Psychological approaches to panic disorder: a review.

Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the "fear-of-fear" construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made.

[1]  M. D. van den Broek,et al.  Failure to replicate evidence for phobic schemata in agoraphobic patients. , 1988, The British journal of clinical psychology.

[2]  J. B. Furst,et al.  Combined use of imaginal and interoceptive stimuli, in desensitizing fear of heart attacks , 1970 .

[3]  G. Hibbert,et al.  Respiratory Control: Its Contribution to the Treatment of Panic Attacks , 1989, British Journal of Psychiatry.

[4]  P. Lang,et al.  Psychophysiology of fear imagery: differences between focal phobia and social performance anxiety. , 1978, Journal of consulting and clinical psychology.

[5]  S. Rachman.  The conditioning theory of fearacquisition: A critical examination , 1977 .

[6]  P. Salkovskis.  Phenomenology, assessment, and the cognitive model of panic. , 1988 .

[7]  S. Rachman,et al.  Experimental analyses of panic--II. Panic patients. , 1988, Behaviour research and therapy.

[8]  W. Roth,et al.  Sodium lactate infusions and panic attacks: a review and critique. , 1986, Psychosomatic medicine.

[9]  H. J. Grosz,et al.  Blood lactate in the development of anxiety symptoms. A critical examination of Pitts and McClure's hypothesis and experimental study. , 1969, Archives of general psychiatry.

[10]  R. A. Peterson,et al.  The Anxiety Sensitivity Index: Construct validity and factor analytic structure. , 1987 .

[11]  G. Flaker,et al.  Non-fearful panic disorder: panic attacks without fear. , 1987, Behaviour research and therapy.

[12]  R. McNally.  Is anxiety sensitivity distinguishable from trait anxiety? Reply to Lilienfeld, Jacob, and Turner (1989). , 1989, Journal of abnormal psychology.

[13]  Z. Segal.  Appraisal of the self-schema construct in cognitive models of depression. , 1988, Psychological bulletin.

[14]  E. Griez,et al.  Cardiovascular and subjective responses to inhalation of carbon dioxide. A controlled test with anxious patients. , 1982, Psychotherapy and psychosomatics.

[15]  D. Clark.  A cognitive approach to panic. , 1986, Behaviour research and therapy.

[16]  S. Mineka,et al.  Unpredictable and uncontrollable events: a new perspective on experimental neurosis. , 1978, Journal of abnormal psychology.

[17]  Haslam Mt.  The Relationship Between the Effect of Lactate Infusion on Anxiety States, and their Amelioration by Carbon Dioxide Inhalation , 1974 .

[18]  W. Roth,et al.  Biological models of panic disorder and agoraphobia--a review. , 1986, Behaviour research and therapy.

[19]  Lars-Göran Öst.  Applied relaxation vs progressive relaxation in the treatment of panic disorder. , 1988 .

[20]  J. Williams.  Cognitive Psychology and Emotional Disorders , 1991 .

[21]  D. Klein,et al.  Anxiety attacks with subsequent agoraphobia. , 1969, Comprehensive psychiatry.

[22]  P. Tyrer,et al.  Awareness of cardiac function in anxious, phobic and hypochondriacal patients , 1980, Psychological Medicine.

[23]  A. Beck,et al.  Ideational components of anxiety neurosis. , 1974, Archives of general psychiatry.

[24]  E. Griez,et al.  Reduction of CO2-induced anxiety in patients with panic attacks after repeated CO2 exposure. , 1987, The American journal of psychiatry.

[25]  J. Maser,et al.  Anxiety and the Anxiety Disorders , 2019 .

[26]  D. Clark,et al.  Does anxiety lead to selective processing of threat-related information? , 1991, Behaviour research and therapy.

[27]  R. Noyes,et al.  Is agoraphobia a variant of panic disorder or a separate illness , 1987 .

[28]  D. Pauls,et al.  A family study of panic disorder. , 1983, Archives of general psychiatry.

[29]  P. Lang,et al.  Emotional imagery and the differential diagnosis of anxiety. , 1988, Journal of consulting and clinical psychology.

[30]  P. Johnson-Laird.  The computer and the mind: an introduction to cognitive science , 1988 .

[31]  E. Griez,et al.  CO2 inhalation in the treatment of panic attacks. , 1986, Behaviour research and therapy.

[32]  R. McNally,et al.  Selective processing of threat cues in posttraumatic stress disorder. , 1990, Journal of abnormal psychology.

[33]  S. Dager,et al.  Biological markers in panic states: Lactate-induced panic and mitral valve prolapse , 1987, Biological Psychiatry.

