Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization

ABSTRACT

Background and Objectives

Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization.

Design

We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention.

Methods

Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires.

Results

As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship.

Conclusions

These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.

KEYWORDS:

• Anxiety
• depersonalization
• derealization
• anxiety sensitivity
• distress tolerance
• interpretation bias

Acknowledgements

We would like to thank the Program for Anxiety, Cognition, and Treatment at the University of Virginia for their support and feedback throughout the study and Gus Sjobeck for his help with statistical analyses. Preregistration for the study can be found at https://doi.org/10.17605/OSF.IO/XGAZD. The data that support the findings of this study and analysis scripts are openly available on the Open Science Framework (OSF) at https://doi.org/10.17605/OSF.IO/J486G.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 We know of no evidence that distinguishes between individuals with predominant depersonalization versus derealization (American Psychiatric Association, 2013), and many authors do not regard the two as separate constructs (Radovic & Radovic, 2002). Therefore, for brevity, we use depersonalization to describe the range of low-intensity dissociative experiences that encompass feelings of unreality with respect to oneself and/or one’s external world.

2 For example, greater anxiety sensitivity and lesser distress tolerance confer higher risk for anxiety (Allan et al., 2014; Keough et al., 2010; McNally, 2002; Michel et al., 2016). Negative interpretation bias is associated with more severe symptoms in social anxiety (Chen et al., 2020), panic disorder (Teachman et al., 2007), and generalized anxiety disorder (Hayes et al., 2010). Depersonalization has been linked to higher anxiety sensitivity and interpretation bias (Schweden et al., 2018; Weiner & McKay, 2013).

3 Internal consistency was calculated based on McDonald’s omega total, as recommended by methodologists (Dunn et al., 2014). Calculations were done using the MBESS package (ver. 4.7.0; Kelley, 2007) in R (ver. 3.5.2).

4 This decision, based on Wang and Maxwell (2015), deviates from the preregistration and reflects the authors’ more advanced statistical training since publishing the preregistration.

5 Adding only a random intercept (no random slope for time) for each participant also deviates from the preregistration and was done across all mixed-effects models to eliminate convergence and singularity warnings.

6 Had we used the natural logarithm of trait anxiety scores (instead of untransformed trait anxiety scores) for this model, assumptions of linearity and dependent variable continuousness would have been violated, though the predicted effect of trait anxiety on trait depersonalization would have still held, β = 0.59, SE = 0.05, t(300) = 12.7, p < .001, 95% CI [0.50, 0.68].

7 We inverse-transformed scores on the anxiety sensations subscale of the ADSIQ prior to standardizing to meet model assumptions. Therefore, the negative β suggests that greater negative interpretation bias for anxiety sensations strengthens the trait anxiety-trait depersonalization relationship.

8 The above is also true for scores on the depersonalization sensations subscale of the ADSIQ, meaning the negative β suggests that greater negative interpretation bias for depersonalization sensations also strengthens the trait anxiety-trait depersonalization relationship.

Additional information

Funding

This research was supported by a grant awarded to the first author from the University of Virginia's Harrison Undergraduate Research Awards program and a NIMH R01MH113752 grant awarded to the third author.