Recognition bias for safe faces in panic disorder with agoraphobia

Panic patients with agoraphobia were compared with normal controls on tasks of face recognition. The subjects were presented with 20 photos, and were required to make a judgement of the persons on the photos; shortly afterwards they were unexpectedly presented with a recognition task. In the first study, one task was to judge whether the persons on the photos were critical or accepting: unlike social phobics (Lundh and Ost, 1996b, Behaviour Research and Therapy, 34, 787-794), panic patients showed no bias for critical vs accepting faces on the recognition task. In a secondary study, the task was to judge whether the persons on the photos were 'safe' or 'unsafe', i.e. whether they could be relied on if the subject would need help in some situation. The results showed a recognition bias for safe vs neutral faces in panic patients. The index of recognition bias for safe faces correlated with avoidance of feared situations when accompanied by others, as measured by the Mobility Inventory. The possibility that memory bias in emotional disorders is a function of basic concern, or functional importance, rather than positive/negative valence is discussed. The results are also discussed in terms of degree of elaboration, exposure duration of the stimuli, and the generality of the findings.     

Preattentive bias for emotional information in panic disorder with agoraphobia.

A combined emotional Stroop and implicit memory (tachistoscopic identification) task with 3 types of words (panic-related, interpersonal threat, and neutral words) and 2 exposure conditions (subliminal, supraliminal) was administered to 35 patients with panic disorder and 35 age- and sex-matched controls. The patients showed Stroop interference for panic-related words both sub- and supraliminally and a similar but not equally robust effect on interpersonal threat words. On the tachistoscopic identification task, the patients identified more panic-related words than the controls did but showed no implicit memory bias effect. The patients' subliminal Stroop interference for panic-related words was found to correlate with trait anxiety and depression, although not with anxiety sensitivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catastrophic cognitions in panic disorder with and without agoraphobia

The cognitive models of panic disorder with (PDA) or without (PD) agoraphobia are now widely recognised. These models propose that patients misinterpret external or internal cues in a catastrophic manner and as a result of these catastrophic cognitions the symptoms are maintained. There is now a large body of empirical evidence for this proposal and the aim of this paper is to systematically review the literature to evaluate whether the empirical evidence supports the contribution of catastrophic cognitions to PD and PDA. Empirical studies using different methodologies, such as interview, questionnaire, self-monitoring, and in vivo techniques are reviewed. The results indicate there is substantial empirical evidence in support of the central role of catastrophic cognition in cognitive models. Different methodologies provided convergent support for the importance of catastrophic cognitions in the maintenance of panic disorder and agoraphobia. Limitations in the interpretation of the existing research are highlighted and future research directions are proposed.     

Memory bias in panic disorder.

Investigated selective memory effects in patients with panic disorder. 30 patients with panic disorder and 20 normal controls learned panic-related, strongly pleasant, and strongly unpleasant words. During the incidental learning task, Ss imagined scenes combining the referent of a presented word with themselves. After a distractor task, Ss took a free-recall test. Panic Ss showed enhanced memory for panic-related words but not for positive or negative words. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explicit and implicit memory for rotating objects.

Although both the object and the observer often move in natural environments, the effect of motion on visual object recognition has not been well documented. The authors examined the effect of a reversal in the direction of rotation on both explicit and implicit memory for novel, 3-dimensional objects. Participants viewed a series of continuously rotating objects and later made either an old-new recognition judgment or a symmetric-asymmetric decision. For both tasks, memory for rotating objects was impaired when the direction of rotation was reversed at test. These results demonstrate that dynamic information can play a role in visual object recognition and suggest that object representations can encode spatiotemporal information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of the Fear Questionnaire in panic disorder with agoraphobia.

The Fear Questionnaire responses of 390 patients with panic disorder with agoraphobia were used in a confirmatory factor analysis. The results provide strong support for the 3-factor model of this scale (agoraphobia, social phobia, blood/injury phobia) and the multidimensional model of fears proposed by W. A. Arrindell (1980). The presence of fear clusters other than agoraphobia existing in panic disorder is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia

BACKGROUND: Imipramine has proven efficacy for panic disorder. This study assesses the net effectiveness of systematic, open imipramine treatment in a homogenous sample of panic disorder patients with agoraphobia. METHODS: One hundred and ten consecutive patients with DSM-III-R moderate to severe panic disorder with agoraphobia were treated with a fixed regimen of imipramine 2.25 mg/kg/day for 24 weeks. No instructions or encouragement for self-directed exposure to phobic situations or other coping strategies with panic or fear were given. Assessments were conducted at the end of the 2-week placebo run-in and at weeks 8, 16, and 24 of treatment. RESULTS: Overall, 53% had a marked and stable response. Most measures revealed that substantial improvement continued beyond week 8 of treatment. Treatment success was accompanied with significant improvements in anxiety sensitivity, dysphoric mood, and functional well-being. CONCLUSIONS: These results provide a clinically relevant reference with which to compare the effectiveness of alternative treatments in providing nearly complete symptom remission in patients with primary panic disorder with agoraphobia.     