[34]  J. Gorman,et al.  A neuroanatomical hypothesis for panic disorder. , 1989, The American journal of psychiatry.

[35]  D. Clark.  A cognitive model of panic attacks. , 1988 .

[36]  S. Rachman,et al.  The overprediction of fear , 1988 .

[37]  S. Dager,et al.  Lactate-induced panic in primary affective disorder. , 1986, The American journal of psychiatry.

[38]  A. Rush,et al.  Cognitive biases and depression. , 1989, Journal of abnormal psychology.

[39]  Andrew Mathews,et al.  COGNITIVE PROCESSES IN ANXIETY , 1983 .

[40]  Walter Schneider,et al.  Controlled and automatic human information processing: II. Perceptual learning, automatic attending and a general theory. , 1977 .

[41]  Isaac Marks.  Fears, phobias, and rituals , 1987 .

[42]  S. Dager,et al.  Lactate infusions in major depression without panic attacks. , 1987, Journal of psychiatric research.

[43]  R. Stevenson,et al.  Selective memory effects in agoraphobic patients. , 1984, The British journal of clinical psychology.

[44]  W. Agras,et al.  Lactate infusions and panic attacks: Do patients and controls respond differently? , 1986, Psychiatry Research.

[45]  Paul M. Salkovskis,et al.  Tests of a cognitive theory of panic. , 1988 .

[46]  A. Beck,et al.  Cognitive aspects of panic disorders , 1987 .

[47]  W. F. Prokasy,et al.  Classical conditioning II: Current research and theory. , 1972 .

[48]  G. Razran,et al.  The observable unconscious and the inferable conscious in current Soviet psychophysiology: interoceptive conditioning, semantic conditioning, and the orienting reflex. , 1961, Psychological review.

[49]  J. Maser,et al.  Panic: Psychological Perspectives , 1988 .

[50]  E. Foa,et al.  Agoraphobia: Phenomenological aspects, associated characteristics, and theoretical considerations. , 1984 .

[51]  S. Dager,et al.  Clinical characteristics and response to sodium lactate of patients with infrequent panic attacks. , 1987, The American journal of psychiatry.

[52]  E. Griez,et al.  Treatment of phobophobia by exposure to CO2-induced anxiety symptoms. , 1983, The Journal of nervous and mental disease.

[53]  P. Salkovskis,et al.  Respiratory Control in the Treatment of Panic Attacks: , 1986, British Journal of Psychiatry.

[54]  S. Torgersen.  Genetic factors in anxiety disorders. , 1983, Archives of general psychiatry.

[55]  Michel Hersen,et al.  Handbook of anxiety disorders. , 1988 .

[56]  Daniel Holender,et al.  Semantic activation without conscious identification in dichotic listening, parafoveal vision, and visual masking: A survey and appraisal , 1986, Behavioral and Brain Sciences.

[57]  R. Rescorla,et al.  A theory of Pavlovian conditioning : Variations in the effectiveness of reinforcement and nonreinforcement , 1972 .

[58]  W. Roth,et al.  Selective processing of threat cues in subjects with panic attacks , 1988 .

[59]  I. Fischler,et al.  Automatic and attentional processes in the effects of sentence contexts on word recognition , 1979 .

[60]  D. Charney,et al.  Increased anxiogenic effects of caffeine in panic disorders. , 1985, Archives of general psychiatry.

[61]  E. Griez,et al.  Effects of carbon dioxide-oxygen inhalations on subjective anxiety and some neurovegetative parameters. , 1982, Journal of behavior therapy and experimental psychiatry.

[62]  M. Seligman.  Competing theories of panic. , 1988 .

[63]  D. Klein,et al.  Anxiety-new research and changing concepts , 1984 .

[64]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[65]  E. Foa,et al.  Memory bias for anxiety information in patients with panic disorder , 1989 .

[66]  David H. Barlow,et al.  Behavioral treatment of panic disorder , 1989 .

[67]  D. Charney,et al.  Agoraphobia with panic attacks. Development, diagnostic stability, and course of illness. , 1986, Archives of general psychiatry.

[68]  Carr Db.  Panic anxiety: a new biological model , 1984 .

[69]  Jürgen Margraf,et al.  Case studies and clinical replication series: Panic attack associated with perceived heart rate acceleration: A case report , 1987 .

[70]  S. Mineka.  Animal Models of Anxiety-Based Disorders , 2019, Anxiety and the Anxiety Disorders.

[71]  T. S. Hyde,et al.  Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study. , 1986, The Journal of clinical psychiatry.

