Anxiety sensitivity is not anxiety itself — it is the fear of what anxiety feels like. People with high anxiety sensitivity interpret the physical sensations of anxiety — a racing heart, shallow breathing, dizziness — as signals of serious danger. This second layer of fear amplifies the original anxiety response and is one of the strongest predictors of panic disorder. Research by Reiss (1991), Taylor (1999), and Craske (2014) identifies anxiety sensitivity as a core maintaining factor across anxiety disorders.
Anxiety sensitivity is the belief that the sensations produced by anxiety are themselves harmful. Where most people experience a racing heart as unpleasant but tolerable, a person with high anxiety sensitivity interprets that same sensation as evidence of a heart attack, loss of control, or impending collapse.
This is distinct from interoceptive sensitivity — which refers to how accurately you perceive body signals — and from hypervigilance, which refers to scanning for threat. Anxiety sensitivity is specifically about the meaning assigned to those sensations.
The Anxiety Sensitivity Index (ASI), developed by Reiss and Peterson, measures three dimensions:
Anxiety sensitivity is partly temperamental — some people are born with a more reactive nervous system — but it is strongly shaped by experience. It tends to develop through:
Anxiety sensitivity creates a self-sustaining loop that sits on top of the standard anxiety cycle:
This is why panic attacks can feel so overwhelming and so sudden. The original trigger may be minor; it is the fear of the sensations that drives the escalation.
High anxiety sensitivity is found across a range of anxiety presentations, but its role varies:
Anxiety sensitivity is the primary driver of panic disorder. The feared sensations — dizziness, racing heart, breathlessness — are misread as catastrophic, producing the full panic response. Research by Clark and Barlow shows that reducing anxiety sensitivity through interoceptive exposure is the most effective treatment for panic.
In GAD, cognitive concerns dominate — particularly the fear that anxiety will impair thinking, decision-making, or lead to mental breakdown. This fuels chronic worry as a way of mentally preparing for catastrophe.
Social concerns drive anxiety sensitivity in social contexts — specifically, the fear that visible symptoms (blushing, trembling, sweating) will be noticed and negatively judged. This reinforces avoidance of social situations and safety behaviours.
Physical concerns dominate here. Normal bodily fluctuations are interpreted as signs of serious illness. This produces compulsive monitoring, repeated medical checking, and significant distress even in the absence of any physical pathology.
"My heart is racing — something must be wrong." A racing heart is a normal anxiety response. It cannot cause a heart attack in a healthy person. The sensation is uncomfortable, not dangerous.
"If I feel dizzy, I might faint." Anxiety-induced dizziness is caused by hyperventilation and changes in blood pressure. Fainting from anxiety is extremely rare — in fact, anxiety raises blood pressure, making fainting less likely.
"I need to avoid anything that triggers these sensations." Avoidance maintains and strengthens anxiety sensitivity. Gradual, safe exposure to the sensations is the most effective way to reduce fear of them.
"These sensations mean I am losing control." The feeling of losing control is itself an anxiety sensation. No one has ever "lost control" due to anxiety — the sensation of impending loss of control is the fear, not the reality.
CBH addresses anxiety sensitivity through a combination of top-down cognitive work and bottom-up somatic retraining, supported by research from Craske, Clark, Barlow, and Alladin.
Based on inhibitory learning research by Michelle Craske, interoceptive exposure involves deliberately inducing the feared sensations in a safe clinical context — spinning in a chair to produce dizziness, breathing through a straw to produce breathlessness — and remaining present with those sensations without avoidance. This teaches the brain that the sensations are tolerable and not predictive of catastrophe.
The catastrophic beliefs attached to sensations — "racing heart means heart attack," "dizziness means I will faint" — are identified and tested against evidence. Research by Clark shows that directly challenging these misappraisals produces rapid and lasting reductions in panic frequency.
In hypnosis, the emotional charge attached to physical sensations can be reduced directly. Metaphors such as turning down a volume dial on internal signals, or observing sensations as weather passing through rather than emergencies requiring action, help the nervous system develop a more neutral relationship with its own signals.
Many anxiety sensitivity responses are maintained by chronic hyperventilation, which produces lightheadedness, tingling, and breathlessness — the very sensations that are misread as dangerous. Diaphragmatic breathing retraining, reinforced in hypnosis, corrects the physiological driver of many feared sensations.