Implicit associations between anxiety-related symptoms and catastrophic consequences in high anxiety sensitive individuals
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COGNITION AND EMOTION
2006, 20 (2), 295±308
Implicit associations between anxiety-related
symptoms and catastrophic consequences in high
anxiety sensitive individuals
Marie-joseÂe Lefaivre
Dalhousie University, Halifax, Nova Scotia, Canada
Margo C. Watt
Dalhousie University, Halifax and St. Francis Xavier University, Antigonish,
Nova Scotia, Canada
Sherry H. Stewart and Kristi D. Wright
Dalhousie University, Nova Scotia, Canada
Anxiety sensitivity refers to the fear of anxiety-related physical sensations arising
from beliefs that these sensations have harmful consequences (Reiss & McNally,
1985). The present study examined whether individuals with high (vs. low) anxiety
sensitivity show stronger implicit associations in memory between anxiety-related
symptoms, as opposed to neutral body parts, and harmful, as compared to harm-
less, consequences. A total of 22 undergraduate students (14 F, 8 M) completed the
Extrinsic Affective Simon Task (EAST; De Houwer, 2003). Results indicated that
high anxiety sensitive individuals (n = 10) tended to implicitly associate harmful
consequences with anxiety-related symptoms. Their performance was significantly
faster on trials where target words related to anxiety symptoms were mapped on to
the same response key as harmful consequences. No significant difference in
performance was found for low anxiety sensitive individuals (n = 12) or when
target words were body parts unlikely related to diseases. Between-group differ-
ences persisted after controlling for trait anxiety and history of panic attacks, but
not when illness-related beliefs were introduced as a covariate. Identifying this
implicit association bias provides additional empirical support for the concept of
anxiety sensitivity.
Correspondence should be addressed to Dr Margo C. Watt, Department of Psychology, St.
Francis Xavier University, P.O. Box 5000, Antigonish, Nova Scotia B2G 2W5, Canada; e-mail:
mwatt@stfx.ca
The authors would like to thank members of Dr Ray Klein's laboratory at Dalhousie University
(particularly Patti Devlin) for their assistance with the computer programming and Tara MacDonald
at St. Francis Xavier University for her assistance with data collection.
# 2006 Psychology Press Ltd
http://www.psypress.com/cogemotion DOI:10.1080/02699930500336466296 LEFAIVRE ET AL. Anxiety sensitivity is an individual difference factor that refers to the fear of anxiety-related physical sensations. This fear arises from beliefs that anxiety- related sensations have harmful somatic, psychological, or social consequences (Reiss & McNally, 1985). Whereas individuals with low anxiety sensitivity recognise that bodily sensations associated with anxiety are unpleasant but transient and harmless, individuals with high anxiety sensitivity fear these symptoms may have dire consequences (McNally, 1999a). Anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992), has demonstrated incremental validity above and beyond measures of trait anxiety in discriminating between panic disorder and generalised anxiety disorder (e.g., Taylor, Koch, & McNally, 1992), as well as in predicting fear and panic (Peterson & Reiss, 1992). Anxiety sensitivity has been shown to be an important risk factor for the development and maintenance of panic disorder (see review by Cox, Borger, & Enns, 1999), and hypochondriasis (Otto, Demopulos, McLean, Pollack, & Fava, 1998; Stewart & Watt, 2000). Information-processing models consider anxiety disorders to result from maladaptive schemas in memory misguiding information processing (Teachman & Woody, 2003; for a review, see Coles & Heimberg, 2002). These models predict that anxiety-congruent information will be subject to attentional, pro- cessing, and retrieval biases, which contribute to the development and main- tenance of anxiety disorders (Foa & Kozak, 1986; for a review, see Coles & Heimberg, 2002). For example, Beck and Clark (1997) propose a three-stage model to explain the relative roles of explicit (conscious) and implicit (auto- matic) information-processing in the etiology of pathological anxiety. Whereas most research has focused on the third stage of Beck and Clark's model (i.e., self-reported cognitions), more recently, researchers have started to explore the earlier stages; stages not accessible to conscious processing (see McNally, 1995). In order to examine the more automatic and implicit stages of information- processing, researchers generally must employ tasks that measure, in milli- seconds, automatic actions, or judgements that do not, by definition, require conscious awareness on the participant's part (see Egloff & Schmukle, 