Selective attention to physical threat in subjects with panic attacks and specific phobias

Abstract

That patients with panic disorder exhibit an attentional bias towards physical threat has been inferred from their responses to such words in modified Stroop paradigms. The present study investigated selective attention to physical cues directly. Subjects were given a mild electrical shock to one ring finger followed by a target stimulus (vibration of one index finger) applied to either the same or the other hand. An attentional bias index was calculated by subtracting mean reaction times in trials in which the neutral target and the electrical stimulus were applied to the same hand from those trials in which both stimuli were applied to different hands. Sixty-one patients with panic disorder, 45 subjects with infrequent spontaneous panic attacks, 24 patients with specific phobias, and 40 normal controls participated in the study. Consistent with our hypothesis, subjects with spontaneous panic attacks, but not normal controls, shifted their attention toward the threatening stimulus. There was no difference between panic disorder patients and infrequent panickers. Selective attention to physical threat could increase the probability that anxiety is triggered or that it escalates during panic attacks. Patients with simple phobias showed the same response pattern as panickers. Lack of specificity in our paradigm may be related to the importance of “fear of fear” for all anxiety disorders or to the relevance of tactile stimuli for the fear structures of animal phobics.