- Email: [email protected]
Relationships between anxiety sensitivity, emotional arousal, and interpersonal distress
hmal of AnxietyDim&m, W. 10,No.4. pp. 267-282 1996 C4lpJTi~Q19%EIsevier-Ltd pliJtkdial&USA.‘Ul@tSresavsd 0887-61wM SlS.co + .oo
Pergamon
PII !30887-61a(%poo11-4
Relationships Between Anxiety Sensitivity, Emotional Arousal, and Interpersonal Distress FAITH A. BENTON,PH.D. CL&f Behavioral
GEORGE University
Health
J. ALLEN,
Systems
PH.D.
of Connedcut
Abstract - We investigated relationships between anxiety sensitivity, physiological arousal, and interpersonal functioning in conflict situations following relaxation and hyperventilation in a 2 x 2 x 2 repeated-measures experimental design. High (n = 32) and low (n = 32) anxiety-sensitive (AS) women were obtained from the top and bottom 25% of 900 respondents. Participants were exposed to S-min inductions of either relaxation or hyperventilation, followed by a 5-min role-play of a conflict scenario with their boyfriends, who were coached to act in either an approving or a disapproving manner. Following the interaction, participants rated tbeii self-perception, perception of parmer, projections about how p-r was viewing them, and feelings about the interaction. The women then underwent the same breathing manipulation as previously and engaged in a second scenario with their boyfriends, who acted in the manner opposite to that of the fti scenario. Order of support vemus disapproval was randomly counterbalanced across couples. A pattern of significant triple interactions and tendencies toward significant triple interactions revealed that high-AS women who hyperventilated and experienced disapproval were most seifderogatory, most lily to perceive their partners as evaluating them unfavorably, and most likely to influence their partners to devalue them. In addition, experiencing relaxation and approval from their partners did not diminish tbe subjectively reported anxiety and depression in high-AS women as much as expected relative to low-AS women. -
This investigation was based upon a doctoral dissertation conducted by the senior author under the guidance of the second author. We acknowledge with appreciation permission provided by Professor Steven Reiss and IDS Publishing Corporation to reproduce the Anxiety Sensitivity Index for screening participants in this investigation. Requests for reprints should be sent to George J. Allen, Department of Psychology, U-20.406 Babbidge Road, University of Connecticut, Storrs, CT 06269-1020. 267
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In their classic theorizing about agoraphobia, Chambless and Goldstein (198 1; Goldstein & Chambless, 1978) integrated what has grown into two disparate areas of investigation, the “fear of fear” literature (Reiss, 1991) and research focusing on the numerous interpersonal problems experienced by panic sufferers and agoraphobic individuals. Their theory and subsequent elaborations (Allen & Sheckley, 1992; Reiss, 1991) posited the existence of positively escalating feedback loops between the experience of panic episodes, diminished self-esteem, and deteriorated interpersonal functioning. Subsequent research has linked panic disorder to such interpersonal difficulties as family enmeshment (Shean & Lease, 1991), gender-role stereotypy (Chambless& Mason, 1986; Hafner & Minge, 1989), reduced intimacy (Fisher & Wilson, 1985), and avoidant and schizoid personality styles (Richman & Nelson-Gray, 1994). This research, however, has not clearly delineated whether such social dysfunctions develop as a result of having experienced panic episodes (Belfer 8z Glass, 1992; Richman & Nelson-Gray, 1994) or whether they precede the onset of panic symptoms (Kleiner & Marshall, 1987; Shean & Lease, 1991). Belfer and Glass (1992), for example, posited the existence of a vicious spiral between feelings of panic and interpersonal distress in clinically anxious individuals. Within their model, panic creates physiological distress and subsequent anticipatory anxiety, both of which pull the sufferer’s attention away from interpersonal cues that dictate appropriate social responding. Failure to respond appropriately to these cues, in turn, is believed to create a backlash of negative disapproval from significant others. Goldstein and Chambless (1978), however, postulated that agoraphobic individuals possess an “hysterical” interpersonal style that leads them to misinterpret multiple forms of physiological arousal as impending anxiety. These authors implied that this interpersonal style exists prior to the experience of clinically diagnosed panic and argued that such catastrophic hypervigilence is likely to exacerbate interpersonal conflict situations. Anxiety sensitivity (AS; Peterson, & Reiss, 1987; Reiss, Peterson, Gursky, & McNally, 1986) refers to the tendency to interpret anxiety-related physiological arousal as having catastrophic consequences. The AS construct provides a potentially useful link between the “hysterical” style that presumably exists prior to the experience of panic episodes and deteriorated interpersonal functioning. AS has been demonstrated to be a relatively stable personality trait that is predictive of panic episodes in both clinical and nonclinical populations (Maller & Reiss, 1992; Taylor, 1995). When undergoing biological challenge tasks (e.g., hyperventilation), high-AS individuals typically report more intensely negative experiences and discomfort compared to low-AS individuals (Rapee, 1995), even though both groups display equivalent levels of actual physiological arousal (Whittal & Goetsch, 1995). Elevated AS also has been associated with many of the interpersonal difficulties that are similar to the problems experienced by clinical panickers and agoraphobic persons, including insecure interpersonal attachment (Laraia, Stuart, Frye, Lydiard, & Ballenger, 1994) overreliant dependency on signifi-
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cant others (Stewart, Knize, & Pihl, 1992), and hypochondriac concerns (Otto, Pollack, Sachs, & Rosenbaum, 1992). Thus, although AS does not directly assess social functioning, it represents a construct that may link existing literatures concerning symptomatic overreactivity to hyperventilation, selective attention to threatening stimuli, and diminished interpersonal functioning. Presently, little is known about the mechanisms that may mediate physiological overreactivity and social dysfunction. Rapee (1995) has conjectured that hyperventilation has more deleterious psychological effects for people who feel neither safe nor able to exert control. He also postulated that high AS predicts feelings of being threatened, especially in ambiguous situations. Liebman and Allen (1995) provided evidence supporting Rape& speculation. In their study, high- and low-AS women rated the intensity of facial emotions following inductions of relaxation and hyperventilation. These researchers noted that high-AS women entered the experimental situation reporting significantly higher levels of dysphoric atfect than low-AS women even before experiencing either mood induction. Hyperventilation led to relatively larger increases in intensity ratings of sadness and fear by high-AS scorers, especially when it was induced before relaxation. Liebman and Allen concluded that induced hyperventilation interacted with the initial apprehension of high-AS women, which then led them to view facial stimuli as containing more intensely negative emotions. The present investigation further explores relationships between AS, physiological arousal, and emotional responsiveness to interpersonal situations. Highand low-AS women experienced two 5-min inductions of either hyperventilation or relaxation and then participated in two conflict-laden role-plays with their boyfriends. In a repeated-measures cross-over design, the boyfriends were instructed to act in either an approving or a disapproving manner, with order of approval versus disapproval being randomly determined. We hypothesized that, before the experiment began, (a) high-AS women would report more negative perceptions of themselves and their relationships in general than low-AS women and (b) partners of high-AS women would also evaluate their girlfriends and their relationships with them less favorably than would the partners of low-AS women. More important, we predicted the emergence of significant three-way interactions such that the high-AS participants who hyperventilated would rate themselves most negatively and would also perceive their partners as viewing them least favorably when their boyfriends were disapproving of them. In contrast, the low-AS participants who relaxed would have the most positive selfperceptions as well as the most positive projections about their partners’ views of them when their partners behaved in an approving manner. METHODS Participants
The Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1987) was administered to approximately 900 undergraduate women, and those who scored in the top and bottom 25% were deemed eligible to participate. Of the 115 women