2002; McNally, 2001). These types of tasks provide complementary information to explicit research designs (e.g., self-report, free-recall test) interested in the more reflective and conscious processing stage of Beck and Clark's (1997) model by providing insight on earlier information-processing stages. Studies employing implicit cognition tasks have demonstrated that, as opposed to controls, clinically diagnosed anxiety disorder patients have a ten- dency to show selective processing biases favouring information relevant to their anxiety-related concerns (see reviews in Coles & Heimberg, 2002; McNally, 1999b; Williams, Mathews, & MacLeod, 1996). Other studies have examined the relationship between anxiety sensitivity and information- processing biases before the onset of anxiety problems to determine if anxiety
ANXIETY SENSITIVITY AND IMPLICIT BIAS 297 sensitivity could be considered a cognitive risk factor for anxiety disorders (Keogh, Dillon, Georgiou, & Hunt, 2001; Lees, Mogg, & Bradley, 2005; McCabe, 1999; McNally, Horning, Hoffman, & Han, 1999; Stewart, Conrod, Gignac, & Pihl, 1998). It remains unclear whether cognitive biases precede or follow the development of an anxiety disorder given the limited amount of research on nonclinical samples to date (see McNally et al., 1999). The above studies have varied by sample and methodology. Moreover, none have used association-type tasks thereby preventing the examination of auto- matic associative processes as a function of anxiety sensitivity levels. By defi- nition, high anxiety sensitive individuals should be differentiated from low anxiety sensitive individuals not simply by their fear of anxiety-related sensa- tions but also by their beliefs about the catastrophic consequences of experi- encing these sensations. Consequently, the objective of the present study was to extend previous findings by examining whether high anxiety sensitive indivi- duals tend to catastrophise the consequences of their physical symptoms. More precisely, we were interested in whether there is a stronger implicit association (vs. dissociation) between physical symptoms and harmful outcomes (vs. harmless outcomes) concepts in memory for high anxiety sensitive individuals as compared to low anxiety sensitive individuals. Identifying the presence of an implicit association bias between anxiety-related sensations and negative out- comes among high anxiety sensitive individuals using a novel research task could provide additional empirical support for the concept of anxiety sensitivity, as well as explicating possible cognitive mechanisms involved in high anxiety sensitive individuals' risk for panic disorder and hypochondriasis. The present study employed the Extrinsic Affective Simon Task (EAST) recently developed by De Houwer (2003). The EAST is a modified version of the popular Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) that measures participants' reaction times (RTs) when categorising stimuli by pressing either a left or a right computer key. The underlying assumption that forms the basis of tasks, such as the EAST or IAT, is that a relationship exists between cognitive structures and automaticity (see Teachman & Woody, 2003). The EAST is therefore seen as a measure of cognitive structure or automatic associations in memory based on RTs. The EAST was chosen for the present study because it circumvents some of the problems associated with the IAT (see De Houwer, 2003). In the present study, individuals were asked to categorise body parts (e.g., abdomen, elbow) and anxiety-related sensations (e.g., breath- less, dizzy) based on their colour, as well as to categorise positive (e.g., benign, healthy) and negative (e.g., faint, stroke) health outcomes, presented in white, based on their valence (see details in the Method section). As suggested by Palfai and Ostafin (2003), we selected words representing body parts unlikely to be associated with negative physical outcomes (e.g., diseases) as control targets, because similar evaluative responses would be expected across individuals therefore providing, hopefully, a stable contrast.
298 LEFAIVRE ET AL.
It was hypothesised that, if a tendency to catastrophise anxiety-related phy-
sical sensations existed among the high anxiety sensitive participants, their
performance would be superior on trials where they needed to select an
extrinsically negative (vs. positive) response key for coloured target words that
were anxiety-related sensations. It was also expected that this performance
facilitation for targets by pairing with the extrinsically negative response key
would be specific to high anxiety sensitive (as opposed to low anxiety sensitive)
individuals, and to trials involving anxiety-related sensations (as opposed to
body parts) as target items.
