Anticipatory anxiety and avoidance in panic disorder with agoraphobia

The present study utilized the responses of 34 patients with panic disorder with agoraphobia to investigate the occurrence and anticipation of panic attacks in relation to the avoidance of specific situations from the Fear Questionnaire [Marks & Mathews (1979) Behaviour Research and Therapy, 17, 263-267]. Results indicated that self-reports of avoidance of specific situations were often significantly correlated with the anticipation of panic but rarely with the occurrence of panic. The occurrence and anticipation of panic were also frequently associated with social phobic situations in addition to agoraphobic situations.     

Situations and specific coping strategies associated with clinical and nonclinical panic attacks.

The present paper reports the results of further comparisons between clinical and nonclinical panickers. Both panic disorder patients and nonclinical panickers reported a variety of situational contexts associated with panic attacks, and differed markedly in their attempts to cope with panic. Nonclinical panickers tended to use more 'positive' coping strategies in response to panic. Conversely, one of the most commonly used and subjectively effective coping strategies reported by panic disorder patients was to escape the situation.     

Agoraphobia with and without current panic attacks

MMPI and SCL-90-R profiles of agoraphobics with and without current panic attacks are presented. Agoraphobics with current panic attacks were more elevated on Psychopathic Deviate (4), Psychasthenia (7), and Social Introversion (0) scales of the MMPI. On the SCL-90-R agoraphobics with current panic attacks had higher scores on Interpersonal Sensitivity, Anxiety, Phobic Anxiety, and Total/90.     

The efficacy of couples-based interventions for panic disorder with agoraphobia

From this systematic literature review it was concluded that panic disorder with agoraphobia (PDA) can sometimes occur in conjunction with marital problems. Couples-based treatments for PDA – partner-assisted exposure and marital therapy – can be an effective treatment for the condition. It is as effective as individually based cognitive behaviour therapy. Involving partners of people with PDA in therapy may be appropriate in some cases, particularly those in which there are marital difficulties. Couple-focused interventions may enhance the maintenance of treatment gains by facilitating interactions that positively reinforce and perpetuate attempts by people with PDA to enter feared situations and cope with these effectively. People with PDA who have good marital relationships show a better response to both individual and couples-based treatment programmes. In some instances effective couples-based treatment leads to improvement in marital adjustment as well as in PDA symptomatology.     

Healthcare utilization following cognitive-behavioral treatment for panic disorder with agoraphobia

The aim of this study was to examine the overall changes in healthcare services utilization after providing an empirically supported cognitive-behavioral treatment for panic disorder with agoraphobia. Data on healthcare utilization were collected for a total of 84 adults meeting DSM-IV criteria. Participants were completers of a cognitive-behavioral treatment for panic disorder with agoraphobia. Data on utilization of healthcare services and medication were obtained from semi-structured interviews from baseline to 1-year after treatment. Results of the Friedman non-parametric analysis reveal a significant decrease in overall and mental health-related costs following treatment. This study shows a significant reduction in healthcare costs following cognitive behavior therapy for panic disorder with agoraphobia. More studies are needed to examine the potential long-term cost-offset effect of empirically supported treatments for panic disorder.     

Preattentive bias for emotional information in panic disorder with agoraphobia.

A combined emotional Stroop and implicit memory (tachistoscopic identification) task with 3 types of words (panic-related, interpersonal threat, and neutral words) and 2 exposure conditions (subliminal, supraliminal) was administered to 35 patients with panic disorder and 35 age- and sex-matched controls. The patients showed Stroop interference for panic-related words both sub- and supraliminally and a similar but not equally robust effect on interpersonal threat words. On the tachistoscopic identification task, the patients identified more panic-related words than the controls did but showed no implicit memory bias effect. The patients' subliminal Stroop interference for panic-related words was found to correlate with trait anxiety and depression, although not with anxiety sensitivity.     

Personality in panic disorder with agoraphobia: a Rorschach study.

In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses such as avoidance, repression, denial, and reaction formation against dependency needs. These defenses are thought to lead to a greatly impoverished affective life. The Rorschach Comprehensive System was used to assess the personality features of avoidance, restricted affective life, and reaction formation against dependency needs. We found evidence for the presence of a highly avoidant information-processing style (86% of protocols had lambda [L] greater than .99) and a constricted affective life (low weighted sum color [WSumC] and low affective ratio [Afr]). Our results were consistent with the hypothesis of reaction formation against dependency needs (low food content [Fd]). Findings are discussed in light of studies that found a high incidence of avoidant personality disorder in PDA patients.     

Sensations, cognitions and the perception of cues associated with expected and unexpected panic attacks

Panic attacks may be perceived by patients as either cued or uncued (spontaneous) and either expected or unexpected. The purpose of the present study was to examine the prevalence and characteristics of these types of panic. Twenty-six panic disorder patients with mild avoidance and 18 with moderate or severe avoidance were instructed to complete a questionnaire during or immediately following each of three consecutive naturally occurring panic attacks they experienced. They were asked to rate the extent to which they expected the panic attack to occur, whether they felt it was associated with an external panic "cue" (e.g. a shopping mall), whether they would expect to panic again in similar circumstances, their mood, present level of life stress, and fear and severity of their body sensations and disturbing cognitions. Results indicated that from a sample of 92 questionnaires, each representing a separate panic, nearly 70% of panic attacks were rated as cued-expected and only one panic was rated as uncued-expected. The other two categories each comprised about 15% of all panic attacks. There were few reported differences in body sensations and cognitions reported as a function of type of panic and no differences with regard to extent of agoraphobic avoidance. Expected panic was associated with a higher expectation of future panic in similar circumstances.     

Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia.

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921-928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.     

Prediction of outcome in the behavioural treatment of panic disorder with agoraphobia

Outcome was predicted from pre-treatment characteristics for 62 patients with a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude who were treated with 16 sessions of behavioural therapy. Two approaches to the task of prediction was compared: (i) predicting class membership as clinically significantly improved at post-test and at 1-year follow-up on a composite score; and (ii) predicting individual change from the same variable. Agoraphobic severity was found to be a significant predictor of clinically significant improvement at both post-treatment and follow-up. It was also found to be a significant predictor of change at post-treatment, but not at follow-up. Instead the duration of the disorder was found to be a significant predictor of change at follow-up. Perceived treatment credibility, motivation, anxious cluster personality disorder or trait anxiety were not identified as significant predictors of outcome.     

Anxiety sensitivity and nonclinical panic attacks

The present study examined anxiety sensitivity in relation to trait anxiety and the occurrence of nonclinical panic attacks in 265 subjects. Fifty percent of high anxiety sensitivity subjects reported panic attacks (both cued and spontaneous) in the past year. In addition, almost 42% of subjects with high anxiety sensitivity but no history of panic reported a high level of trait anxiety concerning physical danger. The results suggest that anxiety sensitivity is frequently not independent of other forms of anxiety.