Panic disorder: cognitive-behavioral treatment

The effectiveness of an integrated treatment program utilizing cognitive-behavioral therapies for Panic Disorder was examined. Treatment was comprised of Cognitive Model of Panic-derived procedures, Cognitive Therapy and Applied Relaxation Training. Subjects meeting DSM-III-R criteria for Panic Disorder received thirteen 2.5-hr sessions of outpatient therapy in small groups, over a 12-week period. Subjects were given an extensive rationale of the etiology, development and maintenance of Panic Disorder, within the framework of the Cognitive Model of Panic, and controlled behavioral experiments in panic evocation to internal panicogenic cues, cognitive reappraisal of somatic and ideational cues, breathing retraining, Applied Relaxation Training and Cognitive Therapy to identify and remediate maladaptive beliefs and dysfunctional cognitive schemas. A comprehensive assessment battery was given at pre-mid-post-treatment which included measures of tripartite functioning, global severity, panic, fear, anxiety, depression and psychiatric symptomatology. Analyses indicated statistically significant improvements across all outcome domains. All subjects were free of spontaneous (uncued) panic attacks at post-treatment, and all met operationalized criteria for high endstate functioning. These findings are discussed, with recommendations for future research.     

惊恐障碍的认知偏向研究

文章综述了惊恐障碍患者对威胁性信息的注意偏向、解释偏向、记忆偏向等认知偏向。对威胁性信息的优先注意激发焦虑体验,对模糊信息的灾难化解释增加焦虑水平,对引起焦虑感信息的记忆保持促使惊恐体验更易于提取,这3种认知偏向促使具有焦虑倾向的个体对惊恐障碍更易感,也是惊恐障碍形成和保持的关键因素     

Cigarette Smoking and Panic Psychopathology

ABSTRACT— The present paper summarizes empirical evidence suggesting that smoking and panic problems often co-occur; that smoking is a risk factor for, and may serve to maintain, panic attacks and panic disorder; and that premorbid panic-specific vulnerability variables and full-blown panic problems are related to coping-oriented smoking motives and perhaps to the maintenance of smoking behavior. An integrative model is offered to stimulate further work on this topic, followed by future directions for research.     

Anchoring the Panic Disorder Severity Scale

The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend its clinical meaningfulness by examining its association with quality of life. A total of 63 individuals with a primary diagnosis of panic disorder were assessed on completion of a 6- or 8-week psychotherapy or pharmacotherapy trial for the treatment of panic disorder. As expected, the PDSS was correlated with both the CGI-S and quality of life. These results provide further support for the validity and clinical utility of the PDSS and provide simple anchors to help guide the potential use of the PDSS scale to measure treatment progress in clinical practice.     

A Very Childish Moral Panic: Ritalin

This paper examines some of the moral panics around hyperactive children, the construction of Attention Deficit-Hyperactivity Disorder, and the lure of Ritalin in turning kids identified as “at risk” into successful, productive individuals. Through a historicization of the child as a psychiatric subject, we try to demonstrate Ritalin's part in the uneven development of modern trends towards the pathologization of everyday life, a developing continuum between normality and abnormality, and an emphasis on the malleability of children and the importance of environment in their upbringing. We conclude that Ritalin is a part of modernity's project of turning people into individuals—in this case, a kind of US transcendence fantasy—which, along with discourses and institutions, promises to transform young subjects and biocosmetically alter their futures.     

Panic as a form of foreclosed experience

Following a discussion of panic states and their relationship to psychosomatic illness and related disorders, the author presents an extended clinical vignette in which he initially viewed the patient's intense anxiety as a manifestation of repressed conflict and, accordingly, used verbal interpretations as the principal mode of intervention. After this approach did not prove effective, the analyst began to make use of nonverbal interventions consistent with his emerging understanding of the patient's distress as a manifestation of the foreclosure (de M'Uzan 2003) and relegation to the body of undreamable experience (Bion 1962).     

A Mild Panic? Media Accounts of Kratom

ABSTRACT

Historically, the news media has been a primary participant in the construction of moral panics surrounding various drugs and their users. The current study utilizes the moral panic framework to depict how the media represents a drug new to the Western world: kratom. Kratom, a traditional plant-based substance from South Asia, came in to the public’s view when the DEA announced its intent to emergency schedule the substance, citing a threat to public health. We use content analysis to explore how kratom and kratom use is depicted in a sample of news media articles gathered from an online source. Broadly, we find that the news media seems to report more information about the substance and less hyperbole than is typical of media reports on drugs in the past.     

