The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective

Within the triple vulnerabilities model of anxiety disorders, a genetic contribution to the development of anxiety and negative affect (i.e., generalized biological vulnerability), a diminished sense of perceived control over aversive events and emotional experiences (i.e., generalized psychological vulnerability), and elevated levels of anxiety sensitivity (i.e., specific psychological vulnerability) are posited to increase the risk of developing and maintaining panic disorder (Barlow American Psychologist 55(11):1247–1263, 2000). The purpose of the present study was to investigate the direct and interactive effects of perceived control and anxiety sensitivity on panic disorder symptom severity. Structural equation models (SEM) were conducted in data derived from a sample of 379 adults with panic disorder participating in a multi-site randomized controlled trial. Findings indicated that both perceived control and anxiety sensitivity uniquely predicted panic disorder symptoms. A moderation model examining the interactive effects of perceived control and anxiety sensitivity on panic symptoms indicated that the effect of anxiety sensitivity on panic symptoms increased with greater deficits in perceived control. The present findings suggest that deficits in perceived control and elevated levels of anxiety sensitivity exert unique and shared effects on panic disorder symptoms, thereby illustrating the relationship between putative vulnerability factors and panic disorder symptoms as predicted by the triple vulnerabilities model.     

Psychological and physiological predictors of response to carbon dioxide challenge in individuals with panic disorder

Past studies in nonclinical samples have found that suffocation fear, but not a behavioral index of carbon dioxide (CO2) sensitivity (i.e., breath-holding duration), predicts anxious response to CO2 challenge. These associations were examined in individuals with panic disorder while adding more sensitive indices of CO2 sensitivity. Consistent with the earlier studies, the authors found that suffocation fear predicted anxious responding to CO2 challenge but breath-holding duration did not. However, highly precise measures of CO2 sensitivity, not included in earlier studies, did predict anxious challenge responding. These findings support the predictive value and possible etiological relevance of both specific psychological variables and physiological CO2 sensitivity in panic vulnerability. Further work is still needed to determine whether the findings are specific to panic disorder.     

Adaptations for Youth

Aaron T. Beck exemplified the clinical scientist, willing to test his hypotheses, and willing to share his experiences and treatment features with others. Assessment and treatment of emotional disorders have been forever improved through the efforts of Aaron T. Beck. Using the psychological treatment of an emotional disorder in youth (i.e., anxiety), this commemorative reflects on how Aaron T. Beck’s clinical strategies have been impactful well beyond his initial focus. As a world-renowned clinical scientist, Beck’s work has influenced multiple fields addressing mental health. As a friend and colleague, Beck was a gentleman and a scholar.     

The role of optimism and engagement coping in college adaptation: A career construction model

From the perspective of the career construction theory (Savickas, 2005, 2013), adaptation is fostered by adapt-ability resources via the process of adapting. Using this model, the current research tested hypotheses representing the conceptual formulation that academic and psychological adjustments (i.e., adaptation) are associated with optimism (i.e., an adapt-ability resource) via engagement coping (i.e., adapting). These hypotheses were tested in a short-term multiwave study with a sample of incoming college undergraduates (N = 236). The resultant data were largely consistent with the study's hypotheses. In structural equation analyses optimism was shown to be a direct predictor of the greater use of engagement coping, and better psychological adaptation to college transition. Further, empirical tests of mediation revealed that the relationships of optimism with academic and psychological adaptation were mediated by engagement coping.     

The catastrophic misinterpretation model of panic disorder.

In the catastrophic misinterpretation model of panic Clark [Behav. Res. Ther. 24(1986)1461] proposes that panic attacks result from the misinterpretation of autonomic arousal stimuli as precursors to a physical or psychological emergency. The model has been widely examined, with many researchers suggesting that this specific cognitive bias is implicated in both the phenomenon of panic, and the aetiology and maintenance of panic disorder. Various research methodologies have provided only partial or inconclusive support for the model as being uniquely associated with panic, and as a cognitive process underpinning the experience of panic. This paper reviews the body of existing evidence and its implications for the model and proposes future research directions. The influence of implicit operational definitions of key terms in the catastrophic misinterpretation literature (e.g. 'catastrophe', 'threat', 'anxiety-related') are examined, and clarifications proposed. Inconsistencies and limitations in the measurement of catastrophic misinterpretation are highlighted, and subsequently developments to measurement instruments are proposed.     

