Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T13:33:32.670Z Has data issue: false hasContentIssue false
  • English
  • Français

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

Published online by Cambridge University Press:  26 March 2010

David Berle ,
Vladan Starcevic ,
Denise Milicevic ,
Anthony Hannan  and
Karen Moses
David Berle*
Affiliation:
Sydney West Area Health Service, Australia
Vladan Starcevic
Affiliation:
University of Sydney, Australia
Denise Milicevic
Affiliation:
Sydney West Area Health Service, Australia
Anthony Hannan
Affiliation:
Sydney West Area Health Service, Australia
Karen Moses
Affiliation:
Sydney West Area Health Service, Australia
*
Reprint requests to David Berle, Nepean Anxiety Disorders Clinic, Sydney West Area Health Service, PO Box 63, Penrith NSW 2751, Australia. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

Keywords

Panic disorderagoraphobiacognitionsmisinterpretationpanic symptoms
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 38 , Issue 3 , May 2010 , pp. 275 - 289
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
Arrindell, W. A. (1993). The fear of fear concept: evidence in favor of multidimensionality. Behaviour Research and Therapy, 31, 507–518. doi: 10.1016/0005-7967(93)90133-FCrossRefGoogle ScholarPubMed
Baron, R. M. and Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi: 10.1037/0022-3514.51.6.1173CrossRefGoogle ScholarPubMed
Beck, A. T., Emery, G. and Greenberg, R. L. (1985). Anxiety Disorders and Phobias: a cognitive perspective. New York: Basic Books.Google Scholar
Casey, L. M., Oei, T. P. S. and Newcombe, P. A. (2004). An integrated model of panic disorder: the role of positive and negative cognitions. Clinical Psychology Review, 24, 529–555. doi: 10.1016/j.cpr.2004.01.005CrossRefGoogle ScholarPubMed
Chambless, D. L. (1985). The relationship of severity of agoraphobia to associated psychopathology. Behaviour Research and Therapy, 23, 305–310. doi: 10.1016/0005-7967(85)90009-9CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097. doi: 10.1037/0022-006X.52.6.1090CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy, 23, 35–44. doi: 10.1016/0005-7967(85)90140-8CrossRefGoogle ScholarPubMed
Chambless, D. L. and Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13, 9–20. doi: 10.1007/BF01178486CrossRefGoogle Scholar
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. doi: 10.1016/0005-7967(86)90011-2CrossRefGoogle ScholarPubMed
Craske, M. G., Rachman, J. and Tallman, K. (1986). Mobility, cognitions and panic. Journal of Psychopathology and Behavioral Assessment, 8, 199–210. doi: 10.1007/BF00959832CrossRefGoogle Scholar
de Jong, G. M. and Bouman, T. K. (1995). Panic disorder: a baseline period. Predictability of agoraphobic avoidance behavior. Journal of Anxiety Disorders, 9, 185–199. doi: 10.1016/0887-6185(95)00001-5CrossRefGoogle Scholar
de Ruiter, C. and Garssen, B. (1989). Social anxiety and fear of bodily sensations in panic disorder and agoraphobia: a matched comparison. Journal of Psychopathology and Behavioral Assessment, 11, 175–184. doi: 10.1007/BF00960478CrossRefGoogle Scholar
Derogatis, L. R. (1994). SCL-90R Administration, Scoring and Procedures Manual (3rd ed.). Minneapolis, MN: NCS Pearson.Google Scholar
Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Goldstein, R. B., Smith, S., Huang, B. and Saha, T. D. (2006). The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 363–374.CrossRefGoogle ScholarPubMed
Fleming, B. and Faulk, A. (1989). Discriminating factors in panic disorder with and without agoraphobia. Journal of Anxiety Disorders, 3, 209–219. doi: 10.1016/0887-6185(89)90015-7CrossRefGoogle Scholar
Hoffart, A., Friis, S., Strand, J. and Olsen, B. (1994). Symptoms and cognitions during situational and hyperventilatory exposure in agoraphobic patients with and without panic. Journal of Psychopathology and Behavioral Assessment, 16, 15–32. doi: 10.1007/BF02229063CrossRefGoogle Scholar
Hofmann, S. G., Meuret, A. E., Rosenfield, D., Suvak, M. K., Barlow, D. H., Gorman, J. M., Shear, M. K. and Woods, S. W. (2007). Preliminary evidence for cognitive mediation during cognitive-behavioral therapy of panic disorder. Journal of Consulting and Clinical Psychology, 75, 374–379. doi: 10.1037/0022-006X.75.3.374CrossRefGoogle ScholarPubMed
Katschnig, H. and Amering, M. (1998). The long-term course of panic disorder and its predictors. Journal of Clinical Psychopharmacology, 18, 6s–11s. doi: 10.1097/00004714-199812001-00003CrossRefGoogle ScholarPubMed
Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., Janavs, J. and Dunbar, G. C. (1997). The Mini International Neuropsychiatric Interview (MINI): a short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry, 12, 224–231. doi: 10.1016/S0924-9338(97)83296-8CrossRefGoogle Scholar
MacKinnon, D. P., Fairchild, A. J. and Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. doi: 10.1146/annurev.psych.58.110405.085542CrossRefGoogle ScholarPubMed
Marks, I. M. and Matthews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263–267. doi: 10.1016/0005-7967(79)90041-XCrossRefGoogle ScholarPubMed
Meuret, A. E., White, K. S., Ritz, T., Roth, W. T., Hofmann, S. G. and Brown, T. A. (2006). Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder. Journal of Psychiatric Research, 40, 520–527. doi: 10.1016/j.jpsychires.2005.09.006CrossRefGoogle ScholarPubMed
