Anxiety sensitivity mediates gender differences in post-concussive symptoms in a clinical sample

Abstract

Traumatic brain injury (TBI) is both prevalent and potentially disabling. Extant literature has demonstrated women to report greater post-concussive symptoms (PCS) compared to men, highlighting the necessity of investigations into malleable, gender-linked risk factors for PCS that hold promise for reducing this gender disparity. Anxiety Sensitivity (AS) and Distress Tolerance (DT) are gender-linked risk factors that may be related to PCS. Despite a breadth of research supporting elevated AS and reduced DT in women, no study to date has investigated whether AS and DT mediate gender differences in PCS. The current sample was composed of 59 participants selected from a larger study based on their report of a past TBI. Findings indicated that AS, but not DT, significantly mediated gender differences in PCS. The present results suggest that AS is a cognitive risk factor that can partially account for the gender disparity in the expression of PCS. AS may influence an individual’s interpretation of PCS as dangerous, thereby amplifying the perception of PCS severity. This suggests that efforts to reduce the burden of TBI may benefit from targeting AS in prevention and treatment paradigms, especially among women.

Interactive Effects of Traumatic Brain Injury and Anxiety Sensitivity on PTSD Symptoms: A Replication and Extension in Two Clinical Samples

“…TBI is believed to influence PTSS via disruptions in cognitive control (i.e., cognitive dyscontrol) and exaggerated emotional reactivity (Aupperle, Melrose, Stein, & Paulus, 2012 ; Bryant et al, 2010 ; Glenn et al, 2017). As described above, AS increases both PTSS-related (Asmundson & Stapleton, 2008 ; Boffa et al, 2016 ; Taylor, 2003 ; Vujanovic, Zvolensky, & Bernstein, 2008) and TBI-related (Albanese, Boffa, Macatee, & Schmidt, 2017) symptoms of cognitive dyscontrol and arousal via the misinterpretation of these sensations as harmful. Therefore, the effects of TBI on PTSS may be potentiated among those with high AS cognitive and AS physical concerns due to the amplification of TBI-related symptoms of cognitive dyscontrol and anxious arousal, respectively.…”

“…Therefore, the effects of TBI on PTSS may be potentiated among those with high AS cognitive and AS physical concerns due to the amplification of TBI-related symptoms of cognitive dyscontrol and anxious arousal, respectively. Indeed, Albanese et al (2017) found evidence that TBI was more strongly related to PTSS among those with elevated AS cognitive concerns. However, this study was unable to test if AS total score, physical concerns, or social concerns demonstrated similar interactive effects.…”

“…One study has also directly tested this hypothesis. Among a sample of active duty soldiers, Albanese et al, (2017) demonstrated that TBI amplified the relations between AS cognitive concerns and PTSS. Yet, as mentioned above, this study was unable to test the interactive effects of TBI and AS total, AS physical concerns, and AS social concerns, representing a considerable limitation.…”

Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society

“…Women have been reported elevated AS both in nonclinical [ 59 ] and clinical samples [ 95 ]. It is confirmed that patients with higher AS tends to exaggerate PCS symptoms by amplifying its severity [ 96 ].…”

Interactive Effects of Traumatic Brain Injury and Anxiety Sensitivity Cognitive Concerns on Post-traumatic Stress Among Active Duty Soldiers

“…As described above, ASCC increases PTS through the amplification of cognitive-dyscontrol symptoms of anxiety through the misinterpretation of these sensations as harmful (Asmundson & Stapleton, 2008; Boffa et al, 2016; Taylor, 2003; Vujanovic et al, 2008). Importantly, TBI is associated with similar symptoms of cognitive dyscontrol (Ryan & Warden, 2003) which may be amplified by AS (Albanese, Boffa, Macatee, & Schmidt, 2017) and are theorized to be a mechanism explaining the link between TBI and PTS (Aupperle, Melrose, Stein, & Paulus, 2012). Thus, high ASCC may increase the effect of TBI on PTS through the misinterpretation of cognitive dyscontrol symptoms as harmful, thereby amplifying emotional reactions to a trauma reminder.…”