Evaluating panic-specific factors in the relationship between suicide and panic disorder

Work during the past decade has suggested an association between panic disorder and suicide (i.e., suicidal ideation and suicide attempts) that cannot simply be accounted for by co-occurring depression symptoms. To clarify the linkage between panic disorder and suicide, the association between panic-specific clinical and cognitive variables and suicide indicators were evaluated in patients with panic disorder (N=146). Analyses predicting the presence of suicidal ideation (positive, negative) after covarying the effects of a current mood disorder diagnosis and depression symptoms indicated a number of significant predictors including: (1) overall anxiety symptoms; (2) level of anticipatory anxiety; (3) avoidance of bodily sensations; (4) attentional vigilance toward bodily perturbations; and (5) phrenophobia (i.e., fear of cognitive incapacitation). Anxiety-specific variables did not account for unique variance in predicting prior history of suicide attempts.     

Clinical Experiences in Using Cognitive-Behavior Therapy to Treat Panic Disorder

Although there is a growing body of research to support the use of psychological treatments for specific disorders, there has been no way for practitioners to provide feedback to researchers on the barriers they encounter in implementing these treatments in their day-to-day clinical work. In order to provide practitioners a means to give researchers information about their clinical experience, the Society of Clinical Psychology and the Division of Psychotherapy of the American Psychological Association collaborated on an initiative to build a two-way bridge between practice and research. A questionnaire was developed on the therapist, patient, and contextual variables that undermine the effective use of CBT in reducing the symptoms of panic disorder, a clinical problem that occurs frequently in clinical practice and has an extensive research base. An Internet-based survey was advertised internationally in listservs and professional newsletters, asking clinicians to indicate all aspects of CBT that they used in treating panic disorder, and to respond to a series of questions with variables that presumably limited successful symptom reduction in clinical work using CBT to treat panic disorder. The final database included responses from 338 participants who varied in experience in applying CBT to the treatment of panic disorders. Participants identified a wide range of patient factors that were barriers to symptom reduction, including symptoms related to panic, motivation, social system, and the psychotherapy relationship, in addition to specific problems with implementing CBT for the treatment of panic disorder.     

Psychological sequelae of remote exposure to the September 11th terrorist attacks in Canadians with and without panic

The purpose of the present investigation was to examine the psychological impact of remote exposure to the events and aftermath of the terrorist attacks in the USA on September 11th, 2001, and to assess what differences, if any, exist between individuals classified with probable panic disorder and those without. Telephone interviews were conducted with 122 residents of the capital city of the Canadian prairie province of Saskatchewan in spring 2002 in order to gather information regarding current mood, fears and avoidance behaviours as well as current post-traumatic stress disorder symptoms specific to September 11th. Consistent with previous findings and despite the remote nature of exposure, results indicated that the psychological well-being and behaviour of participants with probable panic disorder was more adversely affected by the events and aftermath of September 11th than those without panic disorder. These results suggest that remote viewing of traumatic events can have a significant and lingering impact on psychological well-being and behaviour and that these effects are more pronounced in those with panic disorder. Implications of the findings and future research directions are discussed.     

Attachment and loss: a test of three competing models on the association between attachment-related avoidance and adaptation to bereavement

It is widely assumed that emotionally avoidant or defensive individuals will have a difficult time adjusting to the loss of a loved one. However, recent research suggests that defensive individuals tend to adapt quite well to loss. Such findings pose a number of challenges to attachment theory--a theory that has traditionally held that emotional avoidance is indicative of poor psychological adjustment. In this article, the authors argue that contemporary models of individual differences in adult attachment allow the derivation of at least three competing hypotheses regarding the relationship between avoidant attachment and adaptation to loss. These hypotheses are tested using two-wave data on 59 bereaved adults. Results indicate that whereas some avoidant individuals (i.e., those who are fearfully avoidant) have a difficult time adapting to the loss of a loved one, other avoidant adults (i.e., those who are dismissingly avoidant) show a pattern of resilience to loss.     

