Anxiety Sensitivity and Pain Catastrophizing:
Distinct Factors in Predicting Pain
Susan T. Heinze, Jamie L. Elftman, W. Hobart Davies
University of Wisconsin-Milwaukee
PURPOSE/BACKGROUND
• Both anxiety sensitivity (AS) and pain catastrophizing (PC)
have been noted as predisposing factors for chronic pain.
• These constructs may increase fear and avoidance of pain,
which perpetuates pain sensitivity and decreased healthrelated quality of life (HRQOL; Stewart & Asmundson,
2006).
• While there is a wealth of research relating each of these
factors to chronic pain, there are few studies which include
both AS and PC.
• It is the goal of this study to demonstrate that although these
two constructs are related, they are distinct entities.
• Hypotheses: PC will predict pain intensity, frequency and
duration, while AS will be a broader risk factor and will be
less predictive of these pain variables compared to PC.
METHODS
• This data was collected as part of a larger online community
sample survey. Data were collected as part of an
undergraduate psychology course in which students recruited
young adults from the community
• Participant characteristics:
• N = 470; 55% female
• Young adults between 18 and 24 years old
(M age = 21.63, SD = 1.71 )
• Caucasian (81%); full-time college students (60%)
RESULTS
RESULTS (CONTINUED)
• The PCS and ASI total scores were significantly correlated (r = .48, p < .001).
All 6 of the subscales across both measures were also found to be significantly
and positively correlated with each other, with between measure subscale
correlation coefficients ranging from r = .25 to .47, all p < .001.
• The ASI total score was more strongly correlated with all 3 ASI subscales (r =
.81, .82, .86, all p < .001) than all 3 PCS subscales (r = .36, .46, .46, p < .001).
• The PCS total score was more strongly correlated with all 3 PCS subscales (r =
.89, .86, .91, p < .001) than all 3 ASI subscales (r = .37, .45, .38, p < .001).
• In order to assess whether the ASI and PCS are measuring two separate
constructs, a factor analysis including all 18 ASI items and all 13 PCS items was
conducted.
• Although the two measures were correlated on every subscale, the results of the
factor analysis demonstrated that ASI and PCS items loaded onto different
factors. The 31 items loaded onto six factors, four consisting of ASI items, and 2
with PCS items; there was no overlap of items between measures. See Table 1.
Table 1. Factor analysis of ASI and PCS
1
ASI 1
ASI 2
3
4
.569
.739
5
PCS 1
.495
PCS 2
.762
ASI 3
.664
PCS 3
.712
ASI 4
.514
PCS 4
.565
PCS 5
.571
ASI 5
.654
ASI 6
.750
6
PCS 6
.662
.774
PCS 7
.600
ASI 8
.729
PCS 8
.800
PCS 9
.826
PCS 10
.850
PCS 11
.802
PCS 12
.532
PCS 13
.514
.607
ASI 10 .701
ASI 11
.782
ASI 12
ASI 13
.617
.643
ASI 14 .760
ASI 15
•Pain frequency, intensity, and duration were significantly
correlated with total PCS and all 3 subscales. The ASI was less
predictive of the pain variables. See Table 2.
Table 2. Correlations between PC and AS and painrelated variables
HRQOL Pain
Usual
Usual
Worst
Worst
frequency intensity duration intensity duration
ASI Phys -.29**
.10
.08
.03
.11
.06
ASI Cog
-.35**
.07
.12*
.08
.12*
.09
ASI Soc
-.23**
.06
.03
.07
.15*
.10
ASI Total -.33**
.09
.08
.09
.14*
.14*
PCS Rum -.44**
.30**
.33**
.26**
.33**
.24**
PCS Mag -.46**
.33**
.30**
.23**
.26**
.16**
PCS Help -.53**
.35**
.32**
.25**
.29**
.17**
PCS Total -.53**
.37**
.37**
.30**
.35**
.21**
* p< .05; **p< .01
CONCLUSION
ASI 7
ASI 9
• Measures:
• Demographic information
• Pain information on pain frequency, severity and
duration,
• SF12: 12-item measure of health-related quality of life
• Anxiety Sensitivity Index (ASI): 18-item measure of AS
• Total score and three subscales: Physical, Cognitive,
and Social
• Pain Catastrophizing Scale (PCS): 13-item measure of
PC
•Total score and three subscales: Rumination,
Magnification, and Helplessness
2
•Further analyses were run to determine the relationship of both
AS and PC to pain-related variables. All ASI and PCS scores
were significantly related to HRQOL.
.682
•The results suggest that both AS and PC are important to
consider in the experience of pain. The correlations between the
two measures constructs suggest that AS and PC share common
variance regarding negative evaluations of physical sensations.
•The items of the two measures loaded separately in a factor
analysis, and have different predictive values. The ASI and the
PCS may measure different constructs that assess catastrophizing
over different somatic events (Drahovzal, Stewart & Sullivan,
2006).
•The ASI measures fears of somatic experiences, while the PCS is
specific to experiences of pain. This is supported by the finding
that PCS scores were more significantly correlated with pain
severity, frequency, and duration.
ASI 16 .800
ASI 17
.586
ASI 18 .785
For more information, please contact Susan Heinze, stheinze@uwm.edu
Presented at the 2010 APA Annual Convention
•Further research is required regarding the distinct roles of PC
and AS. Based on this study, it appears that PC is more closely
related to chronic pain than AS, however both may be worthy
targets of treatment.