Anxiety Sensitivity or Fear of Anxiety Symptoms

Anxiety is a normal part of life, but for some us, it feels much worse because they fear the sensations that come with it. This fear is called Anxiety Sensitivity (AS) or simply put “Fear of Anxiety Symptoms.” People with high AS worry that the physical signs of anxiety—like a fast heartbeat, dizziness, or shaky hands—mean something bad is happening. For example, we might think a racing heart means we’re having a heart attack, or that trembling hands will make others judge us. These thoughts can make normal feelings of anxiety feel much scarier and harder to handle.

Anxiety Sensitivity is important because it makes us more likely to develop mental health issues like panic attacks, generalized anxiety, PTSD, and even depression. Unlike regular anxiety, which is usually a reaction to stress or fear of something outside of us, AS is about being afraid of what’s happening inside the body. This makes it a key factor in keeping anxiety disorders going or making them worse. It is also important to deal with AS in therapy as part of uncover anxiety roots to prevent relapse and address the core fears driving anxiety disorders.

The good news is that Anxiety Sensitivity can be treated. It’s not something we are stuck with forever. Therapies that target AS can help us feel less afraid of their symptoms and stop the cycle of fear. This article will explain what AS is, why it matters, how to spot it, and what can be done to reduce it. Understanding and treating AS is an important step toward helping people feel better and take back control of their lives.

Anxiety Sensitivity (AS) is the fear of the physical, mental, and social sensations that come with anxiety. While some of us see these sensations—like a fast heartbeat, dizziness, or sweating—as harmless or temporary, someone with high AS believes these feelings are dangerous or will lead to terrible outcomes. This fear can make normal bodily sensations feel overwhelming and even terrifying.

Anxiety Sensitivity is not the same as regular anxiety. It’s a specific fear of the symptoms of anxiety and what they might mean. For example:

• Physical fears: “If my heart races, I might have a heart attack.”
• Mental fears: “If my thoughts race, I could lose control of my mind.”
• Social fears: “If people see me shaking, they will think I’m weak or judge me.”

People with high AS don’t just feel anxious—they fear the sensations of anxiety itself, which can make their anxiety spiral out of control.

Anxiety Sensitivity acts like an amplifier, making small sensations feel much bigger and scarier. For example:

• A racing heart might just mean you’re excited or exercising, but someone with high AS might interpret it as a sign of a heart problem.
•   Feeling dizzy might just be from standing up too fast, but with AS, it could feel like you’re losing control or fainting.

This fear of sensations can create a vicious cycle:

        1.      The body reacts to stress with physical sensations (like a fast heartbeat).

        2.      The person interprets these sensations as dangerous.

        3.      This interpretation causes more fear, which makes the sensations stronger.

        4.      The stronger sensations confirm their fear, and the cycle repeats.

While general anxiety is often about external threats (like worrying about work, money, or relationships), Anxiety Sensitivity is about internal threats—fearing what’s happening inside your body. Someone with high AS might not be more anxious overall, but their reactions to anxiety symptoms can be much more intense.

For example:

• General anxiety: “I’m worried about giving a speech.”
• Anxiety Sensitivity: “What if my shaking hands or racing heart during the speech mean something is wrong with me?”

Anxiety Sensitivity can come from a mix of genetics, experiences, and learned behaviors:

• Genetics: Some of us are naturally more sensitive to bodily sensations.
• Life experiences: If someone has a traumatic experience or grows up in an environment where bodily symptoms (like illness) are seen as dangerous, they may develop AS.
• Learned behaviors: People who are taught to fear bodily sensations—for example, being told as a child that a fast heartbeat is a sign of sickness—may develop higher AS.

The good news is that Anxiety Sensitivity is not permanent. It’s a common issue that can be treated with the right tools and techniques. By understanding how it works, people can start breaking the cycle of fear and regain control over their lives.

Anxiety Sensitivity (AS) is more than just a fear of bodily sensations—it is a key factor in the development and worsening of several psychological disorders. By amplifying fear and distress, AS acts as a predisposing factor for mental health issues, interacts with stress to heighten vulnerability, and even affects physical health and behaviors like substance use.

Anxiety Sensitivity has been shown to increase the risk of developing several anxiety-related disorders. It acts as a “vulnerability factor,” meaning that people with high AS are more likely to experience these conditions, especially when they encounter stressors.

• Panic Disorder: AS is strongly linked to panic attacks because it amplifies the fear of physical sensations like a racing heart or dizziness. These fears can trigger or worsen panic attacks, creating a cycle of avoidance and heightened sensitivity.
• Generalized Anxiety Disorder (GAD): In GAD, AS often contributes to excessive worry by increasing the fear of sensations associated with stress and anxiety.
• Post-Traumatic Stress Disorder (PTSD): AS can heighten reactivity to trauma-related triggers by intensifying the fear of bodily sensations associated with trauma memories, such as a pounding heart or hypervigilance.
• Obsessive-Compulsive Disorder (OCD): AS can make individuals with OCD more distressed by their intrusive thoughts, as they may misinterpret these thoughts as evidence of losing control or danger.

