Cognitive Factors in Panic Attacks: Symptom Probability and Sensitivity

Abstract

Psychological models of panic disorder propose that panic attacks result from the patient's fear response to certain body sensations. In the present study, we assessed three aspects of the fear of body sensations: subjective symptom probability, symptom sensitivity, and perceived coping ability (Symptom Probability and Cost Questionnaire, SPCQ). One-hundred-and-ten patients with panic disorder (88 with current panic attacks, 22 in remission), 81 infrequent panickers, 37 patients with other anxiety disorders, and 61 normal controls without a history of psychiatric disorders answered the SPCQ for three groups of bodily sensations: general anxiety, panic, and nonanxiety control symptoms. Significant group differences were found for the anxiety and panic scales, and for control symptom probability. With the exception of panic symptom sensitivity in the patient control group, all anxiety groups differed from normal control subjects on the anxiety and panic scales. Overall, group differences in anxiety and panic symptom appraisal could not be accounted for by differences in trait anxiety or depression scores. Even when these variables were controlled for by analysis of covariance, panic disorder patients and infrequent panickers differed significantly from normal controls. Panic patients endorsed a higher probability of anxiety and panic symptoms and a higher sensitivity and lower coping ability for panic symptoms than infrequent panickers, and higher anxiety and panic symptom probabilities and sensitivities than patients with other anxiety disorders. Subjects with infrequent panic attacks gave similar ratings on the anxiety symptom scales as patients with other anxiety disorders, but had higher probability and sensitivity scores for panic symptoms. The present study provides evidence that a fear of body sensations associated with anxiety is a prominent characteristic of patients with panic disorder, but is also found to a lesser degree in infrequent panickers and patients with other anxiety disorders. Panic attacks are discrete episodes of apprehension or fear accompanied by a variety of symptoms such as palpitations, dyspnea, sweating or dizziness (American Psychiatric Association, 1987). There is agreement among current psychological models that panic attacks result from the patient's maladaptive response to internal stimuli, most commonly body sensations (Barlow, 1986; Beck, 1988; Clark, 1986; Ehlers, Margraf, & Roth, 1988; Foa, 1988; Rapee, 1987; van den Hout, 1988). Evidence supporting this psychological perspective of panic is rapidly accumulating (for a review see Ehlers, Margraf, & Roth, 1988). Current psychological models of panic are related to the older concept that patients with agoraphobia and anxiety neurosis suffer from "fear of fear" (Evans, 1972; Fenichel, 1945; Frankl, 1975, Goldstein & Chambless, 1978). Especially relevant to the study of panic disorder is the idea that patients are afraid of certain body sensations associated with anxiety. Questionnaire studies have demonstrated that panic patients show a bias in the interpretation of bodily cues in that, compared to normal or clinical control groups, these patients report more fear of body sensations and tend to interpret bodily changes as indicators of an immediately impending danger (Chambless, Caputo, Bright, & Gallagher, 1984; Chambless & Gracely, 1989; Clark et al., 1988; Foa, 1988; McNally & Foa, 1987; McNally & Lorenz, 1987; Reiss, Peterson, Gursky, & McNally, 1986; van den Hout, van der Molen, Griez, & Lousberg, 1987). Interview studies concur that catastrophic misinterpretations of body sensations occur during panic attacks (Beck, Laude, & Bohnert, 1974; Hibbert, 1984; Ottaviani & Beck, 1987; Rapee, 1985; Rachman, Levitt, & Lopatka, 1987; Zucker et al., 1989) and that bodily symptoms usually precede the experience of panic (Hibbert, 1984; Ley, 1985; Ottaviani & Beck, 1987; Zucker etal. …