2022 · This study aimed at systematically reviewing the existing literature on digital mental health interventions targeting anxiety and depressive symptoms in ...