Posttraumatic Stress and Depression Reactions Among Survivors of the Istanbul November 2003 Terrorist Attacks

This study investigated posttraumatic stress and depression reactions among survivors of the Istanbul November 2003 terrorist bombings that destroyed synagogues, an HSBC bank, and the British General Consulate. One hundred and forty-nine survivors completed a questionnaire measuring exposure, current posttraumatic stress, and depression responses 6 months after the blasts. This study showed that the prevalence rate of posttraumatic stress disorder (PTSD) among survivors was 35.6%?and the rate of depression was 23.5%. PTSD was strongly predicted by perceived life threat, whereas depression was strongly predicted by death of a close friend. Overall, female survivors were found to be more vulnerable to developing posttraumatic stress as well as depression after the terrorist bombings.     

Say hello to the scream extractor: working with an autistic child with psychotic mechanisms

This paper describes the first two years of intensive psychotherapy with a six-year-old boy diagnosed with autism. I explore the many ways in which he retreated from reality, most frequently by taking refuge inside the maternal body or flying off into an imaginary space world. He fragmented his identity and that of his objects by using the discourse of fictional characters. Everything was externalised; there was little transmutation of material available for thought. I consider his dilemma – the wish to fuse with the object and the fear of being engulfed; the omnipotent denial of the need for an object and of the parental relationship, leading to an inability to make links. The paper discusses working with a child who experienced any ‘paternal’ firmness as persecuting and destructive. The softer, receptive maternal mind of the therapist was more easily tolerated. He gradually began to internalise a more benign combined object, as he became more able to bear separateness from the other.     

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.     

Interoceptive accuracy and panic

Psychophysiological models of panic hypothesize that panickers focus attention on and become anxious about the physical sensations associated with panic. Attention on internal somatic cues has been labeled interoception. The present study examined the role of physiological arousal and subjective anxiety on interoceptive accuracy. Infrequent panickers and nonanxious participants participated in an initial baseline to examine overall interoceptive accuracy. Next, participants ingested caffeine, about which they received either safety or no safety information. Using a mental heartbeat tracking paradigm, participants' count of their heartbeats during specific time intervals were coded based on polygraph measures. Infrequent panickers were more accurate in the perception of their heartbeats than nonanxious participants. Changes in physiological arousal were not associated with increased accuracy on the heartbeat perception task. However, higher levels of self-reported anxiety were associated with superior performance.     

Validity and reliability of the panic attack symptoms and cognitions questionnaires

The present article reports on the development and validation of two self-report instruments designed to assess the symptoms and cognitions associated with panic attacks. The Panic Attack Symptoms Questionnaire (PASQ) as well as the Panic Attack Cognitions Questionnaire (PACQ) successfully differentiated a group of anxiety-disordered individuals with panic attacks from a group of anxiety-disordered individuals without panic attacks. Reliability estimates based on Cronbach's alpha were adequate, and two discriminant functions designed to determine whether each of these questionnaires contributed uniquely to the separation of individuals with and without panic attacks beyond that provided by standard measures of anxiety and depression supported the validity of these questionnaires. The PASQ and PACQ appear to be useful vehicles for assessing the presence and severity of panic attacks.     

Examining the Panic Attack Specifier in Social Anxiety Disorder

Panic attacks (PAs) are characterized by overwhelming surges of fear and discomfort and are one of the most frequently occurring symptoms in psychiatric populations. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM-5) allows for a panic attack (PA) specifier for all disorders, including social anxiety disorder (SAD). However, there is little research examining differences between individuals diagnosed with SAD with the PA specifier versus individuals diagnosed with SAD without the PA specifier. The current study examined social anxiety, mood, anxiety, and anxiety sensitivity social concerns, a risk factor for social anxiety in SAD-diagnosed individuals without (N = 52) and with (N = 14) the PA specifier. The groups differed only in somatic symptoms of anxiety. Result of the current study provides preliminary evidence that the presence of the PA specifier in social anxiety does not result in elevated levels of comorbidity or a more severe presentation of social anxiety.     

Children's Cognitive Responses to the Somatic Symptoms of Panic

The purpose of this study was to test Nelles and Barlow's (1988) hypothesis that spontaneous panic attacks are rare or nonexistent prior to adolescence as children lack the ability to make the internal, catastrophic attributions (i.e., thoughts of losing control, going crazy, or dying) characteristic of panic according to the cognitive model (Clark, 1986). Conceptions of panic attacks, including the understanding of symptoms and causes, and cognitive interpretations of the somatic symptoms of panic were examined in children from Grades 3, 6, and 9. A significant main effect for grade was found for conceptions of panic attacks, with third graders receiving significantly lower scores than sixth and ninth graders. However, the majority of all children, regardless of age, tended to employ internal (e.g., I'd think I was scared or nervous) rather than external (e.g., I'd think I was feeling that way because of the temperature or the weather) explanations of panic attacks. No significant grade differences were found for the tendency to make internal versus external and catastrophic versus noncatastrophic attributions in response to the somatic symptoms of panic. When presented with panic imagery in a panic induction phase, children, regardless of age, made more internal and noncatastrophic attributions. Finally, internal attributional style in response to negative outcomes and anxiety sensitivity were found to be significant predictors of internal, catastrophic attributions. The challenge that these findings pose to Nelles and Barlow's hypothesis, and their relevance for understanding children's cognitive interpretations of panic symptomatology are discussed.     

When Anxiety Symptoms Masquerade as Medical Symptoms: What Medical Specialists Know about Panic Disorder and Available Psychological Treatments

Under-recognition of somatic symptoms associated with panic in primary care settings results in unnecessary and costly diagnostic procedures and inappropriate referrals to cardiologists, gastroenterologists, and neurologists. In the current study specialists’ knowledge regarding the nature and treatment of panic were examined. One-hundred and fourteen specialists completed a questionnaire assessing their knowledge about panic attacks, including their perceptions of psychologists’ role in treating panic. Respondents answered 51% of knowledge items correctly. Although most knew the definition of a panic attack, they knew less about clinical features of panic and its treatment. Specifically, whereas 97.4% believed medication effectively relieves panic symptoms, only 32.5% knew that cognitive-behavioral therapy (CBT) is a first-line treatment. Only 6% reported knowing how to implement CBT, and only 56.1% recognized that psychologists could effectively treat panic. These findings demonstrate significant gaps in specialists’ knowledge about panic and the need to enhance physician knowledge about panic attacks and their treatment.     

Anxiety and coping with community disasters: The Israeli experience

This study compared anxiety levels and coping strategies in Israeli adults during the Al-Aqsa Intifada (n = 707) and under ballistic missile attacks targeted at Israeli civilians during the Persian Gulf War (n = 328). In view of the differences among the two disaster situations in terms of severity of impact, scope, duration, predictability, and controllability, it was hypothesized that higher levels of state anxiety would be observed for the terror attack than for the missile attack crisis. Furthermore, problem-focused coping was predicted to be more salient than emotion-focused coping during the Gulf War—at a time where more protective action could be taken. Overall, the data supported the hypotheses. The data are discussed and explicated in the context of stress and coping theory and research.