Os transtornos de ansiedade representam uma das formas mais comuns de psicopatologia em crianças e adolescentes e estão associados com prejuízos no funcionamento acadêmico, social e familiar. Porém, permanecem frequentemente subdiagnosticados e subtratados. O bullying escolar é muito comum e está associado com um amplo espectro de problemas psiquiátricos, incluindo sintomas de ansiedade. O principal objetivo desta tese foi examinar a prevalência de bullying em uma grande amostra comunitária de crianças e adolescentes brasileiros e investigar a associação entre bullying e sintomatologia ansiosa de acordo com o DSM-IV. Esse estudo transversal consistiu no preenchimento de um questionário sobre bullying e de sua frequência e de um instrumento auto-aplicativo de triagem para transtornos de ansiedade que é a Screen for Child Anxiety Related Emotional Disorders (SCARED) por 2.353 estudantes entre 9 e 18 anos provenientes de seis escolas pertencentes à área de captação da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre. Um total de 22,9% da amostra relatou envolvimento com bullying frequente, como agressor (7,6%), como vítima (5,7%) ou como agressor-vítima (9,6%). Em geral, meninos foram mais envolvidos como agressores e como agressores-vítimas e meninas como vítimas. Nossos achados demonstraram que estudantes envolvidos com bullying, como vítimas ou agressores-vítimas, apresentavam maiores escores na SCARED total e em suas subescalas do que agressores ou do que os estudantes sem envolvimento com bullying. A prevalência do bullying encontrada no nosso estudo está na média quando comparada com estudos prévios na literatura. Vítimas e agressores-vítimas, mas não agressores, são grupos associados com uma sintomatologia ansiosa mais alta. Embora no Brasil as taxas para as prevalências dos transtornos de ansiedade na infância e adolescência sejam substanciais, há uma carência de instrumentos para avaliar os sintomas de ansiedade e constructos relacionados à ansiedade em crianças e adolescentes. Adicionalmente, essa tese avaliou as propriedades psicométricas de duas escalas que são utilizadas na avaliação da ansiedade em crianças e adolescentes. A SCARED é um instrumento auto-aplicativo que foi originalmente desenvolvido como uma ferramenta de triagem para avaliar os transtornos de ansiedade na infância e adolescência de acordo com o DSM-IV. Os resultados encontrados em nosso estudo evidenciam que a SCARED apresenta propriedades psicométricas apropriadas e é um instrumento válido e confiável para avaliar sintomas de ansiedade em jovens no Brasil. O Childhood Anxiety Sensitivity Index (CASI) é o principal instrumento utilizado para avaliar sensibilidade à ansiedade em crianças e adolescentes. A sensibilidade à ansiedade é um constructo temperamental que pode ser conceitualizado como o medo de que sintomas de ansiedade possam ter graves consequências físicas, psicológicas ou sociais para o indivíduo. A sensibilidade à ansiedade está associada com outras medidas de ansiedade, principalmente àquelas que avaliam sintomas relacionados ao transtorno do pânico, e pode ser considerada um fator de risco para o desenvolvimento de sintomas de ansiedade e de transtornos de ansiedade em jovens. Nossos achados demonstraram uma confiabilidade apropriada e evidência de validade convergente entre a CASI e a SCARED em uma subamostra do nosso estudo, sugerindo que a CASI possa ser uma ferramenta útil na avaliação da sensibilidade à ansiedade nessa população. Tendo em vista os limitados recursos em relação à saúde mental e a pouca atenção clínica aos transtornos de ansiedade, acredita-se que tais instrumentos possam 11 se tornar ferramentas úteis na triagem de crianças e adolescentes com sintomas de ansiedade e que poderão necessitar de avaliações adicionais e de tratamento. / Anxiety disorders are one of the most common forms of psychopathology among children and adolescents and are associated with impairments in academic, social, and family functioning. Although very prevalent, the anxiety disorders are often undetected or untreated. School bullying is common and is associated with a broad spectrum of psychiatric problems, including anxiety symptomatology. The main objective of this study was to examine the prevalence of bullying behaviors in a large communitarian sample of Brazilian children and adolescents and to investigate the association between bullying behaviors and DSM-IV anxiety symptomatology. This cross-sectional study involved completion of a self-report questionnaire about bullying behaviors and their frequency and the Screen for Child Anxiety Related Emotional Disorders (SCARED) that is also a self-report screening tool for childhood anxiety disorders by 2353 students aged 9-18 years from 6 schools located in the catchment area of the Primary Care Unit from the Hospital de Clínicas de Porto Alegre. A total of 22.9% of the sample reported frequent involvement in bullying, as a bully (7.4%), as a victim (5.7%), or as a bully-victim (9.5%). In general, boys were more likely to be involved as bully and as bully-victim, and girls were more likely to be involved as victims. Our findings showed that students involved in bullying behaviors, as victims or bully-victims, were more likely to have higher total scores in SCARED scale, as well as in its subscales than bullies and than uninvolved students. The prevalence of bullying behaviors found in our sample is about average when compared with previous studies described in the literature. Victims and bully-victims, but no bullies, are groups associated with higher anxiety symptomatology. Although prevalence rates of anxiety disorders in Brazilian youth are significant, there is a lack of validated instruments to assess anxiety symptoms and related constructs in children and adolescents. In addition, this study verified the psychometrics properties of two scales that are frequently used in the assessment of anxiety in children and adolescents. The SCARED is a self-report instrument that was originally developed as a screening tool for DSM-IV childhood anxiety disorders. Our study suggested that the SCARED has appropriate psychometric properties and is a useful and reliable instrument to assess anxiety symptoms in Brazilian youth. The Childhood Anxiety Sensitivity Index (CASI) is the principal instrument used to assess anxiety sensitivity in children and adolescents. Anxiety Sensitivity refers to the tendency to fear anxiety-related sensations and is thought to arise from beliefs about their harmful physical, cognitive, or social consequences. Anxiety sensitivity is associated with other anxiety measurements, mainly those evaluating panic symptoms. It is also considered a risk factor for the development of anxious symptomatology and anxiety disorders in youth. Our findings demonstrated an appropriate reliability and evidence of convergent validity in the CASI with the SCARED in a subsample of our study, suggesting that the CASI could be a suitable tool for evaluating anxiety sensitivity in this population. Given the limited mental health resources and the paucity of clinical attention to childhood anxiety disorders in Brazil, these instruments may be a valuable tool for screening Brazilian children and adolescents with anxiety symptoms who may need further assessment and treatment.