METHOD
Participants
The participants were 22 (14 F, 8 M; mean age = 18.5, SD = 0.80) undergraduate
students from St. Francis Xavier University who received course credit for
participating in the study. Participants were randomly selected and assigned to
groups according to their scores on the Anxiety Sensitivity Index (ASI; Peterson
& Reiss, 1992) administered during a mass in-class screening. The high and low
anxiety sensitivity groups were composed of participants scoring at least one
standard deviation above (> 17.9 + 8.7) or below (< 17.978.7) the ASI mass
screening sample mean, respectively (see Peterson & Reiss, 1992; Watt,
Stewart, & Cox, 1998).
The results of independent-sample t-tests and chi-square analyses showed
that the two groups did not significantly differ in terms of age, gender ratio, level
of education in years, or number of participants who had ever experienced a
spontaneous panic attack but they did differ significantly in trait anxiety as
assessed by the State-Trait Anxiety Inventory-Trait Subscale (Spielberger,
Gorsuch, Lushene, Vagg, & Jacobs, 1983) and health anxiety as assessed by the
Illness Attitudes Scale (Kellner, 1987). The descriptive statistics for both groups
are presented in Table 1.
Participants had normal or corrected-to-normal vision. Students who were
colour-blind and/or students whose language was not English were excluded
from the study given that the EAST is a cognitive task that requires the rapid
distinction between two similar colours (i.e., green and blue) and the rapid
categorisation of English words based on their semantic meaning.
Measures
Demographic information. Age, gender, and level of education of the
participants were collected with a researcher-compiled demographic information
questionnaire.ANXIETY SENSITIVITY AND IMPLICIT BIAS 299
TABLE 1
Means (and standard deviations) comparing the two anxiety sensitivity
groups
LAS HAS
(n = 12) (n = 10)
Age 18.42 (0.9) 18.6 (0.7)
Gender 5 M; 7 F 3 M; 7 F
Level of education 14.5 (1.0) 14.2 (0.4)
ASI-Total 7.0 (1.8) 32.9 (2.8)***
STAI-T 36.5 (8.6) 46.0 (10.7)*
IAS-Total 28.9 (12.6) 43.3 (15.4)*
PAQ (% spontaneous panic reporters) 2 (17%) 2 (20%)
LAS, low anxiety sensitive; HAS, high anxiety sensitive; STAI-T, State Trait
Anxiety Inventory-Trait Scale; ASI, Anxiety Sensitivity Index; PAQ, Panic Attack
Questionnaire; IAS, Illness Attitudes Scale. * p < .05; ** p < .01; *** p < .001.
Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992). Using 5-point
Likert-type scales, the ASI assesses the respondent's level of agreement/
disagreement with 16 statements relating to the beliefs that anxiety sensations
are associated with physical, social, or psychological consequences. Psycho-
metric information concerning the excellent reliability and validity of the
measure for clinical and nonclinical populations is available in Peterson and
Reiss (1992).
Illness Attitudes Scale (IAS; Kellner, 1987). This 29-item self-report scale
is divided into nine subscales that assess fears, behaviours, beliefs, and effects
associated with hypochondriasis (see Stewart & Watt, 2000), as well as
psychopathology associated with abnormal illness behaviours. The IAS has been
shown to have good test-retest reliability (see Fava, Kellner, Zielzny, & Grandi,
1988; Kellner, 1987), acceptable internal reliability (see Stewart & Watt, 2000;
Wise & Sheridan, 2001), good concurrent validity (Kellner, Abbot, Winslow, &
Pathak, 1987), and convergent validity (Speckens, Spinhoven, Sloekers, Bolk, &
van Hemert, 1996).