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who identified themselves as members of an exclusively dating couple for more than one month, 64 actually participated. Individuals were excluded if they reported any history of epilepsy, asthma, respiratory difficulties, or heart defibrillation. Only one woman indicated having a formally diagnosed anxiety condition (obsessive compulsive disorder). Each boyfriend was paid $4.00 for his participation and the women received experimental credit. The low-AS group (n = 32) had AS1 scores ranging from 3 to 13 (M = 9.09) and the high-AS group (n = 32) had scores ranging from 25 to 49 (M = 33.84), which is consistent with the scores reported by investigators who work with clinically debilitated populations (e.g., Otto, Pollack, Sachs, Br Rosenbaum, 1992; Stewart, Knize, & Piil, 1992). Participants’ ages ranged from 17 to 43 years (M = 19.64). duration of the current relationship ranged from one month to 22 years (M = 23.1 months), and number of prior relationships ranged from 0 to 10 (M = 1.8). There were no significant differences between high- and low-AS women in terms of age, months in the current relationship, or number of prior relationships. Experimental Design The design was a 2 x 2 x 2 factorial with two between-group factors: Anxiety Sensitivity (AS; High vs. Low) and Physical State (PS; Hyperventilate vs. Relax) and one repeated-measures factor: Interpersonal Situation (INTPS; Approving vs. Disapproving). To eliminate potentially confounding order effects, INTPS was randomly counterbalanced such that half the couples were in the approving condition first. Two different role-play vignettes, adapted from the Inventory of Marital Conflict (Olson & Ryder, 1970), were counterbalanced randomly and equally within the approving and disapproving conditions. Specific Measurement Instruments A demographics questionnaire assessed personal characteristics (e.g., age, religion), dating history (e.g., length of the current relationship, number of previous relationships), and occurrence of panic symptomatology by having participants indicate how many of 13 DSM-III-R (American Psychiatric Association, 1988) symptoms they had experienced simultaneously. A Mood Inventory (Liebman & Allen, 1995) was used to evaluate the women’s emotional states both prior to and following each episode of relaxation or hyperventilation. Following Liebman and Allen (1995). participants rated each of 27 adjectives reflecting common positive and negative emotional experiences (Diener & Emmons, 1984; Diener, Larsen, Levine & Emmons, 1985) on 6-point scales ranging from 0 = not at ail to 5 = extremely. Adjectives were condensed into five subscales: Mellow (mellow, relaxed, comfortable, serene, and content), Energetic (alert, energetic, clear, effective, euphoric, and involved), Depressed (sad, depressed, exhausted, apathetic, fatigued, and confused), Anxious (agitated, anxious, tense, dizzy, lightheaded,
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and apprehensive), and Irritable (frustrated, annoyed, irritable, and negative). Internal consistency analyses, computed on the five subscales separately across four times of administration, yielded Cronbach alphas ranging from .69 to .95, with 18 of the 20 coefficients above .70. General Perceptions of Self and Relationship. Prior to engaging in the experiment, both partners rated their perceptions of themselves, their partners, and their relationship by endorsing six pairs of antonyms, using a 6-point semantic differential format, such that a higher score reflected a more positive evaluation. Each question-antonym cluster represented a conceptually coherent and internally consistent construct. The first assessed general self-perception, “How do you perceive yourself in generalr’ The six antonym pairs, drawn from existing literature describing interpersonal difIiculties experienced by panic sufferers (e.g., Hat&r & Minge, 1989; Shean & Lease, 1991; Stewart et al., 1992), were unappealingappealing; insecure-secure; boring-exciting; self-sufficient-clingy; passiveassertive; indiit-direct. The second question cluster, “How do you generally perceive your partner?” assessedgeneral perception of partner. The third cluster was a semiprojective measure (General Projection About Partner) that asked “How does your partner perceive you in general?” The fourth cluster, “How do you generally perceive your relationshipr’ assessedgeneral feelings about relationship. For all four questions, the same six adjective-pairs were used. Post-Interaction Perceptions of Self and Relationship. This questionnaire followed the same format as the General Perceptions of Self and Relationship Questionnaire except that participants completed it after each role-play and were instructed to respond based solely on how they felt about the interaction they had just experienced. Complementary versions were constructed for the men and women. Women’s Self-Perception (WSP) and Men’s Self-Perception (MSP) were determined from responses to the question “How are you feeling about yourself right now?’ along six adjective pairs (i.e., appealing-unappealing; insecure-secure; exciting-boring; clingy-self-sufficient; passive-assertive; direct-indirect) that were identical for the men and women. The version assessing Women’s Perception of Partner (WPI$ “How did you perceive your partnery) contained seven adjective pairs (i.e., appealing-unap pealing; hostile-friendly; warm-cold; supportive-unsupportive; passiveassertive; direct-indirect; approving-disapproving). Women’s Projection About Partner (WPAP) asked the women to judge how their male partners were feeling about them subsequent to each interaction. This semiprojective measure was considered the most important one in the study and was composed of eight adjective pairs (i.e., appealing-unappealing; insecure-secure; approvingdisapproving; clingy-self-sufficient; passive-assertive; direct-indirect; strong-we&, involved-withdrawn). Scales assessing the Women’s and Men’s Feelings About Interaction (WFAI and MFAI; “How did you feel about this interaction?“) each contained four adjective pairs (i.e., frustrating-satisfying; exciting-boring; stressful-relaxing; easy-difficult) that were identical for both the men and women.
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Two scales for the men’s version of the questionnaire were altered in a manner that permitted comparison of each person’s projections about how the other was feeling toward them with the actual view of the partner along identical adjective sets. Men’s Perception of Partner (MPP) was determined from the eight adjective pairs that the women used in projecting about how their boyfriends were feeling toward them (WPAP). Similarly, Men’s Projection About Partner (MPAP) was based on the seven adjective pairs that the women used to evaluate their boyfriends’ behaviors (WPP). These alterations permitted examination of convergent perceptions among couples, for example, to determine whether the way the men actually perceived the women was consistent with the way the women projected that the men were viewing them. On all questionnaire scales, higher scores indicated more favorable evaluations. Internal consistency analyses suggested that these items clustered to form generally coherent constructs, especially for women’s ratings, where 9 of 12 Cronbach alpha coefficients were above .66. Experimental Procedure
After obtaining informed consent, the couple was separated. The woman completed the General Perceptions of Self and Relationship Questionnaire and responded to a 5-min tape containing either relaxation or hyperventilation instructions, as described by Liebman and Allen (1995). Relaxation was induced through indirect suggestions to release muscle tension and to breathe slowly and deeply. Hyperventilation was induced by instructing participants to pace their breathing to 30 breaths per min in rhythm with a timed chant to “breathe in . . . breathe out . . ..” Following the initial mood induction, the woman completed the Mood Inventory, read a short vignette taken from the Inventory of Marital Conflict (Olson & Ryder, 1970), and was asked to role-play the woman in the couple. As used by Lochman and Allen (1981), the two vignettes in the role-play involved problems frequently experienced by young couples. In one, the woman prefers the company of men to that of other women at a party, which provokes a jealous response from her boyfriend. In the other, the woman asks her boyfriend to give up watching televised sports and spend more time with her. The vignettes were constructed by Olson and Ryder so that each member of the couple would believe that his or her position wasjustified. While the woman underwent mood induction, her partner completed the General Perceptions of Self and Relationship Questionnaire. He was next asked to take either a strongly approving, supportive stance or a disapproving, nonsupportive stance in the upcoming role-play. He was guided in using at least two specifically approving or nonapproving behaviors taken from a list provided by Lochman and Allen (198 1). Order of approval versus disapproval and vignette were randomly counterbalanced. The couple then acted out the first scenario while the experimenters were out of the room. With the couples’ consent, all role-play interactions were video-
