Panic disorder: Description, conceptualization, and implications for treatment

Abstract

This paper reviews the Panic Disorder from diagnostic, clinical, and psychophysiological vantage points and concludes in suggestions for therapeutic intervention. The Panic Disorder is characterized by the repetitive onset of acute panic attacks. Evidence suggests that phasic panic anxiety is distinct from tonic, generalized anxiety, with each type having different treatment requirements. An integrated psychophysiological model incorporating cognitive appraisal theory and interoceptive conditioning theory was developed to conceptualize the panic attack. Stated briefly, stressful conditions or the perception of threat in panic patients elicit autonomic hyperactivity. Through a recurrent feedback loop, these aversive sensations become interoceptive conditional stimuli which elicit further anxiety responses and perceptions of threat. The development and implementation of adaptive coping skills is impeded by high physiological arousal, cognitive disorientation, and behavioral avoidance. The self-appraisal of inadequate coping skills intensifies anticipatory anxiety, further feeding into the cycle of panic escalation. This model suggests three fronts for intervention: (1) alleviating the antecedent stresses and conflicts which result in panic, (2) directly suppressing the physiological responses associated with panic, and (3) reducing the panic-maintaining anticipatory fear of panic through the training of cognitive and behavioral coping skills.