伴有广场恐怖症的惊恐障碍的网络心理学治疗新技术

近年来,加拿大Universitédu Québec en Outaouais大学Bouchard教授领导的团队进行了一系列网络心理学的研究,这种研究尝试将最新的计算机技术融合到传统临床心理治疗中去,并通过实验来评估其疗效。针对伴有广场恐怖症的惊恐障碍的研究一直是其研究重点,其包括对传统认知行为疗法(Cognitive Behavior Therapy,CBT)的评价研究、将远程视频会议技术应用于CBT疗法的研究,以及将虚拟现实技术与传统CBT疗法相结合的研究。     

Panic disorder: A cognitive-behavioural approach to treatment

The present study investigated the relationship between panic disorder and cognitive-behavioural therapy in a sample of 27 panic disorder patients who were randomly assigned to either a Treatment (six weeks of cognitive-behavioural therapy) or a Control group. Panic disorder was operationalized using three subjective and three physiologic indices. Results indicated that six weeks of cognitive-behavioural therapy were effective in decreasing panic disorder, as measured by three report measures: the Anxiety Sensitivity Index (catastrophic thoughts), State-Trait Anxiety Inventory (trait anxiety), and number of panic attacks, for the Treatment group relative to the Control group. In contrast, cognitive—behavioural therapy was ineffective in decreasing physiologic arousal as defined by blood pressure, pulse rate, and finger temperature. Implications of these results are discussed.     

Panic attacks without fear: An overview*

‘Non-fearful panic disorder’ (NFPD) is a condition that meets DSM III-R criteria for panic disorder but lacks a report of subjective fear or anxiety. Presenting the first comprehensive overview of this issue, the authors describe studies investigating a wide range of apparently overlapping phenomena including NFPD, ‘somatically expressed panic’, ‘non-cognitive panic’, ‘alexithymic panic’, ‘non-clinical panic’, and ‘masked anxiety’. The review shows that such conditions account for from 20 to 40% of the panic disorder found in various medical populations, and that this group resembles conventional panic disorder in cross-sectional comparisons. We emphasize that a ‘triple-response’ model of anxiety is consistent with our conclusion that NFPD should be conceptualized as a panic disorder subtype. Finally, we discuss unresolved issues regarding the construct and predictive diagnostic validity of NFPD.     

Panic disorder: A product of classical conditioning

Contrary to the common view that all panic attacks have a single etiology, it is shown that a distinction must be made between initial attacks, for which there are many causes, and recurrent attacks (panic disorder) which have a common basis. Most initial panic attacks are attributable to the physiological effects of hyperventilation resulting from severe and prolonged anxiety. It has been claimed that the attacks are due to such symptoms as dyspnea, tachycardia and dizziness being misattributed to deadly illness or incipient insanity. We reject this view on several grounds, and in particular because of a pilot study that showed that such attributions follow the onset of panic. Apart from some biological cases, the common initial panic is an unconditioned response to a bizarre stimulus complex produced by excessive hyperventilation, and panic disorder is the result of contiguous stimuli, especially endogenous stimuli, being conditioned to the elicited anxiety. Treatment accords with principles of conditioning.     

Panic symptoms during trauma and acute stress disorder

This study investigated the role of panic symptoms that occur during trauma and subsequent acute stress disorder (ASD). Civilian trauma (N=51) survivors with either acute stress disorder (ASD), subclinical ASD, or no acute stress disorder (non-ASD) were administered the Acute Stress Disorder Scale, Impact of Event Scale, Beck Anxiety Inventory, Beck Depression Inventory, and the Anxiety Sensitivity Index (ASI). Participants also completed the Physical Reactions Scale to index panic symptoms that occurred during their trauma. Overall, 53% of participants reported panic attacks during their trauma. ASD and subclinical ASD participants reported more peritraumatic panic symptoms, and higher ASI scores, than non-ASD participants. These findings are consistent with the notion that peritraumatic panic may be related to subsequent posttraumatic stress, and suggest that modification of maladaptive beliefs about physical sensations should be addressed in posttraumatic therapy.