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taped. This procedure helped increase fidelity to the experimental instructions. Following the role-play, the woman completed the Post Interaction Perceptions of Self and Relationship Questio~aire.The woman then listened to the same mood induction tape as previously, completed another Mood Inventory, and was given her second vignette. The man received instructions for behaving in the opposite manner as he had for the first vignette. The couple then acted out the second conflict scenario, filled out the Perceptions of Self and Relationship Questionnaire and the woman completed another Mood Inventory. Finally, they were fully informed about the experimental manipulations, given an opportunity to discuss any concerns, and thanked for their participation. RESULTS Validity Assessments of the Experimental Manipulations The validity of the breathing manipulation was assessed post hoc through analyses of the Mood Inventory scales. Multiple two-factor ANOVAs (AS x PS) revealed significant (p < .05) changes on four of the five mood variables, such that hyperventilation led to increases in depression, anxiety, and irritability, and a reduction in feeling “mellow.” Although these data provide evidence that hyperventilation and relaxation produced significantly different affective states between high- and low-AS women, validation of actual physiological differences would have been more dearly provided by using independently assessed physiological measures (e.g., heart rate). Validity of differences between the approval and disapproval conditions during the role-plays was assessed in two ways. The first method involved examination of the couples’ responses following each interaction. Three-factor (AS x PS x INTPS) ANOVAs revealed significant @ < .Ol) main effects for interpersonal situation, such that boyfriend negativity was associated with more unfavorable evaluations of their partners by both the women (WF’P) and the men (MPP) and also in the women’s ratings of the disapproving interaction (WFAI). Both men (MPAP) and women (WPAP) projected more negativity toward their partners in the disapproving encounters (p c .OOOl). The second method involved having trained observers analyze the videotapes of the couples’ interactions. Preliminary results indicated that the men in the disapproving condition exhibited significantly more hostility through both nonverbal and verbal channels. These analyses suggest that the role-plays were effective in engendering behavior by the men and affect by the women that was appropriate to the experimental conditions. Initial Differences Between Groups Multiple one-way analyses of variance were computed to assessdifferences between the high- and low-AS women prior to beginning the experimental manipulations. There were no differences in age, number of prior relationships, and number of months in their current relationships. High-AS women,
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however, reported significantly more panic symptoms (il4 = 5.8) than low-AS women (M = 3.3; F(1,62) = 10.13,~ < .Ol). High-AS women reported more negative self-perceptions, F( 1,62) = 19.27, p < .OOOl, less favorable perceptions of their partners, F(1,62) = 12.66, p < .OOl, and more negative feelings about their relationships in general, F(1,62) = 8.44, p < .Ol. On the semiprojective measure, high-AS women reported believing that their partners thought less highly of them than did lowAS women, F(1,62) = 15.65, p c .OOl. The male partners of the high-AS women mirrored this negativity, reporting significantly less positive perceptions of their partners, F(1,62) = 3.79, p < .05, and more negative feelings about their relationships, F(1,62) = 4.95, p < .05. The finding that high-AS women reported significantly greater negative appraisals about themselves and their relationships provided support for the first hypothesis. In addition, this finding necessitated using these general appraisals as covariates in tests of the second experimental hypothesis. AS, Hyperventilation,
and Intelpersonal
Perceptions
Table 1 presents means and standard deviations of the interpersonal perceptions reported by high- versus low-AS women and their boyfriends following the approving and disapproving role-plays. Three-way analyses of covariance were performed using two between-group variables, Anxiety Sensitivity (AS, High vs. Low), and Physical State (PS, Relaxed vs. Hyperventilating) with a multivariate solution being applied to the one within-subjects variable, Interpersonal Situation (INTPS, Approval vs. Disapproval). In each case, the appropriate general perception construct was used as the covariate. Of particular importance was the emergence of triple interactions between AS, physical state, and interpersonal situation. Significant differences or strong tendencies toward significance were found on three of the four women’s ratings. The same pattern was found for all three scales such that high-AS women were particularly likely to downgrade themselves when in a hyperventilative state of physiological arousal and after having dealt with a disapproving boyfriend. The strongest triple interaction emerged on the Women’s Projections About Partner subscale, F(1,62) = 9.35, p < -01, Figure 1 depicts this disordinal interaction. Hyperventilation did not affect the projections made by low-AS women about what their partners thought of them, regardless of whether the boyfriend was approving or disapproving. For low-AS women who relaxed, however, disapproval elicited significantly more negative projections about what their boyfriends thought about them than did approval. This pattern was reversed for high-AS women, such that their relaxation did not lead to differential projections as a function of boyfriend approval or disapproval. The WPAP scores for the high-AS women who hyperventilated, however, were significantly lower when their boyfriends were disapproving. This same disordinal triple AS x PS x INTPS interaction occurred, and approached significance, on both Women’s Self Perceptions, F( 1,62) = 3.62,
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TABLE 1 MEANS AND STANDARD DEVLWIONS (m PA RENMSES) OF bIlERFERSONAL PE!JtCWtlONS OF HIGH- VERSUS Low-AS WOMEN AND THEJR PARTNER S BY EXPERBUXWI. CONDITION Relaxed Approval
MeaSUlE Couples having WSP WPP WPAP WFAl MSP MPP MPAP Couples having WSP WPP WPAP WFAI MSP MPP MPAP -
high-AS
low-AS
Hyperventilating
Disapproval
Approval
Disapproval
women 25.1 29.4 32.5 9.9 24.9 32.4 29.0
(5.2) (7.2) (6.9) (3.0) (5.4) (5.7) (5.9)
25.8 22.5 32.9 8.4 26.4 31.9 20.1
(5.3) (5.5) (5.4) (2.9) (4.4) (5.4) (2.7)
26.6 27.7 35.0 10.7 23.3 34.9 26.3
(4.9) (9.1) (6.8) (3.3) (5.7) (3.7) (4.6)
23.1 22.4 27.8 8.2 26.6 30.1 21.8
(6.6) (7.5) (8.3) (2.6) (4.6) (7.5) (5.6)
29.4 32.0 38.7 11.9 25.4 36.6 28.2
(5.0) (6.6) (5.3) (2.5) (5.3) (3.7) (6.2)
26.8 23.9 30.9 8.4 26.6 31.8 21.3
(7.3) (7.6) (8.3) (2.5) (5.7) (7.6) (5.0)
28.4 29.6 37.4 10.1 23.2 33.3 26.9
(5.9) (6.5) (6.2) (3.0) (4.2) (5.0) (3.4)
28.4 25.8 36.6 8.9 23.9 31.7 22.1
(4.6) (7.0) (6.3) (2.5) (6.5) (6.6) (4.6)
women
p < .07), and Women’s Feelings About the Interaction, F(1,62) = 3.76, p < .06. In both cases, parsing the interaction revealed that low-AS women who hyperventilated and high-AS women who relaxed were not at&ted differentially by the approval or disapproval encountered in the role-plays. Experiencing hyperventilation led the high-AS women to report reductions in self-esteem and more negative feelings about the interaction when they had experienced disapproval. For the low-AS women, however, relaxation was associated with reduced selfesteem and negative feelings about the interaction with a disapproving boyfriend. On all three measures, the relaxed low-AS women with approving boyfriends had the most positive scores, whereas the high-AS women who hyperventilated and whose boyfriends were disapproving had the least positive. One significant three-way disordinal interaction was found for the Men’s Perception of Partner rating, F(1,62) = 3.80, p < .05, which mirrored the pattern found in the women’s projections about their boyfriends’ appraisals of them. The partners of high-AS women perceived their relaxed girlfriends with equivalent favor in the approval and disapproval conditions. However, the hyperventilating high-AS women in the approval condition were perceived more positively by their boyfriends than their relaxed counterparts, whereas in the disapproving condition the hyperventilating high-AS women were perceived less favorably than the relaxed high-AS women. Again, the low-AS women who relaxed in the approving condition were perceived most favorably by their boyfriends, whereas the hyperventilating high-AS women in the disapproval condition were perceived least favorably.
FIG. 1. THREE-WAY
Negative INTERACTION
BETWEEN
I
PARTNER.
STATE, AND INTERPERSONAL ABOUT
AS, PHYSICAL
Negative
26
Disapproval
26
Relaxed
Hyperventilated
40
Positive
28
Approval
Low AS
28
38
40
Positive
I
SITUATION
Approval
I
Hyperventilated
Relaxed
PROJFXTION
Disapproval ON WOMEN’S
1
High AS
1
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SiN3TMTY
These findings support the second hypothesis, in that the experience of disapproval by hyperventilating high-AS women led to the largest relative increases in negative projections about their boyfriends’ appraisals, greatest self-depreciation, and most dysphoric feelings about the interaction. The social negativity experienced by these high-AS women was congruent with the fact that they also elicited the most unfavorable evaluations from their boyfriends in this situation. Similarities Among Partners’ Perceptions as a Function of AS One possibility for the outcomes just reported is that high-AS women are generally more sensitive to subtle cues sent by their partners than are low-AS women. This possibility was examined by computing correlations that represented convergence of perceptions between the partners about the relationship in general (e.g., women’s-self perception compared to men’s perceptions of their partners). Five convergent perceptions were computed separately for the high- and low-AS women and are presented in Table 2. Coefticients in both columns indicate the existence of significant congruence between how members within each couple viewed one another. This congruence existed for overt ratings, such as each members’ view of the relationship and women’s self-perceptions compared with their boyfriends’ views of them. Significant congruence also was evident in the two items that involved some degree of projective estimation; that is, when the women and the men projected about how their partners rated them compared with their partners’ actual evaluations of them. TABLE CONVERGENT PERCEPTIONS
VALIDITY Comcm WITHIN COUPLIZ
Scale
2
DESCRIBING SIMILARITIES IN FOR HIGH- AND Low-AS WOMEN
High-AS
Low-AS
.55***
.42*
.62***
.39*
Women’s Perception of Relationship Men’s Perception of Relationship
.53**
.69**
Men’s Self-Perception Women’s Perception
.53**
.31*
.55**
.45**
Women’s Self-Perception Men’s Perception of Partner Women’s Projection Toward Men’s Perception of Partner
Partner
of Partner
Men’s Projection Toward Partner Women’s Perception of Partner
*p < .05; **p < .Ol; ***p c .ool.
