Anxiety Sensitivity: Fear of Fear

There's been a great deal of research on the subject of anxiety sensitivity over recent years. We take a look at this research as well as the disorder itself.
Anxiety Sensitivity: Fear of Fear

Last update: 17 June, 2022

People with high sensitivity to anxiety (AS) have a tendency to overinterpret typical manifestations of anxiety as a sign of danger. This type of sensitivity is considered to be a psychological risk factor. In fact, clinical and epidemiological studies of anxiety disorders have been conducted on the subject.

Research indicates that high levels of anxiety sensitivity predict the onset of anxiety symptoms and panic attacks (McLaughlin & Hatzenbuehler, 2009; Calkins et al., 2009). They also predict the emergence of anxiety and depressive disorders. In addition, an investigation found that they were a predictor of the persistence of anxiety disorders.


Anxiety is a complex system of cognitive, physiological, behavioral, and emotional responses associated with anticipatory preparation for a circumstance perceived as threatening. This reaction is linked to fear and manifests as a future-oriented state of mind.

Anxiety is normal. However, when it’s triggered as a result of an overestimation of perceived threat or a misappraisal of danger, it becomes pathological. Its main symptoms are the following:

  • Agitation.
  • Strain.
  • Tiredness.
  • Dizziness.
  • Frequent urination.
  • Heart palpitations.
  • Feelings of being about to faint.
  • Difficulty breathing.
  • Sweating.
  • Tremors.
  • Concern and apprehension.
  • Insomnia.
  • Difficulty in focusing.
  • Hypervigilance.
Woman with anxiety due to polycystic ovary syndrome
Anxiety is related to worry about the future.

The characteristic features of clinical anxiety are as follows:

  • False alarms. The sufferer experiences intense fear even though there are no threatening signals.
  • Persistence. Anticipation of a threat causes the sufferer to experience a higher level of apprehension and thoughts about a threat. This is regardless of whether or not it materializes.
  • Impaired functioning. It interferes with the sufferer’s effective and adaptive coping with a perceived threat. Furthermore, it affects their social life.
  • Stimulus hypersensitivity. They experience fear due to a broader range of stimuli or situations of relatively mild intensity.
  • Dysfunctional cognition and cognitive symptoms. Their thinking is characterized by an overestimation of threat or appraisal of danger.

Now that we have an idea of what anxiety is and what its characteristics are at a clinical level, we’ll move on to the main topic of this article: what anxiety sensitivity is and how it works.

Anxiety sensitivity

Anxiety sensitivity is understood as the fear of anxiety symptoms. It’s activated by irrational beliefs about the damaging potential, both psychological and physical, of these symptoms.

For example, say someone is afraid of spiders and also has a high sensitivity to anxiety. In this case, their real fear isn’t spiders, but the symptoms of anxiety that they cause.

In fact, their fear of spiders triggers a series of symptoms and signs that are intolerable for them, since they consider them to be harmful. This leads them to avoid all contact with spiders. It’s not because they represent an imminent danger to them, but because they generate physiological, cognitive, affective, and behavioral activity that they perceive as threatening.

We should be careful not to confuse anxiety sensitivity with trait anxiety. After all, many people experience anxiety without being afraid of the symptoms. However, when someone has a high sensitivity to anxiety, they experience fear of the anxiety symptoms themselves, and they have a tendency to exhibit exaggerated and prolonged reactions to them.

Anxiety sensitivity often involves and greatly augments the physiological symptoms of anxiety. For example, tachycardia, palpitations, light-headedness, labored or shortness of breath, dyspnea, tremor, etc.

Thus, there’s a vicious circle, in which anxiety generates more anxiety as the sufferer perceives its symptoms as a danger. This perception of an unfounded threat causes them even more anxiety. In effect, they’re trapped.

In the clinical setting, anxiety sensitivity assessment can be used to:

  • Recognize individuals at risk for increased response to affect and arousal-based sensations during the course of treatment.
  • Identify those who may benefit from interoceptive exposure or other anxiety sensitivity reduction techniques.
  • Evaluate the progress in treatment and report any need to modify it.

How does anxiety sensitivity work?

To understand the causes of psychological and emotional problems, different models and constructs have been proposed.