[72]  E. Griez,et al.  Cognitive factors in carbon dioxide therapy. , 1982, Journal of psychosomatic research.

[73]  R. Crowe.  Mitral valve prolapse and panic disorder. , 1985, The Psychiatric clinics of North America.

[74]  R. McNally,et al.  Effects of anxiety sensitivity on the response to hyperventilation. , 1987, Journal of abnormal psychology.

[75]  R. McNally,et al.  Bio-informational processing in agoraphobia. , 1988, Behaviour research and therapy.

[76]  J. Lucas,et al.  Anxiety sensitivity: Unitary personality trait or domain-specific appraisals? , 1989 .

[77]  R. Ley,et al.  Panic attacks during sleep: a hyperventilation-probability model. , 1988, Journal of behavior therapy and experimental psychiatry.

[78]  R. Rapee.  Differential response to hyperventilation in panic disorder and generalized anxiety disorder. , 1986, Journal of abnormal psychology.

[79]  J. Wolpe,et al.  Panic disorder: a product of classical conditioning. , 1988, Behaviour research and therapy.

[80]  O. Cameron,et al.  Anxiety in patients with pheochromocytomas. , 1985, Archives of internal medicine.

[81]  F P McKenna,et al.  Colour naming of phobia-related words. , 1986, British journal of psychology.

[82]  R. Rapee.  The psychological treatment of panic attacks: Theoretical conceptualization and review of evidence , 1987 .

[83]  E. Griez,et al.  Cognitive determinants of lactate-induced anxiety. , 1986, Behaviour research and therapy.

[84]  The relationship between panic disorder and agoraphobia: an epidemiologic perspective. , 1986, Psychopharmacology bulletin.

[85]  Barlow Dh.  Behavioral conception and treatment of panic. , 1986 .

[86]  J M Gorman,et al.  Lactate provocation of panic attacks. I. Clinical and behavioral findings. , 1984, Archives of general psychiatry.

[87]  S. Guze.  Biological psychiatry: is there any other kind? , 1989, Psychological Medicine.

[88]  C. MacLeod,et al.  Discrimination of threat cues without awareness in anxiety states. , 1986, Journal of abnormal psychology.

[89]  Walter Schneider,et al.  Controlled and Automatic Human Information Processing: 1. Detection, Search, and Attention. , 1977 .

[90]  A. Richards,et al.  Colour-identification of differentially valenced words in anxiety , 1989 .

[91]  S. Woods,et al.  Neurobiological mechanisms of panic anxiety: biochemical and behavioral correlates of yohimbine-induced panic attacks. , 1987, The American journal of psychiatry.

[92]  E. Griez,et al.  CO2 vulnerability in panic disorder , 1987, Psychiatry Research.

[93]  R. Ley.  Agoraphobia, the panic attack and the hyperventilation syndrome , 1985 .

[94]  D. Chambless,et al.  A reanalysis of agoraphobia. , 1978 .

[95]  T. Aronson.  Is Panic Disorder a Distinct Diagnostic Entity?: A Critical Review of the Borders of a Syndrome , 1987, The Journal of nervous and mental disease.

[96]  R. McNally,et al.  Anxiety sensitivity and panic attacks in a nonclinical population. , 1990, Behaviour research and therapy.

[97]  H. Gardner,et al.  The Mind's New Science , 1985 .

[98]  R. McNally,et al.  Sensitivity to stress-relevant stimuli in posttraumatic stress disorder. , 1987 .

[99]  S. Woods,et al.  Applications of the pharmacologic challenge strategy in panic disorders research , 1988 .

[100]  N Birbaumer,et al.  Anxiety induced by false heart rate feedback in patients with panic disorder. , 1988, Behaviour research and therapy.

[101]  M. Gelder.  Panic disorder: fact or fiction? , 1989, Psychological Medicine.

[102]  R. Balon,et al.  Lactate infusions in panic disorder patients and normal controls: autonomic measures and subjective anxiety , 1989, Acta psychiatrica Scandinavica.

[103]  B. Cox,et al.  Selective memory effects in nonclinical panickers , 1988 .

[104]  G. Hibbert.  Ideational Components of Anxiety: Their Origin and Content , 1984, British Journal of Psychiatry.

[105]  S. Reiss.  Theoretical perspectives on the fear of anxiety , 1987 .

[106]  I. Kirsch,et al.  The role of expectancy in exposure-generated fear reduction in agoraphobia. , 1988, Behaviour research and therapy.

[107]  J. Beck,et al.  Physiological and symptom responses to hyperventilation: A comparison of frequent and infrequent panickers , 1988 .

[108]  A. Beck.  Cognitive approaches to panic disorder: Theory and therapy. , 1988 .