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The degree of convergence was greater for high-AS couples on four of the five measures. For high-AS women there was an especially large difference between the congruence of the projections made about how their male partners viewed them and their partners’ actual views of them (r = 62, p < .OOl), compared to the congruence found for couples containing low-AS women (r = .39, p < .05). Analyses were conducted to determine whether the convergence in perceptions of the high-AS women was significantly greater than those of lowAS women. The significance of these differences was tested by regressing each of the women’s perception scores on the corresponding men’s perception, AS, and the interaction of men’s perception by AS. None of the interaction terms was significant, indicating that AS did not mediate significantly the way that members within couples viewed one another. Mood Effects of Experimental Manipulations Several post hoc analyses were undertaken to evaluate differential responsiveness of the high- versus low-AS women to tire breathing manipulations. We speculated that the hypervigilent style manifested by high-AS women might make them relatively less responsive to the relaxation induction. We generated relative difference measures on the five Mood Induction subscales (Anxious, Irritated, Mellow, Energetic, and Depressed) by computing residual change scores, as follows: (a) regression lines predicting each woman’s expected postinteraction score from her preinteraction score were derived separately for each experimental condition; (b) residual difference scores were calculated to determine how much each woman’s actual score differed from her predicted score on the regression line; and (c) these residualized difference scores were entered into three-factor analyses of variance, separately for each variable. A negative residual difference score indicated that the actual postintervention emotion was lower than would be expected, given the score predicted from preintervention, and a positive score indicated that the actual scorn was higher than would have been expected. Significant three-way interactions emerged on the Anxious, F( 1,62) = 3.77, p < .05, and Depressed subscales, F(1,62) = 5.21, p < .05. These interactions were due primarily to differential effects of the relaxation induction, as shown for Anxiety in Figure 2. Low-AS women who relaxed reported relatively more anxiety when their boyfriends were behaving in a disapproving manner. HighAS women who relaxed, however, reported relatively more anxiety when their boyfriends were supportive. An identical pattern was found on the Depression subscale. On both measures, the high-AS women reported the greatest residual anxiety and depression (relative to their preintervention ratings) following exposure to relaxation and approval from their boyfriends. DISCUSSION As hypothesized, high-AS women reported significantly poorer self-perceptions, less favorable appraisals of their boyfriends, and less positive views of
L
Approval
I
1
AS,
PHYSICAL
Disapproval
I
Hyperventilated
---..-.-.........._.._.._.__...........
FIG. 2. THREE-WAY INTERACTION BENEN
Less Than Predicted
I
Low AS
/“-’
More Than Predicted
SITUATION
ON REMDUALIZED
Relaxed
CHANGE
IN ANXIETY.
Disapproval
High AS
Approval Less Than Predicted
(4) i
STATE, AND 1NTERPERSONAL
.
I
4r
More Than Predicted
.
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their relationships in general. More important, before the experiment even began, they projected that their boyfriends felt significantly less favorably toward them in general than did low-AS women. These projections appeared to reflect accurately their boyfriends’ generally more negative appraisals about the high-AS women. Given that only one of our female respondents reported a prior history of clinically debilitating anxiety, these findings bolster other evidence (Kleiner & Marshall, 1987; Shean & Lease, 1991) that panicprone individuals are likely to experience intimate social relationships as less satisfactory, even before the occurrence of clinical panic disorder. These outcomes also are consistent with previous findings that high-AS women carry heightened dysphoric affect into interpersonal contexts (Liebman & Allen, 1995) and report insecure interpersonal attachment (Laraia, Smart, Frye, Lydiard, & Ballenger, 1994) in much the same way as ‘hysterical style” (Chambless & Goldstein, 1981) individuals, clinical panickers, and sufferers of agoraphobia. One possibility for this more generalized dissatisfaction among couples containing high-AS women is that these women are more sensitive to the behaviors of their partners that signal negative evaluation. Support for this contention was mixed. Correlational analyses indicated the highest degree of concordance between how the high-AS women thought their boyfriends viewed them and the men’s actual perceptions of the women The magnitude of these correlations, however, was not significantly larger for high-AS women than the convergent perceptions of couples containing low-AS women. A second possibility is that couples with high-AS women and their partners actually send negative interpersonal messages more frequently or intensely. Confirmation of this speculation will require observational analysis of the behavioral interactions between high versus low-AS women and their intimate partners. The pattern of significant triple interactions provides some preliminary evidence pertaining to possible causal mechanisms underlying the development of such troubled social relationships. There were important differences between how high- and low-AS women reacted to the induction of hyperventilation and relaxation. However, these differences were not reported directly following the induction of either affective state. Rather, they appeared within the interpersonal contexts of support or disapproval. Our data suggest that high-AS women may be caught in a particularly problematic double bind, which causes them suffering in both hyperventilated and relaxed states. Exposure to even mild hyperventilative arousal appeared to create an interpersonal outcome that fits the vicious-spiral speculation provided by Belfer and Glass (1992). Hyperventilation appeared to sensitize high-AS women in particular to the social disapproval exhibited by their boyfriends. These women downgraded themselves following the disapproving encounter, and, more important, they projected that their boyfriends viewed them most unfavorably in the combined context of their own hyperventilation and their boyfriend’s disapproval. They also appeared to act in ways that their partners did find relatively most unattractive, as indicated by their boyfriend’s evaluations.
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While hyperventilation and disapproval increased the interpersonal distress reported by high-AS women, relaxation in the context of partner approval did not seem to enhance comfort or enjoyment. Post hoc analyses of residualized mood changes within each experimental condition revealed the counter-intuitive finding that, for high-AS women, the relaxation induction led to relatively less reduction in dysphoric feelings of anxiety and depression, especially when their boyfriends had acted supportively. We speculate that this context of relaxation and support may trigger anticipatory anxiety in high-AS women, perhaps about forthcoming experiences that they fear will be unpleasant. This interpretation is somewhat tentative, given the post hoc nature of these particular analyses and our failure to validate the physiological effects of hyperventilation via heart rate changes. Additional evidence for this speculation, however, exists in the finding that high-AS women failed to discriminate reliably between their boyfriend’s approval and disapproval following relaxation, suggesting that their attention was pulled away from salient cues in the interpersonal situation as a result of relaxation. These results have some potentially important therapeutic implications. First, clinicians may find it helpful to embed this counter-intuitive finding in the treatment rationales that they provide to panic-prone individuals. Anticipatory anxiety may be viewed as a form of self-appraisal that occurs at a meta-level of self-analysis (Allen & Sheckley, 1992). In apparently relaxed and interpersonally supportive contexts, panic-prone individuals may evaluate their continued experience of physiological distress as especially inappropriate because they “should be” feeling better. By informing panic-prone individuals that the comfort presumably created by relaxation may, in fact, trigger anticipatory anxiety, clinicians can help their clients effectively short-circuit subsequent vicious spirals between physiological tension and negative self-appraisal. Second, it seems important to attend to the moment-by-moment self-talk of high-AS individuals, not only when these persons are in problematic interpersonal situations, but also as they relax and enjoy positively affirming interpersonal relationships. These additional interventions may help to increase the efficacy of interventions for panic disorder that combine cognitive restructuring with interoceptive exposure. REFERENCES Allen, G. J., & Sheckley, B. G. (1992). Lineal and recursive perspectives on change: An ecological model describing the development and amelioration of agoraphobia. In Y. Klar, J. D. Fisher, J. M. Chinsky, & A. Nadler, (Eds.), Initiating self-chunges: Social, psychological and clinical perspectives. New York: Springer Verlag. American Psychiatric Association (1987). Diagnostic and sfatisfical mmual of menral disorders (3rd. ed., rev.) Washington, DC: Author. Belfer, P. L.. & Glass, C. R. (1992). Agoraphobic anxiety and fear of fear: Test of a cognitive-attentional model. Journal ofAnxiety Disorders, 6.133-146. Chambless, D. L., &Goldstein, A. J. (1981). Clinical treatment of agoraphobia. In M. Mavissakalian & D. H. Barlow (Eds.), Phobk Psychological and Phamacofogicul Tkeubnent (pp. 103-144). New York: The Guilford Press.
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Chambless, D. L.. & Mason, J. (1986). Sex, sex-role stereotyping and agoraphobia. Behaviour Research and Therapy, 24,23 1-235. Diener, E., & Emmons, R. A. (1984). The independence of positive and negative affect. Journal of Personality and Social Psychology, 47.1105-l 117. Diener. E., Larsen, R J.. Levine, S., & Emmons, R. A. (1985). Intensity and frequency: Dimensions underlying positive and negative affect. Journal of Personality and Social Psychology, 48, 1253-1264. Fisher, L. M.. & Wtlson, G. T. (1985). A study of the psychology of agoraphobia. Behaviour Research
and Therapy,
23.97-107.
Gohistein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47-59.
Hafner. I. R, & Minge, P. J. (1989). Sex role stereotyping in women with agoraphobia and their husbands. Sex Roles: A Journal of Research, 20,705-707. Kleiner. L.. & Marshall, W. L. (1987). The role of interpersonal problems in the development of agoraphobia with panic attacks. Joumd ofAnxiety Disoniers. 1.313-323. Laraia, M. T.. Stuart, G. W., Frye, L. H., Lydiard, B.. & Ballenger, J. C. (1994). Childhood environment of women having panic disorder with agoraphobia Journal ofAnxiety Dironfers. 8, 1-18. Liebman, S. E., & Allen, G. J. (1995). Anxiety sensitivity, state anxiety and perceptions of facial emotions. Journal of Anxiety Disoniers, 9,257-267. Lochman. J., & Allen, G. J. (1981). Nonverbal communication of couples in conflict. Journal of Research
in Personality,
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Maller, R. G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Joumd of Anxiety
Disorders,
6.241-247.
