{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:33:11Z","timestamp":1791253991579,"version":"4.1.0"},"reference-count":50,"publisher":"AACN Publishing","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:p>Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as \u201cfear of fear.\u201d This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical (\u201cWhen my heart rate increases, I\u2019m afraid I may have a heart attack\u201d), social (\u201cIf people see me perspire, I fear they will negatively evaluate me\u201d), and cognitive (\u201cWhen I feel these symptoms, I fear it means I\u2019m going crazy or will lose control and do something dangerous like disconnect my IV\u201d). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.<\/jats:p>","DOI":"10.4037\/ajcc2023975","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T22:06:41Z","timestamp":1698790001000},"page":"449-457","source":"Crossref","is-referenced-by-count":18,"title":["Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery"],"prefix":"10.4037","volume":"32","author":[{"given":"Leanne M.","family":"Boehm","sequence":"first","affiliation":[{"name":"Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire M.","family":"Bird","sequence":"additional","affiliation":[{"name":"Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"Warren","sequence":"additional","affiliation":[{"name":"Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Danesh","sequence":"additional","affiliation":[{"name":"Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan M.","family":"Hosey","sequence":"additional","affiliation":[{"name":"Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"McPeake","sequence":"additional","affiliation":[{"name":"Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Potter","sequence":"additional","affiliation":[{"name":"Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Su","sequence":"additional","affiliation":[{"name":"Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy L.","family":"Eaton","sequence":"additional","affiliation":[{"name":"Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark B.","family":"Powers","sequence":"additional","affiliation":[{"name":"Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"issue":"1","key":"2023110102062895100_b1-0320449","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/0005-7967(86)90143-9","article-title":"Anxiety sensitivity, anxiety frequency and the prediction of fearfulness","volume":"24","author":"Reiss","year":"1986","journal-title":"Behav Res Ther"},{"key":"2023110102062895100_b2-0320449","volume-title":"The Clinician\u2019s Guide to Anxiety Sensitivity Treatment and Assessment","author":"Smits","year":"2018"},{"key":"2023110102062895100_b3-0320449","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.cpr.2016.07.003","article-title":"Anxiety sensitivity and working memory capacity: risk factors and targets for health behav-ior promotion","volume":"49","author":"Otto","year":"2016","journal-title":"Clin Psychol Rev"},{"issue":"4","key":"2023110102062895100_b4-0320449","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.jpsychores.2014.07.009","article-title":"Anxiety sensitivity and medication nonadherence in patients with uncontrolled hypertension","volume":"77","author":"Alcantara","year":"2014","journal-title":"J Psychosom Res"},{"issue":"6","key":"2023110102062895100_b5-0320449","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1037\/a0017428","article-title":"Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis","volume":"135","author":"Olatunji","year":"2009","journal-title":"Psychol Bull"},{"issue":"11","key":"2023110102062895100_b6-0320449","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1037\/ccp0000342","article-title":"Anxiety sensitivity and suicidal ideation\/suicide risk: a meta-analysis","volume":"86","author":"Stanley","year":"2018","journal-title":"J Consult Clin Psychol"},{"issue":"6","key":"2023110102062895100_b7-0320449","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1111\/ajad.12765","article-title":"Nonmedical benzodiazepine use in adults with alcohol use disorder: the role of anxiety sensitivity and polysubstance use","volume":"27","author":"McHugh","year":"2018","journal-title":"Am J Addict"},{"key":"2023110102062895100_b8-0320449","doi-asserted-by":"publisher","first-page":"106610","DOI":"10.1016\/j.addbeh.2020.106610","article-title":"Examining the moderating effect of anxiety sensitivity on past-month pain severity and heaviness of smoking among adult smokers experiencing homelessness","volume":"112","author":"Reuven","year":"2021","journal-title":"Addict Behav"},{"issue":"3","key":"2023110102062895100_b9-0320449","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1080\/16506073.2021.1998211","article-title":"Do