This paper tests Reiss' (1991) expectancy theory of fearfulness. Reiss' moderation model of fears speculates that individual differences in fearfulness and phobic avoidance is a function of the interaction between trait vulnerabilities (i.e., sensitivities) and beliefs about potential outcomes during exposure to phobic stimuli (i.e., expectancies). Four hundred and forty-five undergraduates completed questionnaires related to Reiss' fundamental sensitivities (e.g., "anxiety sensitivity"), expectancies (e.g., "expectancy of physical injury or harm") and the intensity of common fears. Informed by findings concerning fear-related outcome expectancies, a system for measuring expectancies was developed for this study called the Focus of Apprehension Survey Schedule (FASS). Additionally, "disgust sensitivity" and "expectancy of contamination or illness" were included to examine whether they account for fearfulness beyond that predicted by Reiss' sensitivities and expectancies alone. In Experiment 1, hierarchical multivariate regression was employed to test Reiss' moderation model of expectancy theory for four fear subtypes (animal, blood/injection/injury (BII), claustrophobic, social). For each of these fear types, results did not support Reiss' moderation model. However, disgust sensitivity improved the prediction of animal fears and contamination expectancies improved the prediction of BII fears beyond Reiss' fundamental sensitivities and expectancies alone. In Experiment 2, a competing mediation model of expectancy theory was tested in which sensitivities were expected to indirectly influence individual differences in fearfulness through outcome expectancies. Results of path analysis using LISREL 8.54 did not support a mediation model per se. However, expectancies were found to mediate relationships between sensitivities and fears in several predicted instances (e.g., contamination expectancies mediated the disgust-BII fears relationship). The results provide some encouraging replications of prior studies and are discussed in the context of implications for theories of fear as well as for future directions in research.

The aim of this study was to examine the association between parent and child anxiety sensitivity in the context of parenting behaviors, specifically by testing parenting behaviors as moderators or mediators of the association between parent and child anxiety sensitivity. Past research implies that parent anxiety sensitivity may be more related to child anxiety sensitivity (moderation) in girls and in the context of certain parenting. Alternatively, parenting behaviors may better account for the association (mediate) between parent and child anxiety sensitivity. To test the hypotheses 191 families (n = 255 youth aged 6-17 and their parents) completed measures of child anxiety sensitivity (CASI) and parenting (APQ-C), and parents completed measures of their anxiety sensitivity (ASI) and parenting (APQ-P). Hypotheses were tested with hierarchical linear modeling. Results indicated that the child’s gender and the child’s report of their parent’s positive parenting behaviors moderated the association between parent and child anxiety sensitivity.