Clinical features in panic disorder with agoraphobia: a comparison of men and women

This study compared 96 women and 58 men suffering from panic disorder with agoraphobia. Participants completed questionnaires assessing various clinical features associated with panic disorder with agoraphobia (PDA), general adjustment, and drug/alcohol use. Results showed that PDA is a more severe condition in women. Women reported more severe agoraphobic avoidance when facing situations or places alone, more catastrophic thoughts, more body sensations, and higher scores on the Fear Survey Schedule. Also, women more often had a comorbid social phobia or posttraumatic stress disorder. The lower agoraphobic avoidance of men was associated with their alcohol use. However, there were no differences between genders in other dimensions, including depression, situational and trait anxiety, stressful life events, social self-esteem, marital adjustment, and drug use.     

Panic disorder and agoraphobia with panic attacks: Covariation along the dimensions of panic and agoraphobic fear.

Tested the validity of the distinction made in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) between the diagnoses of "panic disorder" and "agoraphobia with panic attacks" by examining the pattern of covariation between panic symptoms and agoraphobic fear in a group of individuals presenting with panic attacks as a prominent symptom. Ss were 17 patients (mean age 34.4 yrs) who had been diagnosed as having panic disorder and 56 patients (mean age 36.4 yrs) diagnosed as having agoraphobia with panic attacks, and who had completed at the time of diagnosis both the Fear Survey Schedule and the SCL-90-R. Analyses of the panic-related items and the agoraphobia-related items of these 2 inventories revealed that irrespective of diagnosis, the degree of panic was highly correlated with the degree of agoraphobic fear. Although panic patients tended to experience more severe panic and milder agoraphobic fear than agoraphobics, the groups overlapped with respect to both kinds of symptoms. Findings are discussed in terms of whether panic disorder and agoraphobia should be classified as qualitatively distinct conditions. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of extraverted temperament on agoraphobia in panic disorder.

Although situational avoidance is viewed as the most disabling aspect of panic disorder, few studies have evaluated how dimensions of neurotic (i.e., neuroticism, behavioral inhibition) and extraverted (i.e., extraversion, behavioral activation) temperament may influence the presence and severity of agoraphobia. Using logistic regression and structural equation modeling, we examined the unique effects of extraverted temperament on situational avoidance in a sample of 274 outpatients with a diagnosis of panic disorder with and without agoraphobia. Results showed low extraverted temperament (i.e., introversion) to be associated with both the presence and the severity of situational avoidance. Findings are discussed in regard to conceptualizations of conditioned avoidance, activity levels, sociability, and positive emotions within the context of panic disorder with agoraphobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minnesota Multiphasic Personality Inventory correlates of panic disorder with agoraphobia: changes with treatment

Granulocytes, monocytes, and T- and B-lymphocytes were separated from 28 blood samples collected from 5 bone marrow transplant (BMT) recipients. About 40% of granulocyte, monocyte, and B-lymphocyte samples were CMV DNA-positive by polymerase chain reaction in recipients with cytomegalovirus (CMV) infection. CMV DNA was rarely detected in separated T-lymphocytes. Within each of the simultaneously separated paired samples, there were several with single positive cell subtypes. Monocytes, granulocytes, and B-lymphocytes were the single positive samples in some instances. Thus, it is important to have all of the different cell subtypes present in samples for detection of CMV DNA in peripheral blood. We also studied the appearance of CMV DNA in plasma and peripheral blood leukocytes (PBLs) from 351 blood samples collected from 30 BMT recipients during a follow-up period of at least 3 months after BMT. All cell subtypes were represented in the PBL samples. In the 13 recipients who developed symptoms possibly associated with CMV infection or CMV disease, a correlation with the detection of CMV DNA in < or = 2 x 10(5) PBLs was found. In PBLs from 11 of the 13 BMT recipients, CMV DNA was detected before the onset of symptoms. CMV DNA was not detected in < or = 2 x 10(5) PBLs from recipients without CMV infection. The virus load in PBLs decreased during ganciclovir treatment. Nine of the 13 recipients displayed PCR-positive plasma samples, and CMV DNA was detected frequently after the onset of symptoms.     

Patient dropout from a couples' group treatment for panic disorder with agoraphobia.

This study examined premature termination from couples' group treatment for panic disorder with agoraphobia. Patients were classified as either treatment noncompleters or treatment completers. Comparisons of pretreatment self-report and clinician-rated measures of anxiety and depression indicated no differences between groups. On communication measures, however, partners of noncompleters rated themselves as less communicative about panic-related issues. Of noncompleters, the majority reported "getting to treatment sessions" as problematic and indicated dissatisfaction with the cognitive-behavioral treatment approach. Results are discussed in terms of these issues and their impact on the treatment of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explicit contamination in "implicit" memory for new associations

In one view of implicit memory, priming arises from modification of preexisting representations; however, the role of such representations is currently in doubt following findings of implicit memory for newly formed associations. Closer consideration of studies reporting this effect, and of others that have failed to obtain it, suggests that such priming might results from the employment of explicit memory strategies. With measures designed to permit exclusion of such strategies, three experiments using lexical decision and stem-completion tasks found no evidence of truly implicit memory for unrelated pairs. Instead, priming was found only in those subjects (50% of the total in one experiment) who reported using explicit memory in stem completion. Contrary to previous conclusions, the results indicate a role for established representations in explaining implicit memory.     

