1. Discussion and Next Steps
Anxiety Sensitivity Moderates the Relationship Between Past Exposure to Terrorism and Psychological Outcomes in Undergraduate Students
Nicholas W. Talisman & Cynthia A. Rohrbeck
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Background
Exposure to human-made disasters, such as terrorist attacks, have been shown to have a substantial effect on the development of negative mental health outcomes (Galea et al., 2003). Individual psychological factors have been shown to play an important role in determining differential responses to these traumatic events (Taylor et al., 2000). Anxiety sensitivity is one personality factor that may aid in the understanding of different pathways to mental health outcomes following traumatic exposure.
Anxiety sensitivity refers to an individual’s trait level of fear or avoidance towards the physical symptoms associated with anxiety, such as increased heart rate and perspiration (Reiss & McNally, 1986). Anxiety sensitivity has been shown to play an important role in the maintenance and development of anxiety disorders (Taylor, 2014). Notably, anxiety sensitivity has been found to be especially salient in PTSD, compared to several other anxiety disorders (Olatunji & Wolitzky-Taylor, 2009).
However, not much is known about the nature of the interaction between anxiety sensitivity and stressful event exposure in the development of anxiety disorders. This study examined whether anxiety sensitivity moderates the relationship between exposure to terrorist attacks and symptoms of psychological distress.
Results
Anxiety Symptoms
ANCOVA revealed that ASI predicted STAI scores, such that higher anxiety sensitivity was associated with higher reported trait symptoms of anxiety (F=29.31, p<.0001) after controlling for age, gender, ethnicity, and exposure to terrorist attacks. In addition, the interaction between past exposure to terrorism and ASI scores significantly predicted STAI scores such that higher anxiety sensitivity was associated with a more positive relationship between exposure to terrorism and trait anxiety symptoms (F=2.86, p<.05). The interaction is pictured below.
Depressive Symptoms
ANCOVA revealed that ASI predicted CES-D scores, such that higher anxiety sensitivity was associated with higher reported symptoms of depression (F=28.80, p<.0001) after controlling for age, gender, ethnicity, and exposure to terrorism. In addition, the interaction term between past exposure to terrorist attacks and ASI scores significantly predicted STAI scores such that higher anxiety sensitivity was associated with a more positive relationship between exposure to terrorism and depressive symptoms (F=3.10, p<.05). The interaction is pictured below.
Discussion and Next Steps
Exposure to stressful events, such as terrorist attacks, has long been established as a precursor to the development of anxiety. However, the mechanisms driving this relationship are still a subject of investigation. This study provides initial support for anxiety sensitivity as an important factor in the stressor-anxiety relationship. Specifically, the results suggest that anxiety sensitivity both has a direct effect on anxiety symptoms and moderates the relationship between exposure to terrorist attacks and anxiety symptoms.
Another contribution of this study is the finding that anxiety sensitivity may be associated with mental health outcomes beyond anxiety, particularly depression. Moreover, depressive symptoms were significantly predicted by the interaction between anxiety sensitivity and exposure to terrorism. This presents the possibility that anxiety sensitivity serves as a general mechanism between exposure to stressors and the development of mental health outcomes.
Limitations
The findings of this study are limited due to the cross-sectional nature of the design. Furthermore, all study instruments were self-report, increasing the chance for common method variance. Finally, since the study population was composed of undergraduate students, the findings may not be generalizable to other populations.
Next Steps
Investigate whether the relationships presented here are consistent for exposure to other types of stressors. 
Explore whether anxiety sensitivity also significantly moderates the relationship between exposure to terrorist events and other psychological outcomes, such as PTSD symptoms.
Explore the role of anxiety sensitivity and other putative mechanisms in the development of anxiety symptoms over time, particularly in the context of continued exposure to stressors.
Methods
Participants
The analyses were conducted on a sample of undergraduate students (N=314) at a private, urban university in the Northeastern United States.
Measures
Exposure to Terrorism was assessed using a four-item measure including items that asked whether the individual had been a victim of a terrorist attack, had witnessed a terrorist attack, as well as whether they had a family member who had been a victim of a terrorist attack or had witnessed one.
The Anxiety Sensitivity Index (ASI) is a 16-item self-report measure of anxiety sensitivity that has been validated in clinical and community populations (Peterson & Heilbronner, 1987).
The State Trait Anxiety Inventory (STAI), is a self-report measure that includes items assessing global and short-term symptoms of anxiety (Spielberger, 2010).
The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report measure of depressive symptoms experienced over the past week (Eaton et al., 2004).
Data Analysis
All study analyses were conducted using SAS 9.3 statistical software. In order to explore whether continuous (ASI and exposure to terrorism) and categorical variables (gender and ethnicity) predicted study outcomes (STAI and CES-D), analyses of covariance (ANCOVA) were conducted.
References
Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346(13),
Eaton, W. W., Smith, C., Ybarra, M., Muntaner, C., Tien, A. (2004). Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In ME Maruish (Ed.). The Use of Psychological Testing for Treatment Planning and Outcomes Assessment (3rd Ed.), pp Mahwah, NJ: Lawrence Erlbaum
Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135(6), 974.
Peterson, R. A., & Heilbronner, R. L. (1987). The Anxiety Sensitivity Index: Construct validity and factor analytic structure. Journal of Anxiety Disorders,1(2),
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Taylor, S. E., Kemeny, M. E., Reed, G. M., Bower, J. E., & Gruenewald, T. L. (2000). Psychological resources, positive illusions, and health. American psychologist, 55(1), 99.