Panic Attack Questionnaire±Revised (PAQ-R; Cox, Norton, & Swinson,
1992). The PAQ-R provides a description of a panic attack as defined in the
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-Revised
(American Psychiatric Association, 1987) and asks participants to indicate
whether they have ever experienced such an attack. The experience of at least
one spontaneous (``out of the blue'') panic attack was used to assess panic
history.300 LEFAIVRE ET AL. State-Trait Anxiety Inventory-Trait Subscale (STAI-T; Spielberger et al., 1983). This self-report subscale assesses participants' general tendency to react anxiously to potentially threatening stimuli. Participants are asked to rate how they generally feel about 20 statements using 4-point Likert-type scales. The STAI manual (Spielberger et al., 1983) provides information about the good psychometric proprieties of this scale. EAST Stimulus Materials. Five anxiety-related symptoms (i.e., breathless, dizzy, numbness, palpitation, shaky) were selected from word lists previously used in anxiety sensitivity studies (McCabe, 1999; McNally et al., 1999). Five negative health outcomes matching these particular symptoms (i.e., suffocate, faint, stroke, heart attack, seizure) were then selected in order to reflect the anticipated negative consequences of experiencing such symptoms. Subse- quently, five body parts identified as unlikely related to diseases (i.e., abdomen, ankle, elbow, finger, nose) and five positive health outcomes (e.g., benign, healthy, innocuous, resilient, thriving) were also selected to complete the four stimuli categories for the EAST. The results of two one-way analyses of variance (ANOVA) indicated that the four word groups did not differ in average word length, F(3, 16) = 1.661, ns, and average word frequency, F(3, 16) = 0.828, ns. The average word frequency was calculated using a popular Internet search engine (www.google.com; see Blair, Urland, & Ma, 2003). EAST apparatus. The EAST (De Houwer, 2003) was conducted using the SuperLab software programmed on an iMac computer running in OS 9.1. Participants were seated in front of the computer at a distance of approximately 40 cm from the 14-inch screen. The words' letters were around 7 mm high and 5 mm wide and were presented on a black background. The descriptors were presented in white using the default Adobe Photoshop values. The target words were presented in either blue or green. The red, blue, and green settings used to create the blue (0,117,97) and the green (0,97,117) produced two colours that were quite similar. Participants used either the ``A'' key or ``L'' key of the (QWERTY) keyboard to categorise the stimuli. Participants' response times, defined as the time between the onset of a word and the first key press, were measured using the highly accurate (< 1 ms) Timer-1 included in the SuperLab software. Procedure After reading and signing the Consent Form, the participants completed the EAST and the questionnaires individually. The EAST included several trials during which participants were presented with words one by one, and were asked to classify these words based on either their meaning or colour. Partici- pants had to categorise white words (i.e., descriptors) according to the word's
ANXIETY SENSITIVITY AND IMPLICIT BIAS 301
valence (i.e., positive or negative). Participants were told to press the GOOD key
when words referred to something positive (e.g., healthy, innocuous) or the BAD
key if the word was something negative (e.g., stroke, faint). Participants also had
to categorise coloured words (i.e., targets) according to their colour (i.e., blue vs.
green) regardless of the valence. The target words were either anxiety-related
symptoms or body parts unlikely to be related to disease. On the trials of the test
blocks, one descriptor and one colour were mapped on to one response key (e.g.,
A = positive and blue) and the other descriptor and the other colour were
mapped on to the other response key (e.g., L = negative and green). Conse-
quently, the targets become extrinsically related to the descriptors' valence
because of the task instructions (see De Houwer, 2003; see also Appendix). The
key mapping assignments for the descriptors and the targets were manipulated in
an orthogonal way to control for possible location-effect between participants.
The participants were told to respond as quickly as possible without making any
errors. A red cross appearing on the screen informed participants when they had
made an incorrect response.
The EAST took about 15 minutes to complete and included two practice
blocks of 20 trials followed by four test blocks of 30 trials. Participants were
presented the same stimuli during the practice and test blocks (see De Houwer,
2003). The first practice block consisted of white words only during which each
10 stimuli were presented twice in a random order. The random presentation of
the 10 coloured words, once in each colour, was the second practice block. The
four test blocks of 30 trials followed during which each of the 10 target words
were presented once in each colour and each of the 10 descriptor words were
presented once in white. The words were all presented in random order with the
restriction that the same word could not be presented on two or more con-
secutive trials and that the required response could not be the same on four or
more consecutive trials. At each trial, the presentation of the word was preceded
by a white fixation symbol of 350 ms. The word remained on the screen until the
participants pressed a response key. The intertrial interval was 250 ms. Prior to
starting each block, participants were presented with instructions reminding
them what key to press for which type of stimuli.