Psychological sequelae of remote exposure to the September 11th terrorist attacks in Canadians with and without panic

The purpose of the present investigation was to examine the psychological impact of remote exposure to the events and aftermath of the terrorist attacks in the USA on September 11th, 2001, and to assess what differences, if any, exist between individuals classified with probable panic disorder and those without. Telephone interviews were conducted with 122 residents of the capital city of the Canadian prairie province of Saskatchewan in spring 2002 in order to gather information regarding current mood, fears and avoidance behaviours as well as current post‐traumatic stress disorder symptoms specific to September 11th. Consistent with previous findings and despite the remote nature of exposure, results indicated that the psychological well‐being and behaviour of participants with probable panic disorder was more adversely affected by the events and aftermath of September 11th than those without panic disorder. These results suggest that remote viewing of traumatic events can have a significant and lingering impact on psychological well‐being and behaviour and that these effects are more pronounced in those with panic disorder. Implications of the findings and future research directions are discussed.     

Effets du soutien organisationnel perçu et des caractéristiques de l’emploi sur l’anxiété au travail et l’épuisement professionnel : le rôle médiateur de la satisfaction des besoins psychologiques

Based on organizational support theory, job characteristics model, and self-determination theory, we examined the mechanisms that underlie the relations between organizational factors and ill-being. Specifically, the main purpose of the present study was to demonstrate the mediating role of the psychological needs for autonomy (i.e., the need for individuals to feel volitional and responsible for their own behavior), competence (i.e., the need for individuals to interact effectively with their environment), and relatedness (i.e., the need for individuals to feel connected and accepted by others), in the relationships of perceived organizational support (i.e., the degree to which employees believe that their organization values their contributions and cares about their well-being) and three motivational job characteristics (i.e., task identity, task significance, and work scheduling autonomy) to job anxiety and burnout. This is the first research, to the best of our knowledge, to test for the joint effects of perceived organizational support and motivational job characteristics on job anxiety and burnout through psychological need satisfaction. Four hundred and fifty-seven employees (216 men and 241 women) from different sectors (i.e., industry, trade, crafts) took part in the study. Fifty-seven participants worked in companies with less than 10 employees, 105 in companies with 11–49 employees, 138 in companies with 50–249 employees, 33 in companies with 250–499 employees, and 124 in companies with more than 500 employees. The hypothesized model was tested with structural equation modeling analyses. Results provided support for our hypotheses and revealed that all hypothesized paths were significant. Specifically, our results showed that perceived organizational support and job characteristics were positively related to psychological need satisfaction. In addition, satisfaction of these psychological needs was negatively associated with job anxiety and burnout. Therefore, feelings of autonomy, competence, and relatedness play a central role in the development or reduction of well- and ill-being at work. These results are consistent with previous research in the work context, which has shown that social factors (e.g., autonomy-supportive behaviors) have significant effects on workplace mental health through their influence on psychological need satisfaction. Practical and research implications as well as suggestions for future research are discussed.     

Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks

Panic disorder symptoms are persistent for 50–80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)—the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence—may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed.     

Panic patients reveal idiographic associations between anxiety symptoms and catastrophes in a semantic priming task

In the present study, a modified semantic priming paradigm was used to test whether panic patients more strongly associate catastrophes with anxiety symptoms than nonclinical subjects. Subjects named catastrophic target words (e.g. infarction) and target words neutral to anxiety themes (e.g. weekend) that followed auditive prime sentences immediately (i.e.0ms) or with a delay (i.e. 1500ms). Prime sentences described the perception of anxiety symptoms (e.g. You feel tense) or sensations neutral to anxiety (You feel relaxed). Consistent with an earlier study [Schniering C.A., & Rapee, R.M. (1997). A test of the cognitive model of panic: Primed lexical decision in panic disorder. Journal of Anxiety Disorders, 11, 557-571] the two groups did not differ if semantic priming effects were calculated in the usual way, i.e. by averaging across identical stimuli for all subjects. As expected, however, panic patients demonstrated stronger semantic priming effects for catastrophes immediately following prime sentences if priming effects were calculated for idiographically selected stimuli. The latter result indicated stronger automatic associations between idiographic anxiety symptoms and catastrophes in panic patients consistent with the cognitive model of panic disorder (Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470). The restriction of stronger associations in panic patients to idiographic stimuli is explained from an evolutionary perspective.     

Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks

We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.     