Olson, D. H.. & Ryder, R. G. (1970). Inventory of Marital Conflicts: An experimental interaction procedure Journal of Marriage and the Family, 32,4-G-448. Otto, M. W., Pollack, M. H., Sachs, G. S., & Rosenbaum, J. F. (1992). Hypochondriacal concerns, anxiety sensitivity, and panic disorder. Journal of Aruiety Disoniers, 6.93-104. Peterson, R. A., & Reiss, S. (1987). Test manual for the Anxiety Sensitivity h&x. Orland Park, IL: International Diagnostic Systems. Rapee, R. M. (1995). Psychological factors influencing the affective response to biological challenge procedures in panic disorder. Joumul of Anriety Disorders, 9.59-74. Reiss, S. (1991). Expectancy theory of fear, anxiety, and panic. Ciinicul Psychology Review, 11. 141-153. Reiss, S., Peterson. R. A., Gursky, D. M.. & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Reseurch wtd Thempy. 24.1-g. Richman, H., & Nelson-Gray, R. (1994). Nonclinical panicker personality: Proftle and discriminative ability. Journal of Anxiety Disomkrs, 8.33-48. Shean, G., & Lease, C. (1991). The relationship between interaction patterns and agoraphobic fears among college students. The Journal of Psychology, X25.271-278. Stewart. S. H., Knixe. K., & Pihl. R. 0. (1992). Anxiety sensitivity and dependency in clinical and nonclinical panickers and controls. Joumul of Anxiety Disorders, 6.119-13 1. Taylor, S. (1995). Anxiety sensitivity: Theoretical perspectives and recent findings. Behnviour Research
and Therapy.
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Whit&l, M. L., & Cioetsch,V. L. (1995). Physiological, subjective, and behavioral reponses to hyperventilation in clinical and infrequent panic. Behuviour Reseutch und 79wupy. 33.415-422.
Pergamon
PII !30887-61a(%poo11-4
Relationships Between Anxiety Sensitivity, Emotional Arousal, and Interpersonal Distress FAITH A. BENTON,PH.D. CL&f Behavioral
GEORGE University
Health
J. ALLEN,
Systems
PH.D.
of Connedcut
Abstract - We investigated relationships between anxiety sensitivity, physiological arousal, and interpersonal functioning in conflict situations following relaxation and hyperventilation in a 2 x 2 x 2 repeated-measures experimental design. High (n = 32) and low (n = 32) anxiety-sensitive (AS) women were obtained from the top and bottom 25% of 900 respondents. Participants were exposed to S-min inductions of either relaxation or hyperventilation, followed by a 5-min role-play of a conflict scenario with their boyfriends, who were coached to act in either an approving or a disapproving manner. Following the interaction, participants rated tbeii self-perception, perception of parmer, projections about how p-r was viewing them, and feelings about the interaction. The women then underwent the same breathing manipulation as previously and engaged in a second scenario with their boyfriends, who acted in the manner opposite to that of the fti scenario. Order of support vemus disapproval was randomly counterbalanced across couples. A pattern of significant triple interactions and tendencies toward significant triple interactions revealed that high-AS women who hyperventilated and experienced disapproval were most seifderogatory, most lily to perceive their partners as evaluating them unfavorably, and most likely to influence their partners to devalue them. In addition, experiencing relaxation and approval from their partners did not diminish tbe subjectively reported anxiety and depression in high-AS women as much as expected relative to low-AS women. -
This investigation was based upon a doctoral dissertation conducted by the senior author under the guidance of the second author. We acknowledge with appreciation permission provided by Professor Steven Reiss and IDS Publishing Corporation to reproduce the Anxiety Sensitivity Index for screening participants in this investigation. Requests for reprints should be sent to George J. Allen, Department of Psychology, U-20.406 Babbidge Road, University of Connecticut, Storrs, CT 06269-1020. 267
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In their classic theorizing about agoraphobia, Chambless and Goldstein (198 1; Goldstein & Chambless, 1978) integrated what has grown into two disparate areas of investigation, the “fear of fear” literature (Reiss, 1991) and research focusing on the numerous interpersonal problems experienced by panic sufferers and agoraphobic individuals. Their theory and subsequent elaborations (Allen & Sheckley, 1992; Reiss, 1991) posited the existence of positively escalating feedback loops between the experience of panic episodes, diminished self-esteem, and deteriorated interpersonal functioning. Subsequent research has linked panic disorder to such interpersonal difficulties as family enmeshment (Shean & Lease, 1991), gender-role stereotypy (Chambless& Mason, 1986; Hafner & Minge, 1989), reduced intimacy (Fisher & Wilson, 1985), and avoidant and schizoid personality styles (Richman & Nelson-Gray, 1994). This research, however, has not clearly delineated whether such social dysfunctions develop as a result of having experienced panic episodes (Belfer 8z Glass, 1992; Richman & Nelson-Gray, 1994) or whether they precede the onset of panic symptoms (Kleiner & Marshall, 1987; Shean & Lease, 1991). Belfer and Glass (1992), for example, posited the existence of a vicious spiral between feelings of panic and interpersonal distress in clinically anxious individuals. Within their model, panic creates physiological distress and subsequent anticipatory anxiety, both of which pull the sufferer’s attention away from interpersonal cues that dictate appropriate social responding. Failure to respond appropriately to these cues, in turn, is believed to create a backlash of negative disapproval from significant others. Goldstein and Chambless (1978), however, postulated that agoraphobic individuals possess an “hysterical” interpersonal style that leads them to misinterpret multiple forms of physiological arousal as impending anxiety. These authors implied that this interpersonal style exists prior to the experience of clinically diagnosed panic and argued that such catastrophic hypervigilence is likely to exacerbate interpersonal conflict situations. Anxiety sensitivity (AS; Peterson, & Reiss, 1987; Reiss, Peterson, Gursky, & McNally, 1986) refers to the tendency to interpret anxiety-related physiological arousal as having catastrophic consequences. The AS construct provides a potentially useful link between the “hysterical” style that presumably exists prior to the experience of panic episodes and deteriorated interpersonal functioning. AS has been demonstrated to be a relatively stable personality trait that is predictive of panic episodes in both clinical and nonclinical populations (Maller & Reiss, 1992; Taylor, 1995). When undergoing biological challenge tasks (e.g., hyperventilation), high-AS individuals typically report more intensely negative experiences and discomfort compared to low-AS individuals (Rapee, 1995), even though both groups display equivalent levels of actual physiological arousal (Whittal & Goetsch, 1995). Elevated AS also has been associated with many of the interpersonal difficulties that are similar to the problems experienced by clinical panickers and agoraphobic persons, including insecure interpersonal attachment (Laraia, Stuart, Frye, Lydiard, & Ballenger, 1994) overreliant dependency on signifi-
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cant others (Stewart, Knize, & Pihl, 1992), and hypochondriac concerns (Otto, Pollack, Sachs, & Rosenbaum, 1992). Thus, although AS does not directly assess social functioning, it represents a construct that may link existing literatures concerning symptomatic overreactivity to hyperventilation, selective attention to threatening stimuli, and diminished interpersonal functioning. Presently, little is known about the mechanisms that may mediate physiological overreactivity and social dysfunction. Rapee (1995) has conjectured that hyperventilation has more deleterious psychological effects for people who feel neither safe nor able to exert control. He also postulated that high AS predicts feelings of being threatened, especially in ambiguous situations. Liebman and Allen (1995) provided evidence supporting Rape& speculation. In their study, high- and low-AS women rated the intensity of facial emotions following inductions of relaxation and hyperventilation. These researchers noted that high-AS women entered the experimental situation reporting significantly higher levels of dysphoric atfect than low-AS women even before experiencing either mood induction. Hyperventilation led to relatively larger increases in intensity ratings of sadness and fear by high-AS scorers, especially when it was induced before relaxation. Liebman and Allen concluded that induced hyperventilation interacted with the initial apprehension of high-AS women, which then led them to view facial stimuli as containing more intensely negative emotions. The present investigation further explores relationships between AS, physiological arousal, and emotional responsiveness to interpersonal situations. Highand low-AS women experienced two 5-min inductions of either hyperventilation or relaxation and then participated in two conflict-laden role-plays with their boyfriends. In a repeated-measures cross-over design, the boyfriends were instructed to act in either an approving or a disapproving manner, with order of approval versus disapproval being randomly determined. We hypothesized that, before the experiment began, (a) high-AS women would report more negative perceptions of themselves and their relationships in general than low-AS women and (b) partners of high-AS women would also evaluate their girlfriends and their relationships with them less favorably than would the partners of low-AS women. More important, we predicted the emergence of significant three-way interactions such that the high-AS participants who hyperventilated would rate themselves most negatively and would also perceive their partners as viewing them least favorably when their boyfriends were disapproving of them. In contrast, the low-AS participants who relaxed would have the most positive selfperceptions as well as the most positive projections about their partners’ views of them when their partners behaved in an approving manner. METHODS Participants
The Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1987) was administered to approximately 900 undergraduate women, and those who scored in the top and bottom 25% were deemed eligible to participate. Of the 115 women
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who identified themselves as members of an exclusively dating couple for more than one month, 64 actually participated. Individuals were excluded if they reported any history of epilepsy, asthma, respiratory difficulties, or heart defibrillation. Only one woman indicated having a formally diagnosed anxiety condition (obsessive compulsive disorder). Each boyfriend was paid $4.00 for his participation and the women received experimental credit. The low-AS group (n = 32) had AS1 scores ranging from 3 to 13 (M = 9.09) and the high-AS group (n = 32) had scores ranging from 25 to 49 (M = 33.84), which is consistent with the scores reported by investigators who work with clinically debilitated populations (e.g., Otto, Pollack, Sachs, Br Rosenbaum, 1992; Stewart, Knize, & Piil, 1992). Participants’ ages ranged from 17 to 43 years (M = 19.64). duration of the current relationship ranged from one month to 22 years (M = 23.1 months), and number of prior relationships ranged from 0 to 10 (M = 1.8). There were no significant differences between high- and low-AS women in terms of age, months in the current relationship, or number of prior relationships. Experimental Design The design was a 2 x 2 x 2 factorial with two between-group factors: Anxiety Sensitivity (AS; High vs. Low) and Physical State (PS; Hyperventilate vs. Relax) and one repeated-measures factor: Interpersonal Situation (INTPS; Approving vs. Disapproving). To eliminate potentially confounding order effects, INTPS was randomly counterbalanced such that half the couples were in the approving condition first. Two different role-play vignettes, adapted from the Inventory of Marital Conflict (Olson & Ryder, 1970), were counterbalanced randomly and equally within the approving and disapproving conditions. Specific Measurement Instruments A demographics questionnaire assessed personal characteristics (e.g., age, religion), dating history (e.g., length of the current relationship, number of previous relationships), and occurrence of panic symptomatology by having participants indicate how many of 13 DSM-III-R (American Psychiatric Association, 1988) symptoms they had experienced simultaneously. A Mood Inventory (Liebman & Allen, 1995) was used to evaluate the women’s emotional states both prior to and following each episode of relaxation or hyperventilation. Following Liebman and Allen (1995). participants rated each of 27 adjectives reflecting common positive and negative emotional experiences (Diener & Emmons, 1984; Diener, Larsen, Levine & Emmons, 1985) on 6-point scales ranging from 0 = not at ail to 5 = extremely. Adjectives were condensed into five subscales: Mellow (mellow, relaxed, comfortable, serene, and content), Energetic (alert, energetic, clear, effective, euphoric, and involved), Depressed (sad, depressed, exhausted, apathetic, fatigued, and confused), Anxious (agitated, anxious, tense, dizzy, lightheaded,
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and apprehensive), and Irritable (frustrated, annoyed, irritable, and negative). Internal consistency analyses, computed on the five subscales separately across four times of administration, yielded Cronbach alphas ranging from .69 to .95, with 18 of the 20 coefficients above .70. General Perceptions of Self and Relationship. Prior to engaging in the experiment, both partners rated their perceptions of themselves, their partners, and their relationship by endorsing six pairs of antonyms, using a 6-point semantic differential format, such that a higher score reflected a more positive evaluation. Each question-antonym cluster represented a conceptually coherent and internally consistent construct. The first assessed general self-perception, “How do you perceive yourself in generalr’ The six antonym pairs, drawn from existing literature describing interpersonal difIiculties experienced by panic sufferers (e.g., Hat&r & Minge, 1989; Shean & Lease, 1991; Stewart et al., 1992), were unappealingappealing; insecure-secure; boring-exciting; self-sufficient-clingy; passiveassertive; indiit-direct. The second question cluster, “How do you generally perceive your partner?” assessedgeneral perception of partner. The third cluster was a semiprojective measure (General Projection About Partner) that asked “How does your partner perceive you in general?” The fourth cluster, “How do you generally perceive your relationshipr’ assessedgeneral feelings about relationship. For all four questions, the same six adjective-pairs were used. Post-Interaction Perceptions of Self and Relationship. This questionnaire followed the same format as the General Perceptions of Self and Relationship Questionnaire except that participants completed it after each role-play and were instructed to respond based solely on how they felt about the interaction they had just experienced. Complementary versions were constructed for the men and women. Women’s Self-Perception (WSP) and Men’s Self-Perception (MSP) were determined from responses to the question “How are you feeling about yourself right now?’ along six adjective pairs (i.e., appealing-unappealing; insecure-secure; exciting-boring; clingy-self-sufficient; passive-assertive; direct-indirect) that were identical for the men and women. The version assessing Women’s Perception of Partner (WPI$ “How did you perceive your partnery) contained seven adjective pairs (i.e., appealing-unap pealing; hostile-friendly; warm-cold; supportive-unsupportive; passiveassertive; direct-indirect; approving-disapproving). Women’s Projection About Partner (WPAP) asked the women to judge how their male partners were feeling about them subsequent to each interaction. This semiprojective measure was considered the most important one in the study and was composed of eight adjective pairs (i.e., appealing-unappealing; insecure-secure; approvingdisapproving; clingy-self-sufficient; passive-assertive; direct-indirect; strong-we&, involved-withdrawn). Scales assessing the Women’s and Men’s Feelings About Interaction (WFAI and MFAI; “How did you feel about this interaction?“) each contained four adjective pairs (i.e., frustrating-satisfying; exciting-boring; stressful-relaxing; easy-difficult) that were identical for both the men and women.
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Two scales for the men’s version of the questionnaire were altered in a manner that permitted comparison of each person’s projections about how the other was feeling toward them with the actual view of the partner along identical adjective sets. Men’s Perception of Partner (MPP) was determined from the eight adjective pairs that the women used in projecting about how their boyfriends were feeling toward them (WPAP). Similarly, Men’s Projection About Partner (MPAP) was based on the seven adjective pairs that the women used to evaluate their boyfriends’ behaviors (WPP). These alterations permitted examination of convergent perceptions among couples, for example, to determine whether the way the men actually perceived the women was consistent with the way the women projected that the men were viewing them. On all questionnaire scales, higher scores indicated more favorable evaluations. Internal consistency analyses suggested that these items clustered to form generally coherent constructs, especially for women’s ratings, where 9 of 12 Cronbach alpha coefficients were above .66. Experimental Procedure
After obtaining informed consent, the couple was separated. The woman completed the General Perceptions of Self and Relationship Questionnaire and responded to a 5-min tape containing either relaxation or hyperventilation instructions, as described by Liebman and Allen (1995). Relaxation was induced through indirect suggestions to release muscle tension and to breathe slowly and deeply. Hyperventilation was induced by instructing participants to pace their breathing to 30 breaths per min in rhythm with a timed chant to “breathe in . . . breathe out . . ..” Following the initial mood induction, the woman completed the Mood Inventory, read a short vignette taken from the Inventory of Marital Conflict (Olson & Ryder, 1970), and was asked to role-play the woman in the couple. As used by Lochman and Allen (1981), the two vignettes in the role-play involved problems frequently experienced by young couples. In one, the woman prefers the company of men to that of other women at a party, which provokes a jealous response from her boyfriend. In the other, the woman asks her boyfriend to give up watching televised sports and spend more time with her. The vignettes were constructed by Olson and Ryder so that each member of the couple would believe that his or her position wasjustified. While the woman underwent mood induction, her partner completed the General Perceptions of Self and Relationship Questionnaire. He was next asked to take either a strongly approving, supportive stance or a disapproving, nonsupportive stance in the upcoming role-play. He was guided in using at least two specifically approving or nonapproving behaviors taken from a list provided by Lochman and Allen (198 1). Order of approval versus disapproval and vignette were randomly counterbalanced. The couple then acted out the first scenario while the experimenters were out of the room. With the couples’ consent, all role-play interactions were video-