RESULTS
Results of the evaluation of assumptions indicated a violation of normality,
which required log-transformation of data, but satisfactory homogeneity of
variance-covariance matrices. The analyses were performed using the mean log-
transformed RTs of the test trials where a correct response was made for
coloured words only. The RTs of trials with an incorrect response were excluded
from the analyses as were trials with a RT below 300 ms or above 3000 ms (see
Brendl, Markman, & Messner, 2001). The mean log-transformed RT was cal-
culated for the four types of trials: (1) body parts extrinsically mapped on to a302 LEFAIVRE ET AL.
TABLE 2
Log-transformed means (and standards deviations) of the trial types for
both anxiety sensitivity groups
Trial type LAS HAS
(n = 12) (n = 10)
Body part + Positive Outcome 2.829 (0.112) 2.847 (0.060)
Body part + Negative Outcome 2.924 (0.091) 2.934 (0.088)
Symptom + Positive Outcome 2.827 (0.102) 2.887 (0.108)a
Symptom + Negative Outcome 2.839 (0.080) 2.857 (0.129)a
LAS, low anxiety sensitive; HAS, high anxiety sensitive.
a
Significant difference between these two trial types for the HAS group at p < .05.
positive health outcome response key; (2) body parts extrinsically mapped on to
a negative health outcome response key; (3) anxiety-related symptoms extrin-
sically mapped on to a positive health outcome response key; (4) anxiety-related
symptoms extrinsically mapped on to a negative health outcome response key.
The overall untransformed mean of these fours trial types for both anxiety
sensitivity groups combined was 760.4 (SD = 200.2). The log-transformed
means of the four trial types for each anxiety sensitivity group are presented in
Table 2.
An independent-samples t-test was conducted to evaluate the usefulness of
the selected control categories (i.e., body parts identified as unlikely to be
related to diseases and positive health outcomes). Results indicated no sig-
nificant difference in RT between anxiety sensitivity groups when target
words referring to body parts were mapped on to the same response key as
the white words referring to positive health outcome, t(20) = 70.47, ns. The
absence of a significant difference suggested that these control categories pro-
vided a stable contrast from which a comparison could be made with the
trials of main interest (i.e., trials wherein the participants needed to select
extrinsically negative responses for coloured words that were anxiety-related
symptoms).
The error rates and deleted trials represented, on average, 5.8% and 1.3% of
all trials, respectively. Two 2 6 2 6 2 (anxiety sensitivity group 6 target
words 6 health outcome responses) ANOVA with repeated measures was
conducted on the error rate and deleted trials data. No significant effects were
revealed. The internal consistency of the EAST was assessed using 40 RT
differences for targets paired with negative vs. positive outcomes. Error rates
and deleted trials were treated as missing values and were replaced prior to alpha
calculation. Cronbach's alpha indicated adequate reliability of .63.
A 2 6 2 6 2 ANOVA with repeated measures was conducted to evaluate
the effects of the anxiety sensitivity groups (high vs. low), target words (bodyANXIETY SENSITIVITY AND IMPLICIT BIAS 303 parts vs. anxiety symptoms), and extrinsic health outcome responses (positive vs. negative) on RTs. Results of the ANOVA indicated a significant three- way interaction, F(1, 20) = 10.07, p < .005, partial Z2 = .34. Consequently, two 2 6 2 ANOVAs were conducted to evaluate the effects of target words and extrinsic health outcome responses on RT for each anxiety sensitivity group. Results of the ANOVA for the low anxiety sensitivity group found no significant main effects for target words, F(1, 11) = 0.38, ns, or health out- comes, F(1, 11) = 0.03, ns, nor a significant interaction, F(1, 11) = 1.69, ns. These results suggested that participants in the low anxiety sensitivity group did not differ significantly in their RTs whether the target words (i.e., body parts vs. anxiety symptoms) were extrinsically mapped on to the same response key as positive or negative health outcomes. The results of the ANOVA for the high anxiety sensitivity group found no significant main effects for target words, F(1, 9) = 1.55, ns, or health outcomes, F(1, 9) = 1.07, ns. However, the results indicated a significant target words 6 health out- come interaction, F(1, 9) = 20.50, p < .001, partial Z2 = .70. To further examine this significant two-way interaction for the high anxiety sensitivity group, post hoc analyses were performed. Given that the specific