The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia

The relationship between traumatic experiences and dissociation with pretreatment psychopathology and rates of recovery, relapse and maintenance for patients receiving cognitive-behavioral treatments for panic disorder with agoraphobia (PDA) were investigated. One-hundred and forty-seven subjects who met DSM-III criteria for agoraphobia with panic attacks and who completed participation in one of two previously conducted treatment outcome studies were mailed packets containing measures to assess history of trauma, victimization and dissociation. Eighty-nine of these were returned and completed sufficiently to be included in the present study. It was hypothesized that a variety of trauma-related variables (e.g. history of traumatic experience, type of trauma, age at which the trauma first occurred, perceived responsibility, social supports available, self-perceived severity, level of violence, and whether or not the traumatic event was followed by self-injurious or suicidal thoughts and/or behaviors) and dissociative symptomatology would be predictive of (1) greater psychopathology at pretreatment, (2) poorer treatment response and (3) higher relapse rates and poorer maintenance over a 1 year longitudinal follow-up. These hypotheses were supported by the findings and the theoretical, empirical and clinical implications are discussed.     

Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia

Psychometric properties of the Beck Anxiety Inventory (BAI) (Beck and Steer, 1990) were investigated in a sample of 82 patients suffering from panic disorder with agoraphobia. Before and after brief treatment, patients completed a battery of questionnaires and, for 2-week periods, kept a daily panic diary in which they recorded panic attacks, fear of panic, and average anxiety. The BAI demonstrated excellent internal consistency and good test-retest reliability over a 5-week interval. A partial multitrait, multimethod correlation matrix provided evidence of convergent validity with other measures of anxiety and of divergent validity vis á vis measures of depression. Factor analyses of pretest scores and residual gain scores used to address criticism that the BAI is excessively panic-centric yielded mixed results. In one analysis, the BAI was loaded with multimethod measures of panic and anxiety and, in the other, with questionnaire methods of assessing anxiety and depression. However, the BAI was clearly distinguished from measures of fear of fear, a central construct in panic disorder, and agoraphobic avoidance. Finally, the BAI proved sensitive to change with treatment, yielding effect sizes for improvement comparable to those of other anxiety measures.     

EMDR for panic disorder with agoraphobia: Comparison with waiting list and credible attention-placebo control conditions.

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measure, (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (η?=?.00–.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive–behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of panic disorder with agoraphobia and specific phobia: relationship with the subtypes of specific phobia

The study objectives were to determine comorbidity rates for various subtypes of specific phobia (SP) in a sample of patients with the principal diagnosis of panic disorder with agoraphobia (PDA) and to examine the possible etiologic relatedness of these SP subtypes to PDA. Ninety consecutive day clinic patients with PDA were administered the Structured Clinical Interview for DSM-III-R (SCID) modified for DSM-IV. The overall comorbidity rate for SP was 65.6%. The most frequent subtypes of SP were situational phobia and dental phobia, followed by natural environment phobia, phobia of funerals, cemeteries, dead bodies, and other death-related phenomena and objects (referred to as death-related phobia), and blood-injection-injury phobia. Except for death-related phobia, other subtypes of SP clearly tended to precede the onset of PDA, often by many years. The smallest difference between the age of onset for PDA and particular subtypes of SP (temporal distance) was found for death-related phobia, whereas the temporal difference was longer for situational phobia, hospital phobia, and blood-injection-injury phobia. The frequency and temporal distance data suggest that death-related phobia may constitute a risk factor for developing PDA or that it is a prodrome of PDA, whereas situational phobia, hospital phobia, and blood-injection-injury phobia appear to predispose to PDA to a lesser degree. Of the three broadly conceived groups of SP, mutilation phobias (which include death-related phobia, hospital phobia, blood-injection-injury phobia, and dental phobia) appear most etiologically relevant for PDA, with the group of situational phobias (which also includes the natural environment subtype of SP) being less relevant, and animal phobias showing a negligible etiologic relatedness to PDA.     

Personality disorders and the outcome of cognitive–behavioural treatment of panic disorder with agoraphobia.

In recent years, cognitive–behavioural interventions have proven to be effective in the treatment of Panic Disorder with Agoraphobia (PDA). However, there is controversy concerning treatment efficacy of PDA for patients with a comorbid diagnosis of Personality Disorder (PD). This study evaluates the impact of a PD on PDA treatment response. 81 patients suffering from PDA were recruited from a cognitive–behavioural group treatment program. Diagnoses on Axis I (N?=?81) and Axis II (N?=?36) were made at treatment onset according to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria. Validated questionnaires were used to assess agoraphobia at treatment onset, following treatment, and at the 3 mo follow-up. All patients improved markedly from pretest to posttest and at the 3 mo follow-up. Grouping of patients according to the presence or absence of a personality disorder revealed significant differences between the groups on pre- and posttreatment scores on agoraphobia. Results also reveal that patients with a personality disorder improve more slowly than patients without a personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)