anxiety sensitivity and impulsivity interact in predicting exercise involvement in emerging adult drinkers and cannabis users?","volume":"51","author":"Galbraith","year":"2022","journal-title":"Cogn Behav Ther"},{"issue":"3","key":"2023110102062895100_b10-0320449","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1007\/s10865-022-00325-2","article-title":"Exploring pain experience and anxiety sensitivity among Latinx adults in a federally qualified health center","volume":"45","author":"Zvolensky","year":"2022","journal-title":"J Behav Med"},{"issue":"1","key":"2023110102062895100_b11-0320449","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10608-018-9980-z","article-title":"Examining the role of anxiety sensitivity and intolerance of uncertainty in the relationship between health anxiety and likelihood of medical care utilization","volume":"43","author":"Horenstein","year":"2019","journal-title":"Cogn Ther Res"},{"key":"2023110102062895100_b12-0320449","doi-asserted-by":"crossref","DOI":"10.4324\/9781410603326","volume-title":"Anxiety Sensitivity: Theory, Research, and Treatment of the Fear of Anxiety","author":"Taylor","year":"2014"},{"issue":"1","key":"2023110102062895100_b13-0320449","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1037\/a0018055","article-title":"Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders","volume":"136","author":"Naragon-Gainey","year":"2010","journal-title":"Psychol Bull"},{"issue":"10","key":"2023110102062895100_b14-0320449","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1002\/da.22948","article-title":"Differences in anxiety sensitivity factors between anxiety and depressive disorders","volume":"36","author":"Baek","year":"2019","journal-title":"Depress Anxiety"},{"issue":"3","key":"2023110102062895100_b15-0320449","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.janxdis.2012.01.002","article-title":"Dimensions of anxiety sensitivity in the anxiety disorders: evaluation of the ASI-3","volume":"26","author":"Wheaton","year":"2012","journal-title":"J Anxiety Disord"},{"issue":"2","key":"2023110102062895100_b16-0320449","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1037\/1040-3590.19.2.176","article-title":"Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3","volume":"19","author":"Taylor","year":"2007","journal-title":"Psychol Assess"},{"issue":"4","key":"2023110102062895100_b17-0320449","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1080\/15622975.2022.2099970","article-title":"Systematic review of genome-wide association studies of anxiety disorders and neuroticism","volume":"24","author":"van der Walt","year":"2023","journal-title":"World J Biol Psychiatry"},{"issue":"2","key":"2023110102062895100_b18-0320449","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/jcpp.13725","article-title":"A multivariate genetic analysis of anxiety sensitivity, environmental sensitivity and reported life events in adolescents","volume":"64","author":"Peel","year":"2023","journal-title":"J Child Psychol Psychiatry"},{"issue":"6","key":"2023110102062895100_b19-0320449","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1007\/s10578-020-01078-2","article-title":"Exploring the link between transdiagnostic cognitive risk factors, anxiogenic parenting behaviors, and child anxiety","volume":"52","author":"Casline","year":"2021","journal-title":"Child Psychiatry Hum Dev"},{"issue":"11","key":"2023110102062895100_b20-0320449","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/s0005-7967(99)00138-2","article-title":"Prospective evaluation of the etiology of anxiety sensitivity: test of a scar model","volume":"38","author":"Schmidt","year":"2000","journal-title":"Behav Res Ther"},{"issue":"2","key":"2023110102062895100_b21-0320449","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1177\/0145445506296969","article-title":"Anxiety sensitivity and panic attacks: a 1-year longitudinal study","volume":"31","author":"Li","year":"2007","journal-title":"Behav Modif"},{"issue":"3","key":"2023110102062895100_b22-0320449","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1037\/a0016499","article-title":"Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents","volume":"118","author":"McLaughlin","year":"2009","journal-title":"J Abnorm Psychol"},{"issue":"12","key":"2023110102062895100_b23-0320449","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1177\/0885066620956564","article-title":"Provider-documented anxiety in the ICU: prevalence, risk factors, and associated patient outcomes","volume":"36","author":"May","year":"2021","journal-title":"J Intensive Care Med"},{"issue":"3\u20134","key":"2023110102062895100_b24-0320449","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1159\/000501617","article-title":"Systemic