Background: Increased heartbeat perception accuracy (HBP-accuracy) may contribute to the pathogenesis of Panic Disorder (PD) without or with Agoraphobia (PDA). Extant research suggests that HBP-accuracy is a rather stable individual characteristic, moreover predictive of worse long-term outcome in PD/PDA patients. However, it remains still unexplored whether HBP-accuracy adversely affects patients’ short-term outcome after structured cognitive behaviour therapy (CBT) for PD/PDA. Aim: To explore the potential association between HBP-accuracy and the short-term outcome of a structured brief-CBT for the acute treatment of PDA. Method: We assessed baseline HBP-accuracy using the “mental tracking” paradigm in 25 consecutive medication-free, CBT-naive PDA patients. Patients then underwent a structured, protocol-based, 8-session CBT by the same therapist. Outcome measures included the number of panic attacks during the past week, the Agoraphobic Cognitions Questionnaire (ACQ), and the Mobility Inventory-Alone subscale (MI-alone). Results: No association emerged between baseline HBP-accuracy and posttreatment changes concerning number of panic attacks. Moreover, higher baseline HBP-accuracy was associated with significantly larger reductions in the scores of the ACQ and the MI-alone scales. Conclusion: Our results suggest that in PDA patients undergoing structured brief-CBT for the acute treatment of their symptoms, higher baseline HBP-accuracy is not associated with worse short-term outcome concerning panic attacks. Furthermore, higher baseline HBP-accuracy may be associated with enhanced therapeutic gains in agoraphobic cognitions and behaviours.

Background: People with anxiety disorders occasionally report fears about losing control of basic bodily functions in public. These anxieties often occur in the absence of physical disorder and have previously been recognized as “obsessive” anxieties reflecting a preoccupation with loss of bowel/bladder control. Motivated by our observations of the non-trivial occurrence of such anxieties in our clinical practice we sought to fill a gap in the current understanding of “bowel/bladder-control anxieties”. Method: Eligible participants completed an internet survey. Results: Bowel/bladder-control anxieties (n = 140) tended to emerge in the mid to late 20s and were associated with high levels of avoidance and functional impairment. There was a high prevalence of panic attacks (78%); these were especially prevalent among those with bowel-control anxiety. Of those with panic attacks, 62% indicated that their main concern was being incontinent during a panic attack. Significantly, a proportion of respondents (~16%) reported actually being incontinent during a panic attack. Seventy percent of participants reported intrusive imagery related to loss of bowel/bladder control. Intrusion-related distress was correlated with agoraphobic avoidance and general role impairment. Some differences were noted between those with predominantly bowel-, predominantly bladder- and those with both bowel and bladder-control anxieties. Conclusion: This preliminary characterization indicates that even in a non-treatment seeking community sample, bowel/bladder-control anxieties are associated with high levels of distress and impairment. Further careful characterization of these anxieties will clarify their phenomenology and help us develop or modify treatment protocols in a way that takes account of any special characteristics of such viscerally-centred phobic syndromes.

Background: The present study evaluated attentional bias in adolescents diagnosed with panic disorder. Although a large body of research exists in the area of attentional bias in adults, this feature of panic disorder is not well understood in adolescents. Method: Twenty-five adolescents, aged 12–17, with a panic disorder diagnosis were included in the study. An emotional Stroop task was utilized to assess whether: (1) adolescents with panic disorder exhibit an attentional bias to panic-relevant stimuli; (2) this bias diminishes after completing a course of CBT; and (3) a specific attentional bias towards disorder-relevant stimuli exists. Results: An attentional bias to panic-relevant stimuli was found at pre-treatment but was no longer present following an intensive CBT intervention. Contrary to some findings in the adult literature, no significant differences were found between panic-relevant versus other threatening stimuli. Conclusions: These results suggest that adolescents with panic disorder, similar to adults, do exhibit an attentional bias towards panic-relevant stimuli, and treatment seems to normalize this cognitive process.

A brief treatment for panic disorder with agoraphobia (PDA) supported by self-help materials may be an alternative choice to standard CBT: this type of program may also help to overcome some of the cost-benefit limitations of standard cognitive behavioural therapy. The aim of this study was to test the efficacy of a brief cognitive behaviour therapy (7 weeks) for PDA, with and without partner involvement, along with a self-study manual. A total of 77 participants meeting DSM-IV criteria of PDA were assigned to one of three treatment conditions: 1) a 14-session standard CBT (n = 26); 2) a 7-session brief cognitive behaviour therapy along with a self-study manual (n = 26); and 3) a 7-session brief cognitive behaviour therapy involving a partner along with a self-study manual (n = 25). Results show a statistically and clinically significant improvement on all outcome measures in the three treatment conditions. Gains were maintained up to 6 months. Both brief CBT conditions were as effective as the standard cognitive behavioural treatment. These results suggest that a brief program, supported by self-help materials, that shortens the time during which the patient suffers from this problem may be a good option for the treatment of panic disorder.

To study the role of catastrophic interpersonal cognitions in panic disorder with or without agoraphobia, a questionnaire listing such items – the Interpersonal Panic Fear Questionnaire (IPFQ) – was constructed and administered to English and Norwegian samples. The results of the factor analysis indicated a three-factor structure of interpersonal fears: fear of negative evaluation, fear of being trapped and separated from safe persons and places, and fear of being neglected. The corresponding three IPFQ scales had satisfactory internal consistency and sensitivity to change following therapeutic intervention, discriminated well between diagnostic groups, and correlated moderately with measures of other dimensions of panic disorder and agoraphobia. The construct validity of the interpersonal fears was further supported by mostly significant relationships between the IPFQ scales and a measure of agoraphobic avoidance, when the contribution of intrapersonal (physical, loss of control) fears was controlled.