comparison of interest was the performance of high anxiety sensitive indivi- duals on trials where they needed to select an extrinsically negative (vs. posi- tive) response for words that were anxiety-related (vs. body parts), paired t- tests with Dunnett's correction was used (Tabachnick & Fidell, 2001). This approach revealed that high anxiety sensitive participants responded sig- nificantly faster when anxiety-related symptoms were extrinsically mapped onto the same response key as negative health outcomes vs. positive outcomes, t(9) = 2.28, p < .05. There were no significant differences in participants' responding to the pairings of body parts with either negative or positive out- comes. These findings support the contention that there exists a stronger implicit association (vs. dissociation) between anxiety-related physical symp- toms and harmful (vs. harmless) concepts among high anxiety sensitive individuals. The three-way interaction, F(1, 19) = 4.89, p < .05, and the contrast of interest, t(9) = 1.86, p < .05 remained significant when trait anxiety as assessed by the STAI-T (Spielberger et al., 1983) was entered as a covariate. When history of panic attacks (no spontaneous panic attack vs. at least one sponta- neous panic attack) was entered as a covariate, the three-way interaction, F(1, 19) = 9.53, p < .01 and the contrast of interest, t(9) = 2.22, p < .05, also remained significant. The three-way interaction remains significant when hypochondriacal concerns, as assessed by the IAS (Kellner, 1987), was entered as a covariate, F(1, 19) = 7.09, p < .05, but the contrast of interest becomes only marginally significant, t(9) = 1.78, p < .10. The three-way interaction, however, is only marginally significant when the illness-related beliefs factor is intro- duced by itself as the covariate, F(1, 19) = 4.248, p = .053.
304 LEFAIVRE ET AL.
DISCUSSION
The present experiment was designed to investigate whether high anxiety sen-
sitive individuals tend to catastrophise the consequences of anxiety-related
symptoms based on cognitive implicit associations. This was examined with the
EAST (De Houwer, 2003), an implicit measure of cognitive structure or auto-
matic associations in memory based on RTs. Participants in the present study
were asked to categorise white descriptor words (i.e., harmless and harmful
health outcomes) based on their valence (i.e., positive vs. negative), as well as to
categorise coloured target words (i.e., body parts unlikely related to diseases and
anxiety-related symptoms) based on their colour (i.e., blue or green) while
ignoring their valence. Consistent with information-processing models of
anxiety (e.g., Beck & Clark, 1997), results indicated that high (vs. low) anxiety
sensitive individuals tend to implicitly associate anxiety-related symptoms with
negative consequences. High anxiety sensitive individuals responded sig-
nificantly faster on trials where anxiety-related target words were mapped on to
the same response key as harmful (vs. harmless) health outcomes. High anxiety
sensitive individuals did not show the same tendency for associating body parts
with negative outcomes on the EAST and none of the RTs for the different
pairings of the target words and the health outcomes were significantly faster for
the low anxiety sensitivity group.
The between-group differences persisted after controlling for trait anxiety and
history of panic attacks; however, results suggested that illness-related beliefs
may be contributing to this implicit bias of associating anxiety-related symptoms
with negative outcomes in high anxiety sensitive individuals. This could be due
to the fact that illness-related beliefs factor of the IAS (Kellner, 1987) is the
more closely linked to the DSM-IV's (American Psychiatric Association, 2001)
concept of hypochondriasis (see Stewart & Watt, 2000). This factor is also better
at discriminating between parents with hypochondriasis diagnosis vs. controls
than other IAS factors (see Kellner et al., 1987).
Based on the underlying assumption of the EAST, these results suggest that
the performance of high AS individuals on trials where they needed to make an
negative extrinsic response choice for anxiety-related symptoms (i.e., anxiety-
related target words were mapped on to the same response key as harmful
outcomes) was superior as compared to other trials because this response choice
corresponded more closely to their associations in memory. Thus, anxiety
sensitivity could be a cognitive risk factor for anxiety disorders (see Keogh et
al., 2001; McCabe, 1999; McNally et al., 1999; Stewart et al., 1998).
