The Role of Anxiety Sensitivity and Emotion Regulation Difficulties in the Relationship Between Sensory Processing Sensitivity and Anxiety
DOI:
https://doi.org/10.5708/EJMH.21.2026.0052Keywords:
anxiety sensitivity, emotion regulation, sensory processing sensitivity, trait anxiety, serial mediationAbstract
Introduction: Sensory-processing sensitivity (SPS) describes how deeply and intensely individuals process various environmental stimuli. SPS, as an adult temperament trait, may influence different aspects of an individual’s life.
Aim: This study explored potential mediating roles of anxiety sensitivity (AS) and emotion regulation difficulties (ERD) in the relationship between SPS and trait anxiety (TA).
Methods: Participants (N = 420; 60.5% female; age range: 18–61 years) were administered the Highly Sensitive Person Scale, Trait Anxiety Inventory, Anxiety Sensitivity Index-3, and Difficulties in Emotion Regulation Scale.
Results: Results of the stepwise nested regression models indicated that SPS, AS, and ERD significantly predicted trait anxiety, with the final model explaining 54% of the variance. SPS was a significant predictor initially, but its effect became nonsignificant after AS and ERD were included, indicating a full mediation pattern. Serial multiple mediation analysis indicated that the association between SPS and trait anxiety was fully mediated by AS and ERD, with AS demonstrating a significant independent indirect effect, whereas the indirect effect of ERD alone was not statistically significant. The sequential pathway from SPS to AS to ERD to trait anxiety was statistically supported, and gender remained a significant covariate throughout.
Conclusions: The findings indicate that the association between SPS and trait anxiety is fully accounted for by AS and ERD rather than by a direct relationship. These results underscore the importance of considering sequential psychological mechanisms and covariate-adjusted models when examining vulnerability to trait anxiety.
References
Acevedo, B. P., Aron, E. N., Aron, A., Sangster, M.-D., Collins, N., & Brown, L. L. (2014). The highly sensitive brain: An fMRI study of sensory processing sensitivity and response to others' emotions. Brain and Behavior, 4(4), 580–594.
https://doi.org/10.1002/brb3.242
Ahadi, B., & Basharpoor, S. (2010). Relationship between sensory processing sensitivity, personality dimensions and mental health. Journal of Applied Sciences, 10(7), 570–574.
https://doi.org/10.3923/jas.2010.570.574
Amstadter, A. (2008). Emotion regulation and anxiety disorders. Journal of Anxiety Disorders, 22(2), 211–221.
https://doi.org/10.1016/j.janxdis.2007.02.004
Aron, E., & Aron, A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73(2), 345–368.
https://doi.org/10.1037/0022-3514.73.2.345
Ayvaşık, H. B. (2000). Kaygı duyarlığı indeksi: Geçerlik ve güvenirlik çalışması [Anxiety sensitivity index: A validity and reliability study]. Türk Psikoloji Dergisi, 15(46), 43–57.
Baker, R., Holloway, J., Thomas, P. W., Thomas, S., & Owens, M. (2004). Emotional processing and panic. Behaviour Research and Therapy, 42(11), 1271–1287.
https://doi.org/10.1016/j.brat.2003.09.002
Bakker, K., & Moulding, R. (2012). Sensory-processing sensitivity, dispositional mindfulness and negative psychological symptoms. Personality and Individual Differences, 53(3), 341–346.
https://doi.org/10.1016/j.paid.2012.04.006
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.
https://doi.org/10.1037/0022-3514.51.6.1173
Brindle, K., Moulding, R., Bakker, K., & Nedeljkovic, M. (2015). Is the relationship between sensory‐processing sensitivity and negative affect mediated by emotional regulation? Australian Journal of Psychology, 67(4), 214–221.
https://doi.org/10.1111/ajpy.12084
Campbell-Sills, L., Ellard, K. K., & Barlow, D. H. (2014). Emotion regulation in anxiety disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (2nd ed., pp. 393–412). The Guilford Press.