Anxiety Sensitivity (AS), the belief that anxiety-related sensations may have harmful implications, can alter autonomic nervous system (ANS) function. Exercise has previously been shown to reduce AS; however, the effects of an exercise intervention on heart rate variability (HRV), a measure of ANS function, has not been evaluated in individuals with high AS. This study sought to 1) compare resting HRV in individuals with either low (LAS) or high AS (HAS) and 2) evaluate the effects of a 2-week exercise intervention on HRV and AS. Using the Anxiety Sensitivity Index (ASI-3), participants were identified as LAS (n=9; ASI-3=5.89±1.39) or HAS (n=15; ASI-3=32.87±2.49) and subsequently completed six 20-minute moderate intensity exercise sessions. HRV and psychosocial measures were obtained at baseline and following the 2-week intervention. No significant differences (p>0.05) in time or frequency domain HRV values between groups were revealed at baseline; however, when considering the HAS group alone, strong associations were observed between the ASI-3 score and HRV values in the time domain: RMSSD (r=-0.56), SDNN (r=-0.61), and pNN50 (r=-0.53). Following the intervention, changes observed in HRV and the higher and lower order (subscale) ASI-3 scores were not different between the groups; however, a medium to large effect was observed for the higher order ASI-3 and the cognitive subscale score, suggesting that our findings were likely limited by the small sample size. Further research is warranted to evaluate the relationship between HRV and AS and should seek to determine the most effective exercise interoceptive exposure for improving AS symptomology.

Anxiety sensitivity (AS; fear of anxiety-related bodily sensations) is a risk factor for anxiety and related psychological disorders. Preliminary evidence also associates high AS with reduced levels of physical exercise and fitness. The primary objectives of the five studies comprising this dissertation were 1) to further explore the relationships between AS levels and exercise/fitness levels, and 2) to evaluate outcomes and processes of a brief group cognitive behaviour therapy (CBT) that included a novel exercise-based interoceptive exposure (IE; exposure to feared anxiety-related sensations) component of running, with female undergraduate students. High AS female undergraduate participants endorsed more barriers to exercise than low AS participants, and these accounted for the inverse relationships between AS group and exercise/fitness levels (Study 1). The brief CBT/IE led to decreases in AS levels (Studies 2 and 4) and in symptoms of stress, depression, and anxiety (Study 4) for high AS participants. Processes involved in the brief CBT’s therapeutic effects were explored by examining cognitive (i.e., catastrophic thoughts), affective (i.e., feelings of anxiety), and somatic (i.e., physical sensations) reactions to the running IE component with an existing measure, the hyperventilation questionnaire (HVQ; Study 2), and a brief version of the measure, the HVQ-B, developed and validated in Study 3 (Study 5). Changes in cognitive and affective reactions to running were most closely associated with the brief CBT/IE’s therapeutic benefits, underlying the importance of changing the meaning of and emotional reaction to physiological arousal. Surprisingly, a health education control (HEC) intervention consisting of an interactive discussion on exercise, nutrition and sleep for health, including problem-solving barriers to health behaviours, also led to decreases in AS levels and in symptoms of depression and anxiety (Study 4). Physical exercise, the common link between the two interventions, may be partially driving the interventions’ therapeutic benefits. More specifically, perhaps both interventions addressed barriers to exercise, either by altering the meaning of and emotional reaction to exercise (CBT/IE), or through problem-solving (HEC). Encouraging physical exercise in high AS individuals by acknowledging and addressing barriers to exercise might help decrease these individuals’ AS levels and improve their overall mental health

abstract: Anxiety sensitivity (AS; the fear of anxiety-related bodily sensations) has been earmarked as a significant risk factor in the development and maintenance of pathological anxiety in adults and children. Given the potential implications of heightened AS, recent research has focused on investigating the etiology and developmental course of elevated AS; however, most of this work has been conducted with adults and is retrospective in nature. Data from college students show that early anxiety-related learning experiences may be a primary source of heightened AS levels, but it remains unclear whether AS in children is linked to their learning experiences (i.e., parental reinforcement, modeling, punishment, and/or transmission of information about anxiety-related behaviors). Based on AS theory and its iterations, an emerging theoretical model was developed to aid further exploration of the putative causes and consequences of heightened AS levels. Using a sample of 70 clinic-referred youth (ages 6 to 16 years old; 51.4% Hispanic/Latino), the present study sought to further explicate the role of learning in the development of AS and anxiety symptoms. Results suggest that childhood learning experiences may be an important precursor to heightened AS levels and, subsequently, increased experiences of anxiety symptoms. Findings also indicate that some youth may be more vulnerable to anxiety-related learning experiences and suggest that culture may play a role in the relations among learning, AS, and anxiety symptoms. / Dissertation/Thesis / M.A. Psychology 2012