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taped. This procedure helped increase fidelity to the experimental instructions. Following the role-play, the woman completed the Post Interaction Perceptions of Self and Relationship Questio~aire.The woman then listened to the same mood induction tape as previously, completed another Mood Inventory, and was given her second vignette. The man received instructions for behaving in the opposite manner as he had for the first vignette. The couple then acted out the second conflict scenario, filled out the Perceptions of Self and Relationship Questionnaire and the woman completed another Mood Inventory. Finally, they were fully informed about the experimental manipulations, given an opportunity to discuss any concerns, and thanked for their participation. RESULTS Validity Assessments of the Experimental Manipulations The validity of the breathing manipulation was assessed post hoc through analyses of the Mood Inventory scales. Multiple two-factor ANOVAs (AS x PS) revealed significant (p < .05) changes on four of the five mood variables, such that hyperventilation led to increases in depression, anxiety, and irritability, and a reduction in feeling “mellow.” Although these data provide evidence that hyperventilation and relaxation produced significantly different affective states between high- and low-AS women, validation of actual physiological differences would have been more dearly provided by using independently assessed physiological measures (e.g., heart rate). Validity of differences between the approval and disapproval conditions during the role-plays was assessed in two ways. The first method involved examination of the couples’ responses following each interaction. Three-factor (AS x PS x INTPS) ANOVAs revealed significant @ < .Ol) main effects for interpersonal situation, such that boyfriend negativity was associated with more unfavorable evaluations of their partners by both the women (WF’P) and the men (MPP) and also in the women’s ratings of the disapproving interaction (WFAI). Both men (MPAP) and women (WPAP) projected more negativity toward their partners in the disapproving encounters (p c .OOOl). The second method involved having trained observers analyze the videotapes of the couples’ interactions. Preliminary results indicated that the men in the disapproving condition exhibited significantly more hostility through both nonverbal and verbal channels. These analyses suggest that the role-plays were effective in engendering behavior by the men and affect by the women that was appropriate to the experimental conditions. Initial Differences Between Groups Multiple one-way analyses of variance were computed to assessdifferences between the high- and low-AS women prior to beginning the experimental manipulations. There were no differences in age, number of prior relationships, and number of months in their current relationships. High-AS women,
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however, reported significantly more panic symptoms (il4 = 5.8) than low-AS women (M = 3.3; F(1,62) = 10.13,~ < .Ol). High-AS women reported more negative self-perceptions, F( 1,62) = 19.27, p < .OOOl, less favorable perceptions of their partners, F(1,62) = 12.66, p < .OOl, and more negative feelings about their relationships in general, F(1,62) = 8.44, p < .Ol. On the semiprojective measure, high-AS women reported believing that their partners thought less highly of them than did lowAS women, F(1,62) = 15.65, p c .OOl. The male partners of the high-AS women mirrored this negativity, reporting significantly less positive perceptions of their partners, F(1,62) = 3.79, p < .05, and more negative feelings about their relationships, F(1,62) = 4.95, p < .05. The finding that high-AS women reported significantly greater negative appraisals about themselves and their relationships provided support for the first hypothesis. In addition, this finding necessitated using these general appraisals as covariates in tests of the second experimental hypothesis. AS, Hyperventilation,
and Intelpersonal
Perceptions
Table 1 presents means and standard deviations of the interpersonal perceptions reported by high- versus low-AS women and their boyfriends following the approving and disapproving role-plays. Three-way analyses of covariance were performed using two between-group variables, Anxiety Sensitivity (AS, High vs. Low), and Physical State (PS, Relaxed vs. Hyperventilating) with a multivariate solution being applied to the one within-subjects variable, Interpersonal Situation (INTPS, Approval vs. Disapproval). In each case, the appropriate general perception construct was used as the covariate. Of particular importance was the emergence of triple interactions between AS, physical state, and interpersonal situation. Significant differences or strong tendencies toward significance were found on three of the four women’s ratings. The same pattern was found for all three scales such that high-AS women were particularly likely to downgrade themselves when in a hyperventilative state of physiological arousal and after having dealt with a disapproving boyfriend. The strongest triple interaction emerged on the Women’s Projections About Partner subscale, F(1,62) = 9.35, p < -01, Figure 1 depicts this disordinal interaction. Hyperventilation did not affect the projections made by low-AS women about what their partners thought of them, regardless of whether the boyfriend was approving or disapproving. For low-AS women who relaxed, however, disapproval elicited significantly more negative projections about what their boyfriends thought about them than did approval. This pattern was reversed for high-AS women, such that their relaxation did not lead to differential projections as a function of boyfriend approval or disapproval. The WPAP scores for the high-AS women who hyperventilated, however, were significantly lower when their boyfriends were disapproving. This same disordinal triple AS x PS x INTPS interaction occurred, and approached significance, on both Women’s Self Perceptions, F( 1,62) = 3.62,
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TABLE 1 MEANS AND STANDARD DEVLWIONS (m PA RENMSES) OF bIlERFERSONAL PE!JtCWtlONS OF HIGH- VERSUS Low-AS WOMEN AND THEJR PARTNER S BY EXPERBUXWI. CONDITION Relaxed Approval
MeaSUlE Couples having WSP WPP WPAP WFAl MSP MPP MPAP Couples having WSP WPP WPAP WFAI MSP MPP MPAP -
high-AS
low-AS
Hyperventilating
Disapproval
Approval
Disapproval
women 25.1 29.4 32.5 9.9 24.9 32.4 29.0
(5.2) (7.2) (6.9) (3.0) (5.4) (5.7) (5.9)
25.8 22.5 32.9 8.4 26.4 31.9 20.1
(5.3) (5.5) (5.4) (2.9) (4.4) (5.4) (2.7)
26.6 27.7 35.0 10.7 23.3 34.9 26.3
(4.9) (9.1) (6.8) (3.3) (5.7) (3.7) (4.6)
23.1 22.4 27.8 8.2 26.6 30.1 21.8
(6.6) (7.5) (8.3) (2.6) (4.6) (7.5) (5.6)
29.4 32.0 38.7 11.9 25.4 36.6 28.2
(5.0) (6.6) (5.3) (2.5) (5.3) (3.7) (6.2)
26.8 23.9 30.9 8.4 26.6 31.8 21.3
(7.3) (7.6) (8.3) (2.5) (5.7) (7.6) (5.0)
28.4 29.6 37.4 10.1 23.2 33.3 26.9
(5.9) (6.5) (6.2) (3.0) (4.2) (5.0) (3.4)
28.4 25.8 36.6 8.9 23.9 31.7 22.1
(4.6) (7.0) (6.3) (2.5) (6.5) (6.6) (4.6)
women
p < .07), and Women’s Feelings About the Interaction, F(1,62) = 3.76, p < .06. In both cases, parsing the interaction revealed that low-AS women who hyperventilated and high-AS women who relaxed were not at&ted differentially by the approval or disapproval encountered in the role-plays. Experiencing hyperventilation led the high-AS women to report reductions in self-esteem and more negative feelings about the interaction when they had experienced disapproval. For the low-AS women, however, relaxation was associated with reduced selfesteem and negative feelings about the interaction with a disapproving boyfriend. On all three measures, the relaxed low-AS women with approving boyfriends had the most positive scores, whereas the high-AS women who hyperventilated and whose boyfriends were disapproving had the least positive. One significant three-way disordinal interaction was found for the Men’s Perception of Partner rating, F(1,62) = 3.80, p < .05, which mirrored the pattern found in the women’s projections about their boyfriends’ appraisals of them. The partners of high-AS women perceived their relaxed girlfriends with equivalent favor in the approval and disapproval conditions. However, the hyperventilating high-AS women in the approval condition were perceived more positively by their boyfriends than their relaxed counterparts, whereas in the disapproving condition the hyperventilating high-AS women were perceived less favorably than the relaxed high-AS women. Again, the low-AS women who relaxed in the approving condition were perceived most favorably by their boyfriends, whereas the hyperventilating high-AS women in the disapproval condition were perceived least favorably.
FIG. 1. THREE-WAY
Negative INTERACTION
BETWEEN
I
PARTNER.
STATE, AND INTERPERSONAL ABOUT
AS, PHYSICAL
Negative
26
Disapproval
26
Relaxed
Hyperventilated
40
Positive
28
Approval
Low AS
28
38
40
Positive
I
SITUATION
Approval
I
Hyperventilated
Relaxed
PROJFXTION
Disapproval ON WOMEN’S
1
High AS
1
INTERPERSONAL.
ASPEClS
OF ANXIETY
277
SiN3TMTY
These findings support the second hypothesis, in that the experience of disapproval by hyperventilating high-AS women led to the largest relative increases in negative projections about their boyfriends’ appraisals, greatest self-depreciation, and most dysphoric feelings about the interaction. The social negativity experienced by these high-AS women was congruent with the fact that they also elicited the most unfavorable evaluations from their boyfriends in this situation. Similarities Among Partners’ Perceptions as a Function of AS One possibility for the outcomes just reported is that high-AS women are generally more sensitive to subtle cues sent by their partners than are low-AS women. This possibility was examined by computing correlations that represented convergence of perceptions between the partners about the relationship in general (e.g., women’s-self perception compared to men’s perceptions of their partners). Five convergent perceptions were computed separately for the high- and low-AS women and are presented in Table 2. Coefticients in both columns indicate the existence of significant congruence between how members within each couple viewed one another. This congruence existed for overt ratings, such as each members’ view of the relationship and women’s self-perceptions compared with their boyfriends’ views of them. Significant congruence also was evident in the two items that involved some degree of projective estimation; that is, when the women and the men projected about how their partners rated them compared with their partners’ actual evaluations of them. TABLE CONVERGENT PERCEPTIONS
VALIDITY Comcm WITHIN COUPLIZ
Scale
2
DESCRIBING SIMILARITIES IN FOR HIGH- AND Low-AS WOMEN
High-AS
Low-AS
.55***
.42*
.62***
.39*
Women’s Perception of Relationship Men’s Perception of Relationship
.53**
.69**
Men’s Self-Perception Women’s Perception
.53**
.31*
.55**
.45**
Women’s Self-Perception Men’s Perception of Partner Women’s Projection Toward Men’s Perception of Partner
Partner
of Partner
Men’s Projection Toward Partner Women’s Perception of Partner
*p < .05; **p < .Ol; ***p c .ool.