The relationship between Anxiety Sensitivity and stress is critical in understanding its role in mental health. People with high AS are more likely to experience severe psychological symptoms when exposed to stressful life events.

• Stress as a Trigger: Stressful experiences can activate AS by increasing the frequency or intensity of anxiety-related sensations. For example, during a high-stress event, a person with high AS may experience a racing heart and immediately catastrophize it, believing it signals a heart attack or impending breakdown.
• Stress-AS Feedback Loop: Once triggered, AS can intensify the stress response, creating a feedback loop where stress heightens AS, and AS further worsens the stress reaction. Over time, this cycle increases the likelihood of developing anxiety-related disorders.

Anxiety Sensitivity doesn’t just affect mental health—it can also have far-reaching consequences on physical health and behavior, influencing how individuals approach their day-to-day lives.

• Physical Health Concerns: AS often leads to avoidance of physical activities that produce bodily sensations similar to those of anxiety. For instance:

1. This avoidance can lead to reduced physical fitness, weight gain, or even the worsening of chronic health conditions like heart disease or diabetes.
2. A person might avoid exercising because the elevated heart rate or sweating reminds them of a panic attack.

• Substance Use and Smoking: People with high AS may turn to substances like alcohol, cigarettes, or drugs to cope with their heightened fear of anxiety sensations. However, this coping mechanism can backfire:
  • Smoking and AS: Smoking can temporarily reduce anxiety for some people, but the physiological effects (like increased heart rate) can also mimic anxiety symptoms, feeding into the fear of those sensations and making it harder to quit.
  •  Alcohol and Drugs: Substances may initially suppress anxiety, but over time, dependence can worsen anxiety sensitivity, making recovery more difficult.•         

By amplifying both emotional and physical reactions to stress, AS contributes to a range of challenges that go beyond anxiety disorders, making it a crucial factor to address in both therapy and health interventions.

Assessing Anxiety Sensitivity (AS) is a crucial step in understanding how much a person fears anxiety-related sensations and identifying the specific areas where these fears are most pronounced. Accurate assessment not only helps guide treatment but also gives clients insight into how their beliefs and behaviors are maintaining their anxiety. Two primary approaches are used: self-report measures and clinical interviews, with interoceptive exposure exercises serving as a tool for deeper exploration.

Self-Report Measures

• Anxiety Sensitivity Index (ASI): The original ASI measures a person’s tendency to catastrophically misinterpret bodily sensations. However, this version is unidimensional, meaning it focuses on general AS rather than its specific components.
• Anxiety Sensitivity Index-3 (ASI-3): The ASI-3 improves upon the original by dividing AS into three subscales:
  • Physical concerns: Fear of bodily sensations, such as believing a racing heart signals a heart attack.
  • Cognitive concerns: Fear of losing control of one’s thoughts or mind, such as worrying about going “crazy.”
  • Social concerns: Fear of visible symptoms of anxiety, like sweating or shaking, leading to embarrassment or rejection.

The ASI-3 is widely regarded as the gold standard for measuring AS and is valuable for tailoring interventions based on the client’s specific concerns.

Interoceptive exposure is a powerful assessment tool that involves deliberately triggering anxiety-related sensations to observe the client’s response in a controlled setting. These exercises serve as both diagnostic tools and treatment interventions.

Examples of Interoceptive Exposure Exercises

• Hyperventilation: Breathing rapidly for 30–60 seconds to simulate feelings of dizziness or lightheadedness.
• Spinning in a chair: Induces sensations of disorientation and nausea.
• Head shaking: Shaking the head from side to side for 30 seconds to create dizziness.
• Breath holding: Holding one’s breath for as long as possible to mimic shortness of breath or chest tightness.

These exercises help identify whether a person catastrophically misinterprets the induced sensations. For example, a client might feel lightheaded after hyperventilating and interpret it as a sign of fainting or losing control.

Contraindications for Interoceptive Exercises

While interoceptive exercises are safe for most people, there are situations where they should be avoided or modified:

• Pregnancy: To prevent unnecessary discomfort or risk to the mother or baby.
• Chronic obstructive pulmonary disease (COPD) or asthma: Breathing exercises could trigger shortness of breath or a respiratory attack.
• History of seizures: Exercises like hyperventilation could increase seizure risk.
• Severe pain conditions: Activities like spinning or head shaking may worsen pain symptoms.

When contraindications exist, alternative strategies such as cognitive exploration or less intense exposure techniques can be used.

By combining self-report tools, clinical interviews, and interoceptive exercises, therapists can gain a comprehensive understanding of a client’s Anxiety Sensitivity and develop tailored interventions to address it. These tools help move beyond surface-level anxiety to target the underlying beliefs and fears that sustain it.