Among them is the proposal of sensitivity to anxiety developed by Steven Reiss. Reiss claimed that all fear is motivated by expectations and sensitivities, which explains its increase and persistence. Expectations are established from estimates that something will happen. While sensitivities help to understand why the fear occurs.

Anxiety sensitivity makes the sufferer perceive that they possess somatic, psychological, and social consequences that can be dangerous.

Once the symptoms occur, the sufferer begins to focus their attention on them and their effects. This intensifies their severity, thus increasing the individual’s feelings of discomfort and fear.

Anxious man looking out the window
Expectations coupled with hypervigilance increase fear and anxiety.

Psychotherapeutic treatment

High sensitivity to anxiety is reduced through a wide variety of interventions, including:

  • Emotional acceptance. It teaches the individual to observe their own emotions from acceptance and curiosity, instead of fighting against them. Emotional acceptance has been found to be effective in reducing fear of fear.
  • Psychoeducation. It provides information to the patient about anxiety, how it’s activated, and the organic, cognitive, and behavioral activations it generates.
  • Cognitive restructuring. It changes the distorted beliefs that the sufferer has about the symptoms of anxiety to more adaptive ones.
  • Interoceptive exposure. The sufferer is exposed to their own bodily sensations and they learn how to manage the symptoms rather than fear them, avoid them, or seek escape from them.
  • Live Exposure. The patient is instructed to confront their fear by approaching the feared scenario. This allows their nervous system to habituate to the situation. Furthermore, their newly learned coping responses are able to override the influence of maladaptive fear responses. This process also facilitates their acquisition of skills so they can manage the symptoms of their anxiety and feel more confident.

Finally, sensitivity to anxiety, like fear of fear, is a reaction that makes it more difficult to live and face anxiety. If the sufferer, in addition to experiencing a specific phobia, fears the symptoms they have, the affectation and the seriousness of the problem will be greater.

Therefore, people with high levels of sensitivity to anxiety should seek the relevant help to allow them to regulate their emotional and cognitive activation.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Calkins, A. W., Otto, M. W., Cohen, L. S., Soares, C. N., Vitonis, A. F., Hearon, B. A., & Harlow, B. L. (2009). Psychosocial predictors of the onset of anxiety disorders in women: results from a prospective 3-year longitudinal study. Journal of anxiety disorders23(8), 1165-1169.
  • Chand, S. y Marwaha, R. (2022). Ankiety. StatPearls.
  • Eifert, G. H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry34(3-4), 293-312.
  • Leyro, T.M., Zvolensky, M.J., Vujanovic, A.A. y Bernstein, A. (2008). Anxiety sensitivity and smoking motives and outcome expectancies among adult daily smokers: Replication and extension. Nicotine & Tabacco Research, 10, 985-994.
  • McHugh, R. K. (2019). Assessing anxiety sensitivity. The Clinician’s Guide to Anxiety Sensitivity Treatment and Assessment, 9–29. doi:10.1016/b978-0-12-813495-5.00002-4
  • McLaughlin, K. A., & Hatzenbuehler, M. L. (2009). Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents. Journal of abnormal psychology118(3), 659.
  • Piña, E. V., & Mandujano, J. L. (2013). Asociación entre la sensibilidad a la ansiedad y el consumo de tabaco. Enseñanza e investigación en psicología18(2), 343-358.
  • Reiss, S., Peterson, R., Gursky, D. y McNally, R.J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behavioral Research and Thererapy, 24(1), 1-8.
  • Sandín, B., Valiente, R.M., Chorot, P. y Santed, M.A. (2005). Propiedades psicométricas del Índice de Sensibilidad a la Ansiedad. Psicothema, 17(3), 478-483
  • Sarason, I. G. y Sarason, B. R. (2006). Psicopatología: psicología anormal: el problema de la conducta inadaptada (10ª ed.). Pearson educación.
  • Sphancer, N. (2020, 25 de febrero). Anxiety Sensitivity: When What We Fear Is Fear Itself. Psychology Today.
  • Spinhoven, P., van Hemert, A. M., & Penninx, B. W. (2017). Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: One or many?. Cognitive Therapy and Research41(6), 867-880.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.