278
I? A. BENTON
AND
G. I. ALLEN
The degree of convergence was greater for high-AS couples on four of the five measures. For high-AS women there was an especially large difference between the congruence of the projections made about how their male partners viewed them and their partners’ actual views of them (r = 62, p < .OOl), compared to the congruence found for couples containing low-AS women (r = .39, p < .05). Analyses were conducted to determine whether the convergence in perceptions of the high-AS women was significantly greater than those of lowAS women. The significance of these differences was tested by regressing each of the women’s perception scores on the corresponding men’s perception, AS, and the interaction of men’s perception by AS. None of the interaction terms was significant, indicating that AS did not mediate significantly the way that members within couples viewed one another. Mood Effects of Experimental Manipulations Several post hoc analyses were undertaken to evaluate differential responsiveness of the high- versus low-AS women to tire breathing manipulations. We speculated that the hypervigilent style manifested by high-AS women might make them relatively less responsive to the relaxation induction. We generated relative difference measures on the five Mood Induction subscales (Anxious, Irritated, Mellow, Energetic, and Depressed) by computing residual change scores, as follows: (a) regression lines predicting each woman’s expected postinteraction score from her preinteraction score were derived separately for each experimental condition; (b) residual difference scores were calculated to determine how much each woman’s actual score differed from her predicted score on the regression line; and (c) these residualized difference scores were entered into three-factor analyses of variance, separately for each variable. A negative residual difference score indicated that the actual postintervention emotion was lower than would be expected, given the score predicted from preintervention, and a positive score indicated that the actual scorn was higher than would have been expected. Significant three-way interactions emerged on the Anxious, F( 1,62) = 3.77, p < .05, and Depressed subscales, F(1,62) = 5.21, p < .05. These interactions were due primarily to differential effects of the relaxation induction, as shown for Anxiety in Figure 2. Low-AS women who relaxed reported relatively more anxiety when their boyfriends were behaving in a disapproving manner. HighAS women who relaxed, however, reported relatively more anxiety when their boyfriends were supportive. An identical pattern was found on the Depression subscale. On both measures, the high-AS women reported the greatest residual anxiety and depression (relative to their preintervention ratings) following exposure to relaxation and approval from their boyfriends. DISCUSSION As hypothesized, high-AS women reported significantly poorer self-perceptions, less favorable appraisals of their boyfriends, and less positive views of
L
Approval
I
1
AS,
PHYSICAL
Disapproval
I
Hyperventilated
---..-.-.........._.._.._.__...........
FIG. 2. THREE-WAY INTERACTION BENEN
Less Than Predicted
I
Low AS
/“-’
More Than Predicted
SITUATION
ON REMDUALIZED
Relaxed
CHANGE
IN ANXIETY.
Disapproval
High AS
Approval Less Than Predicted
(4) i
STATE, AND 1NTERPERSONAL
.
I
4r
More Than Predicted
.
280
F. A.BENTONANDG.J.ALLEN
their relationships in general. More important, before the experiment even began, they projected that their boyfriends felt significantly less favorably toward them in general than did low-AS women. These projections appeared to reflect accurately their boyfriends’ generally more negative appraisals about the high-AS women. Given that only one of our female respondents reported a prior history of clinically debilitating anxiety, these findings bolster other evidence (Kleiner & Marshall, 1987; Shean & Lease, 1991) that panicprone individuals are likely to experience intimate social relationships as less satisfactory, even before the occurrence of clinical panic disorder. These outcomes also are consistent with previous findings that high-AS women carry heightened dysphoric affect into interpersonal contexts (Liebman & Allen, 1995) and report insecure interpersonal attachment (Laraia, Smart, Frye, Lydiard, & Ballenger, 1994) in much the same way as ‘hysterical style” (Chambless & Goldstein, 1981) individuals, clinical panickers, and sufferers of agoraphobia. One possibility for this more generalized dissatisfaction among couples containing high-AS women is that these women are more sensitive to the behaviors of their partners that signal negative evaluation. Support for this contention was mixed. Correlational analyses indicated the highest degree of concordance between how the high-AS women thought their boyfriends viewed them and the men’s actual perceptions of the women The magnitude of these correlations, however, was not significantly larger for high-AS women than the convergent perceptions of couples containing low-AS women. A second possibility is that couples with high-AS women and their partners actually send negative interpersonal messages more frequently or intensely. Confirmation of this speculation will require observational analysis of the behavioral interactions between high versus low-AS women and their intimate partners. The pattern of significant triple interactions provides some preliminary evidence pertaining to possible causal mechanisms underlying the development of such troubled social relationships. There were important differences between how high- and low-AS women reacted to the induction of hyperventilation and relaxation. However, these differences were not reported directly following the induction of either affective state. Rather, they appeared within the interpersonal contexts of support or disapproval. Our data suggest that high-AS women may be caught in a particularly problematic double bind, which causes them suffering in both hyperventilated and relaxed states. Exposure to even mild hyperventilative arousal appeared to create an interpersonal outcome that fits the vicious-spiral speculation provided by Belfer and Glass (1992). Hyperventilation appeared to sensitize high-AS women in particular to the social disapproval exhibited by their boyfriends. These women downgraded themselves following the disapproving encounter, and, more important, they projected that their boyfriends viewed them most unfavorably in the combined context of their own hyperventilation and their boyfriend’s disapproval. They also appeared to act in ways that their partners did find relatively most unattractive, as indicated by their boyfriend’s evaluations.
INIERPERSONAL
ASUXl-S
OF ANXIETY
SENSITIVITY
281
While hyperventilation and disapproval increased the interpersonal distress reported by high-AS women, relaxation in the context of partner approval did not seem to enhance comfort or enjoyment. Post hoc analyses of residualized mood changes within each experimental condition revealed the counter-intuitive finding that, for high-AS women, the relaxation induction led to relatively less reduction in dysphoric feelings of anxiety and depression, especially when their boyfriends had acted supportively. We speculate that this context of relaxation and support may trigger anticipatory anxiety in high-AS women, perhaps about forthcoming experiences that they fear will be unpleasant. This interpretation is somewhat tentative, given the post hoc nature of these particular analyses and our failure to validate the physiological effects of hyperventilation via heart rate changes. Additional evidence for this speculation, however, exists in the finding that high-AS women failed to discriminate reliably between their boyfriend’s approval and disapproval following relaxation, suggesting that their attention was pulled away from salient cues in the interpersonal situation as a result of relaxation. These results have some potentially important therapeutic implications. First, clinicians may find it helpful to embed this counter-intuitive finding in the treatment rationales that they provide to panic-prone individuals. Anticipatory anxiety may be viewed as a form of self-appraisal that occurs at a meta-level of self-analysis (Allen & Sheckley, 1992). In apparently relaxed and interpersonally supportive contexts, panic-prone individuals may evaluate their continued experience of physiological distress as especially inappropriate because they “should be” feeling better. By informing panic-prone individuals that the comfort presumably created by relaxation may, in fact, trigger anticipatory anxiety, clinicians can help their clients effectively short-circuit subsequent vicious spirals between physiological tension and negative self-appraisal. Second, it seems important to attend to the moment-by-moment self-talk of high-AS individuals, not only when these persons are in problematic interpersonal situations, but also as they relax and enjoy positively affirming interpersonal relationships. These additional interventions may help to increase the efficacy of interventions for panic disorder that combine cognitive restructuring with interoceptive exposure. REFERENCES Allen, G. J., & Sheckley, B. G. (1992). Lineal and recursive perspectives on change: An ecological model describing the development and amelioration of agoraphobia. In Y. Klar, J. D. Fisher, J. M. Chinsky, & A. Nadler, (Eds.), Initiating self-chunges: Social, psychological and clinical perspectives. New York: Springer Verlag. American Psychiatric Association (1987). Diagnostic and sfatisfical mmual of menral disorders (3rd. ed., rev.) Washington, DC: Author. Belfer, P. L.. & Glass, C. R. (1992). Agoraphobic anxiety and fear of fear: Test of a cognitive-attentional model. Journal ofAnxiety Disorders, 6.133-146. Chambless, D. L., &Goldstein, A. J. (1981). Clinical treatment of agoraphobia. In M. Mavissakalian & D. H. Barlow (Eds.), Phobk Psychological and Phamacofogicul Tkeubnent (pp. 103-144). New York: The Guilford Press.
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