and local corticosteroid use is associated with reduced executive cognition, and mood and anxiety disorders","volume":"110","author":"Savas","year":"2020","journal-title":"Neuroendocrinology"},{"issue":"1","key":"2023110102062895100_b25-0320449","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s00134-017-5009-4","article-title":"Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study","volume":"44","author":"Bienvenu","year":"2018","journal-title":"Intensive Care Med"},{"key":"2023110102062895100_b26-0320449","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.genhosppsych.2016.08.005","article-title":"Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis","volume":"43","author":"Nikayin","year":"2016","journal-title":"Gen Hosp Psychiatry"},{"key":"2023110102062895100_b27-0320449","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.genhosppsych.2020.12.004","article-title":"Anxiety sensitivity and respiratory disease outcomes among individuals with chronic obstructive pulmonary disease","volume":"69","author":"Witcraft","year":"2021","journal-title":"Gen Hosp Psychiatry"},{"issue":"1","key":"2023110102062895100_b28-0320449","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1111\/nicc.12330","article-title":"Intensive care survivor-reported symptoms: a longitudinal study of survivors\u2019 symptoms","volume":"23","author":"Langerud","year":"2018","journal-title":"Nurs Crit Care"},{"issue":"4","key":"2023110102062895100_b29-0320449","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.chest.2022.10.001","article-title":"Multidisciplinary ICU recovery clinic visits: a qualitative analysis of patient-provider dialogues","volume":"163","author":"Boehm","year":"2023","journal-title":"Chest"},{"key":"2023110102062895100_b30-0320449","doi-asserted-by":"publisher","first-page":"103362","DOI":"10.1016\/j.iccn.2022.103362","article-title":"Examining the needs of survivors of critical illness through the lens of palliative care: a qualitative study of survivor experiences","volume":"75","author":"Eaton","year":"2023","journal-title":"Intensive Crit Care Nurs"},{"key":"2023110102062895100_b31-0320449","doi-asserted-by":"publisher","first-page":"104119","DOI":"10.1016\/j.brat.2022.104119","article-title":"Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: evidence from the Coordinated Anxiety Learning management trial","volume":"155","author":"Hunt","year":"2022","journal-title":"Behav Res Ther"},{"key":"2023110102062895100_b32-0320449","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jad.2020.01.160","article-title":"Anxiety sensitivity and emotion regulation as mechanisms of successful CBT outcome for anxiety-related disorders in a naturalistic treatment setting","volume":"267","author":"Asnaani","year":"2020","journal-title":"J Affect Disord"},{"issue":"11","key":"2023110102062895100_b33-0320449","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.brat.2013.09.001","article-title":"Mechanisms of change in cognitive behavioral therapy for panic disorder: the unique effects of self-efficacy and anxiety sensitivity","volume":"51","author":"Gallagher","year":"2013","journal-title":"Behav Res Ther"},{"issue":"9","key":"2023110102062895100_b34-0320449","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.brat.2008.06.010","article-title":"The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: a meta-analytic review","volume":"46","author":"Smits","year":"2008","journal-title":"Behav Res Ther"},{"key":"2023110102062895100_b35-0320449","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/B978-0-12-813495-5.00004-8","article-title":"Treating anxiety sensitivity in adults with anxiety and related disorders","volume-title":"The Clinician\u2019s Guide to Anxiety Sensitivity Treatment and Assessment","author":"Taylor","year":"2019"},{"issue":"6","key":"2023110102062895100_b36-0320449","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1037\/a0036651","article-title":"Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns","volume":"82","author":"Schmidt","year":"2014","journal-title":"J Consult Clin Psychol"},{"issue":"3","key":"2023110102062895100_b37-0320449","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10608-014-9666-0","article-title":"Development of an anxiety sensitivity (AS) intervention for high-AS individuals in substance use disorders treatment","volume":"39","author":"Worden","year":"2015","journal-title":"Cogn Ther Res"},{"issue":"3","key":"2023110102062895100_b38-0320449","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.beth.2013.03.006","article-title":"Anxiety sensitivity and interoceptive exposure: a transdiagnostic construct and change strategy","volume":"44","author":"Boswell","year":"2013","journal-title":"Behav