Noyes, R., Clancy, J., Garvey, M. J. and Anderson, D. J. (1987). Is agoraphobia a variant of panic disorder or a separate illness? Journal of Anxiety Disorders, 1, 3–13. doi: 10.1016/0887-6185(87)90018-1CrossRefGoogle Scholar
Rachman, S., Levitt, K. and Lopatka, C. (1987). Panic: the links between cognitions and bodily symptoms-I. Behaviour Research and Therapy, 25, 411–423. doi: 10.1016/0005-7967(87)90018-0CrossRefGoogle ScholarPubMed
Reich, J., Noyes, R. and Troughton, E. (1987). Dependent personality disorder associated with phobic avoidance in patients with panic disorder. American Journal of Psychiatry, 144, 323–326.Google ScholarPubMed
Rush, A. J., Pincus, H. A., First, M. B., Blacker, D., Endicott, J., Keith, S. J., Phillips, K. A., Ryan, N. D., Smith, G. R., Tsuang, M. T., Widiger, T. A. and Zarin, D. A. (2000). Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association.Google Scholar
Salkovskis, P. M., Clark, D. M. and Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34, 453–458. doi: 10.1016/0005-7967(95)00083-6CrossRefGoogle Scholar
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A. and Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574. doi: 10.1016/S0005-7967(98)00153-3CrossRefGoogle ScholarPubMed
Schmidt, N. B., Salas, D., Bernert, R. and Schatschneider, C. (2005). Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision making. Behaviour Research and Therapy, 43, 1219–1229. doi: 10.1016/j.brat.2004.09.004CrossRefGoogle ScholarPubMed
Sheehan, D., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., Sheehan, M., Lecrubier, Y., Weiller, E., Hegueta, T., Amorim, P., Bonora, L. I. and Lépine, J. P. (1999). The Mini International Neuropsychiatric Interview (M.I.N.I). English version 5.0.0. DSM-IV. Journal of Clinical Psychiatry, 60, 39–62.Google Scholar
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R. and Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 (Suppl. 20), 22–33.Google ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M. F. and Dunbar, G. C. (1997). The validity of the MINI International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241. doi: 10.1016/S0924-9338(97)83297-XCrossRefGoogle Scholar
Shrout, P. E. and Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological Methods, 7, 422–445. doi: 10.1037/1082-989X.7.4.422CrossRefGoogle ScholarPubMed
Slade, T. and Grisham, J. R. (2009). A taxometric investigation of agoraphobia in a clinical and community sample. Journal of Anxiety Disorders, 23, 799–805. doi: 10.1016/j.janxdis.2009.03.004CrossRefGoogle Scholar
Smits, J. A. J., Powers, M. B., Cho, Y. and Telch, M. J. (2004). Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis. Journal of Consulting and Clinical Psychology, 72, 646–652. doi: 10.1037/0022-006X.72.4.646CrossRefGoogle ScholarPubMed
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 290–312.CrossRefGoogle Scholar
Starcevic, V., Kellner, R., Uhlenhuth, E. H. and Pathak, D. (1993). The phenomenology of panic attacks in panic disorder with and without agoraphobia. Comprehensive Psychiatry, 34, 36–41. doi: 10.1016/0010-440X(93)90033-ZCrossRefGoogle ScholarPubMed
Street, L. L., Craske, M. G. and Barlow, D. H. (1989). Sensations, cognitions and the perception of cues associated with expected and unexpected panic attacks. Behaviour Research and Therapy, 27, 189–198. doi: 10.1016/0005-7967(89)90078-8CrossRefGoogle ScholarPubMed
Tecer, A. T., Tükel, R., Erdamar, B. and Sunay, T. (2004). Audiovestibular functioning in patients with panic disorder. Journal of Psychosomatic Research, 57, 177–182. doi: 10.1016/S0022-3999(03)00568-3CrossRefGoogle ScholarPubMed
Telch, M. J., Brouillard, M., Telch, C. F., Agras, W. S. and Taylor, C. B. (1989). Role of cognitive appraisal in panic-related avoidance. Behaviour Research and Therapy, 27, 373–383. doi: 10.1016/0005-7967(89)90007-7CrossRefGoogle ScholarPubMed
Telch, M. J., Jacquin, K., Smits, J. A. J. and Powers, M. B. (2003). Emotional responding to hyperventilation as a predictor of agoraphobia status among individuals suffering from panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 34, 161–170. doi: 10.1016/S0005-7916(03)00037-5CrossRefGoogle ScholarPubMed
Turner, S. M., Williams, S. L., Beidel, D. C. and Mezzich, J. E. (1986). Panic disorder and agoraphobia with panic attacks: covariation along the dimensions of panic and agoraphobic fear. Journal of Abnormal Psychology, 95, 384–388. doi: 10.1037/0021-843X.95.4.384CrossRefGoogle ScholarPubMed
Uhlenhuth, E. H., Leon, A. C. and Matuzas, W. (2006). Psychopathology of panic attacks in panic disorder. Journal of Affective Disorders, 92, 55–62. doi: 10.1016/j.jad.2005.12.036CrossRefGoogle ScholarPubMed
Williams, S. L., Kinney, P. J. and Falbo, J. (1989). Generalization of therapeutic changes in agoraphobia: the role of perceived self-efficacy. Journal of Consulting and Clinical Psychology, 57, 436–442. doi: 10.1037/0022-006X.57.3.436CrossRefGoogle ScholarPubMed
Yardley, L., Britton, J., Lear, S., Bird, J. and Luxon, L. M. (1995). Relationship between balance system function and agoraphobic avoidance. Behaviour Research and Therapy, 33, 435–439. doi: 10.1016/0005-7967(94)00060-WCrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.