[109]  R. McNally,et al.  Anxiety sensitivity and history of panic as predictors of response to hyperventilation. , 1989, Behaviour research and therapy.

[110]  W. Agras,et al.  Panic Attacks in the Natural Environmet , 1987, The Journal of nervous and mental disease.

[111]  B. Burns,et al.  Gender differences in phobias: Results of the ECA community survey , 1988 .

[112]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[113]  H. Wittchen,et al.  Panic and Phobias , 1986, Springer Berlin Heidelberg.

[114]  R. McNally,et al.  Differentiation between classically conditioned and cognitively based neurotic fears: two pilot studies. , 1985, Journal of behavior therapy and experimental psychiatry.

[115]  R. Rapee,et al.  Emotional reactions to physiological sensations: panic disorder patients and non-clinical Ss. , 1988, Behaviour research and therapy.

[116]  E. Sachar,et al.  The Lactate Theory of Anxiety: A Review and Reevaluation , 1974, Psychosomatic medicine.

[117]  Pyke Re,et al.  Norepinephrine challenges in panic patients. , 1986 .

[118]  S. Reiss,et al.  Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. , 1986, Behaviour research and therapy.

[119]  R. McNally,et al.  Perception of threat cues in post-traumatic stress disorder: semantic processing without awareness? , 1987, Behaviour research and therapy.

[120]  M. Roth.  Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances. , 1984, Psychiatric developments.

[121]  R. McNally,et al.  Preparedness and phobias: a review. , 1987, Psychological bulletin.

[122]  K. Mogg,et al.  Memory bias in clinical anxiety. , 1987, Journal of abnormal psychology.

[123]  P. Latimer.  Carbon dioxide as a reciprocal inhibitor in the treatment of neurosis , 1977 .

[124]  S. Reiss,et al.  Anxiety sensitivity, injury sensitivity, and individual differences in fearfulness. , 1988, Behaviour research and therapy.

[125]  L. Covi,et al.  Imipramine and chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients. , 1986, Archives of general psychiatry.

[126]  Crowe Rr.  The genetics of panic disorder and agoraphobia. , 1985 .

[127]  M. Seligman.  Phobias and preparedness , 1971 .

[128]  I. Burgess,et al.  The degree of control exerted by phobic and non-phobic verbal stimuli over the recognition behaviour of phobic and non-phobic subjects. , 1981, Behaviour research and therapy.

[129]  R. McNally,et al.  Selective processing of threat cues in panic disorder. , 1990, Behaviour research and therapy.

[130]  R. Rapee,et al.  Cognitive mediation in the affective component of spontaneous panic attacks. , 1986, Journal of behavior therapy and experimental psychiatry.

[131]  R. Pohl,et al.  A comparison of lactate and isoproterenol anxiety states. , 1984, Psychopathology.

[132]  F. Gaffney,et al.  Hemodynamic, ventilatory, and biochemical responses of panic patients and normal controls with sodium lactate infusion and spontaneous panic attacks. , 1988, Archives of general psychiatry.

[133]  J. Singer,et al.  Cognitive, social, and physiological determinants of emotional state. , 1962 .

[134]  M. Eysenck,et al.  Implicit and explicit memory bias in anxiety. , 1989, Journal of abnormal psychology.

[135]  Klein Df,et al.  Unresolved issues in the treatment of agoraphobia with panic attacks. , 1982 .

[136]  A. W. Melton,et al.  Coding Processes in Human Memory. , 1973 .

[137]  D H Barlow,et al.  The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air. , 1989, Archives of general psychiatry.

[138]  D. Hemsley,et al.  The effects of hyperventilation; individual variability and its relation to personality. , 1982, Journal of behavior therapy and experimental psychiatry.

[139]  C. Weekes.  Simple, effective treatment of agoraphobia. , 1977, American journal of psychotherapy.

[140]  R. McNally,et al.  Anxiety sensitivity in agoraphobics. , 1987, Journal of behavior therapy and experimental psychiatry.

[141]  C. MacLeod,et al.  Selective processing of threat cues in anxiety states. , 1985, Behaviour research and therapy.

[142]  R. Bootzin,et al.  Theoretical Issues in Behavior Therapy , 1985 .

[143]  Interoceptive theory of the fear of anxiety , 1988 .

[144]  C. Bass,et al.  Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation. , 1985, British medical journal.

[145]  C. MacLeod,et al.  Attentional bias in emotional disorders. , 1986, Journal of abnormal psychology.

[146]  S. Reiss,et al.  A behavioral validation of the anxiety sensitivity index , 1987 .