Symptom Attributions Across the Menstrual Cycle in Women with Panic Disorder

Women with panic disorder are likely to experience greater menstrual-specific symptoms (e.g., headaches, cramps) as well as more panic/anxiety-related symptoms (e.g., dizziness, faintness, chest pain, heart pounding), and may be more likely to experience these symptoms during the premenstrual phase. This study examines the attributions women make about the somatic and affective symptoms they experience during the menstrual cycle. Using a 30-day prospective design, women with and without panic disorder monitored physical and affective symptoms. Participants reported on severity of various symptoms and a primary cause for each symptom (menstrual cycle-related, panic/anxiety related, stress-related, health-related). Women with panic disorder reported more panic attacks during the premenstrual phase compared to other cycle phases. They also reported more severe affective and panic symptoms during the premenstrual phase compared to other phases, but did not significantly differ from the comparison group in menstrual symptom severity across the three cycle phases. Although women with panic disorder attributed more panic/anxiety-related causes for their symptoms across the menstrual cycle, they were able to discriminate between panic/anxiety causes and menstrual cycle-related causes. Women with panic disorder may benefit for therapy that focuses on their exacerbation of panic symptoms during the premenstrual phase.     

Varieties of (Scientific) Creativity: A Hierarchical Model of Domain-Specific Disposition, Development, and Achievement

ABSTRACT— Prior research supports the inference that scientific disciplines can be ordered into a hierarchy ranging from the "hard" natural sciences to the "soft" social sciences. This ordering corresponds with such objective criteria as disciplinary consensus, knowledge obsolescence rate, anticipation frequency, theories-to-laws ratio, lecture disfluency, and age at recognition. It is then argued that this hierarchy can be extrapolated to encompass the humanities and arts and interpolated within specific domains to accommodate contrasts in subdomains (e.g., revolutionary versus normal science). This expanded and more finely differentiated hierarchy is then shown to have a partial psychological basis in terms of dispositional traits (e.g., psychopathology) and developmental experiences (e.g., family background). This demonstration then leads to three hypotheses about how a creator's domain-specific impact depends on his or her disposition and development: the domain-progressive, domain-typical, and domain-regressive creator hypotheses. Studies published thus far lend the most support to the domain-regressive creator hypothesis. In particular, major contributors to a domain are more likely to have dispositional traits and developmental experiences most similar to those that prevail in a domain lower in the disciplinary hierarchy. However, some complications to this generalization suggest the need for more research on the proposed hierarchical model.     

The brain basis of emotion: a meta-analytic review

Researchers have wondered how the brain creates emotions since the early days of psychological science. With a surge of studies in affective neuroscience in recent decades, scientists are poised to answer this question. In this target article, we present a meta-analytic summary of the neuroimaging literature on human emotion. We compare the locationist approach (i.e., the hypothesis that discrete emotion categories consistently and specifically correspond to distinct brain regions) with the psychological constructionist approach (i.e., the hypothesis that discrete emotion categories are constructed of more general brain networks not specific to those categories) to better understand the brain basis of emotion. We review both locationist and psychological constructionist hypotheses of brain-emotion correspondence and report meta-analytic findings bearing on these hypotheses. Overall, we found little evidence that discrete emotion categories can be consistently and specifically localized to distinct brain regions. Instead, we found evidence that is consistent with a psychological constructionist approach to the mind: A set of interacting brain regions commonly involved in basic psychological operations of both an emotional and non-emotional nature are active during emotion experience and perception across a range of discrete emotion categories.     

The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder

Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.     

Does Age Moderate the Relation Between Social Negativity and Psychological Distress?: A Meta-Analytic Investigation

Recently, Finch et al. (Journal of Personality, 1999) reported the results of a meta-analysis in which social negativity was demonstrated to be positively related to psychological distress. In the present investigation, we employed meta-analytic techniques to test competing hypotheses as to whether age amplifies or dampens the relation of social negativity and psychological distress. A total of 104 effect sizes (e.g., concurrent correlations between self-report measures of social negativity and psychological distress) from 53 independent samples were extracted from 46 journal articles. Contrary to hypotheses, the relation between social negativity and psychological distress was not significantly different for samples of older (60 + years) and younger (<60 years) adults. An explanation was provided for why the present meta-analysis and previous narrative reviews have resulted in discrepant conclusions about negativity effects.