Identifying this implicit association bias provides additional empirical sup-
port for the concept of anxiety sensitivity. Indeed, the use of the EAST in the
present study extends the work of previous studies investigating cognitive biases
of threat in nonclinical populations (e.g., Keogh et al., 2001; McCabe, 1999;
McNally et al., 1999; Stewart et al., 1998) by distinguishing between theANXIETY SENSITIVITY AND IMPLICIT BIAS 305 anxiety-related symptoms (e.g., breathless) and their possible consequences (e.g., suffocate). This distinction is important because the results of the present study suggest that, consistent with the anxiety sensitivity definition, high anxiety sensitive individuals can be differentiated from low anxiety sensitive persons not simply by their fear of anxiety-related symptoms but also their beliefs about the consequences of experiencing such symptoms. This study, however, only investigated the relationship between anxiety-related symptoms and their pos- sible physical consequences. It did not examine whether this tendency to cata- strophise the consequences of anxiety-related sensations would be observed if participants had also been presented with possible psychological and/or social consequences of experiencing those symptoms. Consequently, the results might only be specific to physical concerns associated with high anxiety sensitivity and should not be generalised to psychological and social concerns associated with anxiety-related symptoms. It is also possible that the significant results are simply an artefact of the small sample, although this seems unlikely given that a predicted three-way interaction emerging by chance is highly unlikely. In any event, these results require replication with an independent sample to ensure that they are reliable. The present study is considered a necessary first step in addressing a related research question as to whether it is possible to differentiate between high anxiety sensitivity individuals and individuals with strong hyponchondriacal tendencies on the basis of their implicit associations between arousal-reactive (vs. arousal-nonreactive) symptoms and immediate (vs. delayed) consequences (e.g., Stewart & Watt, 2000). In this case, it could be hypothesised that stronger implicit associations between arousal-reactive symptoms (e.g., heart palpita- tions) and immediate consequences (e.g., heart attack) would be found in high anxiety sensitive individuals, whereas individuals with more hyponchondriacal tendencies would also show stronger implicit associations between arousal- nonreactive symptoms (e.g., lump) and delayed consequences (e.g., cancer). The sample size of the present study did not allow for the direct comparison of gender differences in anxiety-related implicit associations. However, previous studies suggest that females, compared to males, tend to score higher on the physical concerns factor of the ASI (e.g., Stewart, Taylor, & Baker, 1997). Another study by Stewart et al. (1998) found that, when completing a modified- Stroop colour-naming task, high anxiety sensitive women demonstrated more interference with physical threat cues as compared to their low anxiety sensitive counterparts, whereas high anxiety sensitive men displayed more interference for psychological/social threat as compared to low anxiety sensitive men. Moreover, samples employed in previous studies (e.g., Keogh et al., 2001; McNally et al., 1999) have been predominantly female. Consequently, future research should consider investigating whether high anxiety sensitive women would show a stronger implicit association between arousal-reactive symptoms and negative health outcomes than high anxiety sensitive men. Future research
306 LEFAIVRE ET AL.
also should consider including a measure of depression given the relationship
between anxiety sensitivity and depression (see Taylor, Koch, & Woody, 1996)
and the evidence that depressed individuals tend to show a memory bias for
negative material (Ruiz-Caballero & GonzaÂlez, 1997).
In conclusion, the findings of the present study might eventually lead to
important clinical implications. Because the cognitive biases in high anxiety
sensitive individuals appear to be operating at an automatic level (i.e., not under
intentional control), treatment approaches could benefit from consulting studies
in the field of social cognition (e.g., Dasgupta & Greenwald, 2001) and the
clinical realm (e.g., Teachman & Woody, 2003) that have demonstrated that
automatic associations are sensitive to intervention. Similarly, it has been sug-
gested that measures of automatic associations could be useful intervention tools
(Teachman & Woody, 2004). Finally measures, such as the EAST, might also be
useful as outcome assessment tools to assess the efficacy of treatment in altering
implicit associations in memory (e.g., Teachman & Woody, 2003).
Manuscript received 1 December 2004
Revised manuscript received 17 August 2005
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APPENDIX
Example of instructions for a test-trial block:
This is a test phase with white and coloured words.
For white words with a positive meaning: Press the GOOD key (A)
For white words with a negative meaning: Press the BAD key (L)
For words in a blue-ish colour: Press the GOOD key (A)
For words in a green-ish colour: Press the BAD key (L)You can also read
