Assessment of automatic associations with bodily sensations and agoraphobic situations in panic disorder

Marcella L Woud,Eni S Becker,Mike Rinck,Catherine J Harmer,Andrea Reinecke

doi:10.1016/j.jbtep.2016.04.001

Abstract

Background and objectivesOne of the central assumptions of cognitive models of Panic Disorder (PD) is that automatic panic-related associations are a core feature of PD. However, empirical findings are mixed and inconsistent, rendering it difficult to evaluate the role of panic-related associations adequately, particularly in relation to the relevant theories. The present study aimed to further advance our understanding of automatic associations in PD, and therefore applied a paradigm novel in this context, namely an Extrinsic Affective Simon Task (EAST). MethodsParticipants involved treatment seeking, unmedicated panic patients (n = 45) and healthy controls (n = 38). The EAST was applied prior to treatment. It included the following stimuli as targets: panic-related bodily sensations and agoraphobia-related situations, and as attributes: pleasant versus unpleasant, fear-related words. ResultsContrary to our expectations, panic patients did not show stronger negative than positive automatic associations for either panic-related symptoms or agoraphobia-related situations, compared to healthy controls. Moreover, EAST effects did not correlate with panic-related self-report measures. LimitationsAlthough the present study involved patients who were actively seeking treatment, panic-related associations might not have been activated sufficiently. Hence, a brief activation procedure (e.g., hyperventilation) might have been needed to optimize the assessment condition. ConclusionsThe present findings do not support contemporary theories of panic-related associations. Therefore, follow-up work is needed to disentangle their functional and operational properties more thoroughly.

Highlights

A central assumption of cognitive models of Panic Disorder (PD) (e.g., Beck, Emery, & Greenberg, 1985; Clark, 1986) is that panicrelated associations lie at the heart of PD: They are activated at a very early stage of information processing and occur automatically, i.e., they are activated quickly, unintentionally, and without the individual's control
Clinical self-report measures t's(81) > 10, p's < .001, with panic patients scoring higher than controls
The analysis is based on a two-factorial design with within-subjects factor Target Type and between-subjects factor Group

Summary

Introduction

A central assumption of cognitive models of Panic Disorder (PD) (e.g., Beck, Emery, & Greenberg, 1985; Clark, 1986) is that panicrelated associations lie at the heart of PD: They are activated at a very early stage of information processing and occur automatically, i.e., they are activated quickly, unintentionally, and without the individual's control. A PD patient who notices an increase in heartbeat automatically associates this benign bodily sensation with something alarming, resulting in a catastrophic misinterpretation of that sensation (e.g., a heart attack). This is followed by an amplification of bodily sensations, which in turn triggers anxiety and very likely results in a full-blown panic attack. The EAST was applied prior to treatment It included the following stimuli as targets: panic-related bodily sensations and agoraphobia-related situations, and as attributes: pleasant versus unpleasant, fear-related words. Limitations: the present study involved patients who were actively seeking treatment, panicrelated associations might not have been activated sufficiently. Follow-up work is needed to disentangle their functional and operational properties more thoroughly

Methods

Results

Conclusion