Ther"},{"key":"2023110102062895100_b39-0320449","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/B978-0-12-813495-5.00008-5","article-title":"Targeting anxiety sensitivity as a prevention strategy","volume-title":"The Clinician\u2019s Guide to Anxiety Sensitivity Treatment and Assessment","author":"Schmidt","year":"2019"},{"issue":"2","key":"2023110102062895100_b40-0320449","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1080\/16506073.2019.1621929","article-title":"Trajectory of change in anxiety sensitivity in relation to anxiety, depression, and quality of life among persons living with HIV\/AIDS following transdiagnostic cognitive-behavioral therapy","volume":"49","author":"Paulus","year":"2020","journal-title":"Cogn Behav Ther"},{"issue":"7","key":"2023110102062895100_b41-0320449","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1037\/hea0000588","article-title":"Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria?","volume":"37","author":"Zvolensky","year":"2018","journal-title":"Health Psychol"},{"issue":"1","key":"2023110102062895100_b42-0320449","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1080\/16506073.2013.777466","article-title":"Prospective evaluation of the effect of an anxiety sensitivity intervention on suicidality among smokers","volume":"43","author":"Capron","year":"2014","journal-title":"Cogn Behav Ther"},{"issue":"pt B","key":"2023110102062895100_b43-0320449","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.cct.2015.09.006","article-title":"Examination of a brief anxiety sensitivity cognitive concerns intervention on suicidality among individuals with obsessive-compulsive symptoms","volume":"45","author":"Raines","year":"2015","journal-title":"Contemp Clin Trials"},{"issue":"1","key":"2023110102062895100_b44-0320449","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41533-021-00237-9","article-title":"Cutting through complexity: the Breathing, Thinking, Functioning clinical model is an educational tool that facilitates chronic breathlessness management","volume":"31","author":"Spathis","year":"2021","journal-title":"NPJ Prim Care Respir Med"},{"issue":"6","key":"2023110102062895100_b45-0320449","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1016\/j.jpainsymman.2019.12.359","article-title":"The effect of music on pain in the adult intensive care unit: a systematic review of randomized controlled trials","volume":"59","author":"Richard-Lalonde","year":"2020","journal-title":"J Pain Symptom Manage"},{"issue":"5","key":"2023110102062895100_b46-0320449","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1055\/s-0039-1698404","article-title":"Innovative ICU solutions to prevent and reduce delirium and post\u2013intensive care unit syndrome","volume":"40","author":"Luetz","year":"2019","journal-title":"Semin Respir Crit Care Med"},{"key":"2023110102062895100_b47-0320449","doi-asserted-by":"crossref","DOI":"10.56021\/9781421444000","volume-title":"The Johns Hopkins Guide to Psychological First Aid","author":"Everly","year":"2022"},{"issue":"5","key":"2023110102062895100_b48-0320449","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1097\/CCM.0000000000002282","article-title":"The untapped potential of patient and family engagement in the organization of critical care","volume":"45","author":"Haines","year":"2017","journal-title":"Crit Care Med"},{"issue":"3","key":"2023110102062895100_b49-0320449","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1164\/rccm.201710-2032CI","article-title":"Patient and family engagement in the ICU: untapped opportunities and underrecognized challenges","volume":"198","author":"Burns","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"2023110102062895100_b50-0320449","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1136\/thoraxjnl-2021-218428","article-title":"Evaluation of a health and social care programme to improve outcomes following critical illness: a multicentre study","volume":"78","author":"Henderson","year":"2023","journal-title":"Thorax"}],"container-title":["American Journal of Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article-pdf\/32\/6\/449\/152521\/449.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article-pdf\/32\/6\/449\/152521\/449.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T22:06:54Z","timestamp":1698790014000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ajcconline\/article\/32\/6\/449\/32215\/Understanding-and-Managing-Anxiety-Sensitivity"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":50,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ajcc2023975","relation":{},"ISSN":["1062-3264","1937-710X"],"issn-type":[{"value":"1062-3264","type":"print"},{"value":"1937-710X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}