Behaviour research and therapy
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Fear of anxiety symptoms, or anxiety sensitivity (AS), has been extensively studied in anxiety disorders and more recently has been linked to other psychopathological conditions including pain. Asmundson and colleagues have suggested that AS may act as a risk factor for chronic pain and several studies have demonstrated an association between AS, avoidance behaviors and pain. The present study assessed whether AS levels would be predictive of pain and anxiety during a brief pain induction task. ⋯ Diagnostic status and AS were significantly predictive of pain and anxiety during the cold pressor task. Moreover, AS appears to mediate the relationship between diagnostic status and pain. However, AS appears to be only indirectly associated with pain through its contribution to anxiety.
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In this reply to Bissett and Hayes (this issue) and Staats (this issue) we address critical comments in response to our initial proposal and highlight points of agreement. The overall thesis of our reply is that classification schemes based on nomothetic response covariation, such as DSM, complement, but do not substitute for, an idiographically-based functional analysis and behavioral assessment. In the context of our reply, we address the following primary concerns raised by Bissett, Hayes, and Staats: (a) we are essentially proposing the melding of two theoretically incongruent approaches, and that such a melding is inherently not viable or useful; (b) the behavior analytic approach cannot account for personality or psychological constructs; and (c) that categories based on topography do not have demonstrated treatment utility. We also discuss points of agreement with our respondents: (d) a theoretically-based descriptive classification system is required to ultimately advance clinical science, (e) the DSM personality disorder classification system, to remain viable, needs a stronger empirical base; and (f) that alternatives to DSM classification that more strongly emphasize behavioral principles are in need of development.