Anxiety sensitivity is a multifaceted cognitive risk factor currently being examined in relation to anxiety and depression. The paucity of research on the relative contribution of the facets of anxiety sensitivity to anxiety and depression, coupled with variations in existing findings, indicate that the relations remain inadequately understood. In the present study, the relations between the facets of anxiety sensitivity, anxiety, and depression were examined in 730 Hispanic-Latino and European-American youth referred to an anxiety specialty clinic. Youth completed the Childhood Anxiety Sensitivity Index, the Revised Children’s Manifest Anxiety Scale, and the Children’s Depression Inventory. The factor structure of the Childhood Anxiety Sensitivity Index was examined using ordered-categorical confirmatory factor analytic techniques. Goodness-of-fit criteria indicated that a two-factor model fit the data best. The identified facets of anxiety sensitivity included Physical/Mental Concerns and Social Concerns. Support was also found for cross-ethnic equivalence of the two-factor model across Hispanic-Latino and European-American youth. Structural equation modeling was used to examine models involving anxiety sensitivity, anxiety, and depression. Results indicated that an overall measure of anxiety sensitivity was positively associated with both anxiety and depression, while the facets of anxiety sensitivity showed differential relations to anxiety and depression symptoms. Both facets of anxiety sensitivity were related to overall anxiety and its symptom dimensions, with the exception being that Social Concerns was not related to physiological anxiety symptoms. Physical/Mental Concerns were strongly associated with overall depression and with all depression symptom dimensions. Social Concerns was not significantly associated with depression or its symptom dimensions. These findings highlight that anxiety sensitivity’s relations to youth psychiatric symptoms are complex. Results suggest that focusing on anxiety sensitivity’s facets is important to fully understand its role in psychopathology. Clinicians may want to target all facets of anxiety sensitivity when treating anxious youth. However, in the context of depression, it might be sufficient for clinicians to target Physical/Mental Incapacitation Concerns.

Despite progress that has been made in the areas of maternal acculturation and internalizing symptoms in Hispanic youth, much remains to be learned about the relation between maternal acculturation and youth anxiety. The inclusion of cognitive vulnerabilities such as anxiety sensitivity (AS) further adds to the understanding the development of anxiety in Hispanic youth. Examining the role that youth age and youth sex play in the relation between AS and youth anxiety symptoms also can further understanding of the development of youth anxiety. Thus, the specific aims of this dissertation were to examine whether: (1) a confirmatory factor analysis (CFA) would yield a two factor structure of the Stephenson Multigroup Acculturation Measure (SMAS; Stephenson, 2000); (2) maternal acculturation as measured by the SMAS is related to youth anxiety symptoms; (3) mother country of origin (i.e, Cuban or another Latin country) moderates the relation between youth AS and youth anxiety symptoms; (4) youth age moderates the relation between youth AS and youth anxiety symptoms; (5) youth sex moderates the relation between youth AS and youth anxiety symptoms. In addition, research has shown Hispanic youth report more anxiety symptoms than non-Hispanic youth. The Revised Children’s Manifest Anxiety Scale’s (RCMAS; Reynolds & Richmond, 1978) Lie Scale was included to examine whether it relates to Hispanic youths’ reporting of anxiety symptoms in the current sample. There were no significant differences in youth anxiety associated with the mother country of origin. Specifically, Cuban mothers and mothers from other Hispanic countries of origin did not significantly differ in their ratings of their child’s anxiety symptoms. Mother country of origin did not moderate the relation between AS and youth anxiety symptoms. Also, no significant findings were found with respect to effects of age on the relation between anxiety sensitivity and anxiety. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed.

The objective of this study is to see if nonclinical panickers with unexpected panic attacks (NCPs-U) may be a more useful panic disorder (PD) analogue than nonclinical panickers with expected panic attacks (NCPs-E).

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