Cisler, J. M., & Olatunji, B. O. (2012). Emotion regulation and anxiety disorders. Current Psychiatry Reports, 14, 182–187.
https://doi.org/10.1007/s11920-012-0262-2
Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathology and Behavioral Assessment, 32, 68–82.
https://doi.org/10.1007/s10862-009-9161-1
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558–577.
https://doi.org/10.1037/0021-843x.112.4.558
Eşkisu, M., Ağırkan, M., Çelik, O., Yalçın, R. Ü., & Haspolat, N. K. (2022). Do the highly sensitive people tend to have psychological problems because of low emotion regulation and dysfunctional attitudes? Journal of Rational-Emotive & Cognitive-Behavior Therapy, 40, 683–706.
https://doi.org/10.1007/s10942-021-00436-w
García-Fernández, M., Fuentes-Sánchez, N., Escrig, M. A., Eerola, T., & Pastor, M. C. (2025). Gender, emotion regulation, and cognitive flexibility as predictors of depression, anxiety, and affect in healthy adults. Current Psychology, 44, 5685–5694.
https://doi.org/10.1007/s12144-024-07240-6
Gratz, K. L., & Roemer L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathological Behavior Assessment, 26, 41– 54.
https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J. (2014). Emotion regulation: Conceptual and empirical foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (2nd ed., pp. 3–20). The Guilford Press.
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications.
Hofmann, S. G., & Bitran, S. (2007). Sensory-processing sensitivity in social anxiety disorder: Relationship to harm avoidance and diagnostic subtypes. Journal of Anxiety Disorders, 21(7), 944–954.
https://doi.org/10.1016/j.janxdis.2006.12.003
Hünermund, P., Louw, B., & Rönkkö, M. (2025). The choice of control variables in empirical management research: How causal diagrams can inform the decision. The Leadership Quarterly, 36(2), Article 101845.
https://doi.org/10.1016/j.leaqua.2024.101845
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
https://doi.org/10.1001/archpsyc.62.6.593
Liss, M., Mailloux, J., & Erchull, M. J. (2008). The relationships between sensory processing sensitivity, alexithymia, autism, depression, and anxiety. Personality and Individual Differences, 45(3), 255–259.
https://doi.org/10.1016/j.paid.2008.04.009
Liss, M., Timmel, L., Baxley, K., & Killingsworth, P. (2005). Sensory processing sensitivity and its relation to parental bonding, anxiety, and depression. Personality and Individual Differences, 39(8), 1429–1439.
https://doi.org/10.1016/j.paid.2005.05.007
Lionetti, F., & Pluess, M. (2024). The role of environmental sensitivity in the experience and processing of emotions: Implications for well-being. Philosophical Transactions of the Royal Society B, 379(1908), Article 20230244.
https://doi.org/10.1098/rstb.2023.0244
Mantar, A. (2008). Anksiyete Duyarlılığı İndeksi-3'ün Türkçe formunun geçerlik ve güvenilirlik çalışması [Validity and reliability study of the Turkish version of the Anxiety Sensitivity Index-3]. [Doctoral dissertation, Dokuz Eylül University Faculty of Medicine].
Markarian, S. A., Pickett, S. M., Deveson, D. F., & Kanona, B. B. (2013). A model of BIS/BAS sensitivity, emotion regulation difficulties, and depression, anxiety, and stress symptoms in relation to sleep quality. Psychiatry Research, 210(1), 281–286.
https://doi.org/10.1016/j.psychres.2013.06.004
Maxwell, S. E., Cole, D. A., & Mitchell, M. A. (2011). Bias in cross-sectional analyses of longitudinal mediation: Partial and complete mediation under an autoregressive model. Multivariate Behavioral Research, 46(5), 816–841.
https://doi.org/10.1080/00273171.2011.606716
McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035.
https://doi.org/10.1016/j.jpsychires.2011.03.006
Mennin, D. S. (2004). Emotion regulation therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy, 11(1), 17–29.
https://doi.org/10.1002/cpp.389
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 85–90.
https://doi.org/10.1093/clipsy.9.1.85
Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302.
https://doi.org/10.1016/j.beth.2006.09.001
Neal, J. A., Edelmann, R. J., & Glachan, M. (2002). Behavioral inhibition and symptom anxiety and depression: Is there a specific relationship with social phobia? British Journal of Clinical Psychology, 41(4), 361–374.
https://doi.org/10.1348/014466502760387489
Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187.
https://doi.org/10.1146/annurev-clinpsy-032511-143109
Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135(6), 974–999.
https://doi.org/10.1037/a0017428
Öner, N., & Le Compte, A. (1985). Durumluk-Sürekli Kaygı Envanteri El Kitabı. [State-Trait Anxiety Inventory manual]. İstanbul Boğaziçi Üniversitesi Yayınları.
Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure and Function, 214(5), 451–463.
https://doi.org/10.1007/s00429-010-0258-9
R Core Team (2024). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing.
https://www.R-project.org/
Reiss, S. (1987). Theoretical perspectives on the fear of anxiety. Clinical Psychology Review, 7(6), 585–596.
https://doi.org/10.1016/0272-7358(87)90007-9
Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11(2), 141–153.
https://doi.org/10.1016/0272-7358(91)90092-9
RStudio Team. (2020). RStudio: Integrated development for R. RStudio, PBC.
Rugancı, R. N., & Gençöz, T. (2010). Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale. Journal of Clinical Psychology, 66(4), 442–455.
https://doi.org/10.1002/jclp.20665
Shackman, A. J., Stockbridge, M. D., Tillman, R. M., Kaplan, C. M., Tromp, D. P., Fox, A. S., & Gamer, M. (2016). The neurobiology of dispositional negativity and attentional biases to threat: Implications for understanding anxiety disorders in adults and youth. Journal of Experimental Psychopathology, 7(3), 311–342.
https://doi.org/10.5127/jep.054015
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory-Form (Y1 – Y2). Consulting Psychologists Press.
Stanley, D. (2021). apaTables: Create American Psychological Association (APA) Style Tables. R package version 2.0.8.
https://CRAN.R-project.org/package=apaTables
Suveg, C., Morelen, D., Brewer, G. A., & Thomassin, K. (2010). The emotion dysregulation model of anxiety: A preliminary path analytic examination. Journal of Anxiety Disorders, 24(8), 924–930.
https://doi.org/10.1016/j.janxdis.2010.06.018
Şengül-İnal, G. (2014). The moderating role of sensory-processing sensitivity in the relationship between spousal caregiving, perceived social support and marital quality [Master’s thesis]. Middle East Technical University).
Şengül-İnal, G., & Sümer, N. (2018). Duyusal işlemleme hassasiyeti: Kuramsal çerçeve ve derleme çalışması [Sensory processing sensitivity: Theoretical framework and literature review]. Türk Psikoloji Yazıları, 21(42), 38–54.
Şengül-İnal, G., & Sümer, N. (2020). Exploring the multidimensional structure of sensory processing sensitivity in Turkish samples. Current Psychology, 39, 194–206.
https://doi.org/10.1007/s12144-017-9751-0
Tabak, B. A., Gupta, D., Sunahara, C. S., Alvi, T., Wallmark, Z., Lee, J., Fulford, D., Hudson, N. W., & Chmielewski, M. (2022). Environmental sensitivity predicts interpersonal sensitivity above and beyond Big Five personality traits. Journal of Research in Personality, 98, Article 104210.
https://doi.org/10.1016/j.jrp.2022.104210
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., Abramowitz, J. S., Holaway, R. M., Sandin, B., Stewart, S. H., Coles, M., Eng, W., Daly, E. S., Arrindell, W. A., Bouvard, M., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index–3. Psychological Assessment. 19(2), 176–188.
https://doi.org/10.1037/1040-3590.19.2.176
Thériault, R. (2023). rempsyc: Convenience functions for psychology. Journal of Open Source Software, 8(87), Article 5466.
https://doi.org/10.21105/joss.05466
Tull, M. T., Rodman, S. A., & Roemer, L. (2008). An examination of the fear of bodily sensations and body hypervigilance as predictors of emotion regulation difficulties among individuals with a recent history of uncued panic attacks. Journal of Anxiety Disorders, 22(4), 750–760.
https://doi.org/10.1016/j.janxdis.2007.08.001
Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378–391.
https://doi.org/10.1016/j.beth.2006.10.006
Published 2026-02-27
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