The overall aim of this project was to investigate the nature and structure of the physiological symptoms of panic attacks and the relationship between these symptoms and use of the health care system by people with a clinical diagnosis of panic disorder. Cioffi's model of somatic interpretation was explored in relation to this issue as it had been previously applied to predominantly physiological conditions and appeared to offer a potentially useful framework for understanding the behaviour of people with panic disorder.The first study consisted of a principal components analysis of 153 panic attack symptom checklists from the Anxiety Disorders Interview Schedule - Third Edition - Revised (ADIS-III-R).Five separate physiological components emerged from the analysis which mirrored common medical conditions. A cluster analysis of the symptoms of 153 individuals indicated that the sample formed five separate groups corresponding to the five physiological components identified. The results of this study supported suggestions put forward in the literature regarding the possible clustering of the physiological symptoms of panic attacks. The study also found evidence to suggest that individuals with panic disorder can be identified in distinct sub-groups according to the most predominant physiological symptoms reported.The second study was made up of two parts. Part one investigated the health utilisation behaviour and associated costs for people with panic disorder and compared them with people with social phobia. Significantly higher costs and rates of utilisation were found for the panic disorder group compared to the group with social phobia. Part two of this study investigated the relationship between a person with panic disorder's most predominant physiological panic symptoms and the type of medical specialists consulted. Fifty three individuals with panic disorder ++ / were included in the study and the proposed relationship was analysed using a bi-partial regression analysis. The respiratory group was significantly related to the type of specialist seen.The third study was aimed at clarifying the interpretation of ambiguous symptoms in panic disorder. Thirty eight people with panic disorder completed a questionnaire requiring them to give explanations as to the cause of a number of ambiguous somatic sensations. It was hypothesised that there would be a relationship between the persons highest component score (as identified in the first study) and the interpretation of threat made in response to the items on the questionnaire. No such relationship was found although significantly more threat-interpretations were made when the individual's cognitive threat schema was activated.Study four investigated the influence of the type of panic recording measure upon the severity and number of panic symptoms reported. A secondary aim was to compare panic symptoms recorded following a panic provocation procedure in the clinic with those recorded following naturally occurring panic attacks. Thirty seven people with panic disorder recorded the symptoms of panic attacks experienced in the natural environment and those induced via hyperventilation in the clinic. It was hypothesised that there would be an effect for recording measure on the dependent variables of symptom severity and number. This hypothesis was supported with the structured recording measure producing significantly more symptoms of a greater severity than the unstructured or descriptive measure. An interaction effect was found for the neurological group of symptoms whereby the severity of symptoms was significantly higher in the clinic setting than in the natural environment with the descriptive measure resulting in significantly greater severity ratings.The final study ++ / investigated the efficacy of information-giving as an intervention for panic disorder. Forty individuals with panic disorder were randomly assigned to either receive two sessions of information-giving as well as self-monitoring of their symptoms or self-monitoring only. As hypothesised the group receiving information as well as self- monitoring had significantly lower levels of general anxiety and depression as well as anticipatory anxiety at the end of the intervention period.Several important implications emerge from these results. The finding that people with panic disorder can be identified according to the predominant set of physiological symptoms they report provides some useful information for identification of the problem in general medical settings. This project demonstrated the need for a screening measure for panic disorder in Australian medical settings as well as the potential effectiveness of the provision of information relating to anxiety and panic. In addition, Cioffi's model of somatic interpretation was found to be a useful framework with which to consider underlying processes relating to the interpretation of panic sensations.

Master of Science / The current study aimed to test the efficacy of individual, synchronous Internet Therapy for panic disorder compared to traditional face-to-face therapy. Thirty participants diagnosed with panic disorder were randomly allocated to either Internet Therapy or face-to-face therapy, and received a manualised cognitive-behavioural treatment program. When analysed separately, results indicated that face-to-face treatment significantly reduced panic symptomatology overall, however significant gains were not shown for the Internet Therapy condition. However, a direct comparison of the two active treatments failed to show significant differences, as measured by a Multivariate Analysis of Variance (MANOVA) on pre- and post-treatment variables. Internet Therapy did, however, significantly reduce certain symptoms of panic disorder, indicating that Internet Therapy may be useful as an adjunctive treatment to face-to-face therapy. Intention-to-treat analyses suggested that face-to-face treatment may be more effective than Internet Therapy for treating panic disorder. Additionally, there were no differences between treatment conditions in levels of working alliance, indicating that among those who stay in treatment, working alliance can be established online at a similar level to that of face-to-face therapy. However a high number of dropouts in the Internet Therapy condition warranted consideration. A thorough explanation of the results is offered in addition to recommendations for the future directions of the research and clinical implementation of Internet Therapy.

Although the prevalence rate of panic disorder (PD) among adolescents is relatively low, epidemiological research suggests that panic attacks and subclinical panic disorder symptoms occur in a substantial portion of the adolescent population. Retrospective and prospective studies also suggest that adolescence is a critical developmental period for the onset of PD symptoms. Given the negative academic, social, and emotional outcomes associated with undetected and untreated PD, effective prevention and intervention are warranted. Identifying adolescents with current PD or who may be at-risk for future PD is an important step in such treatment efforts. Among professionals working with youth, physicians and medical staff may be at a particularly advantageous position to screen for adolescent panic symptoms, given the high utilization of medical services among those experiencing such PD symptoms. Although limited time and resources within primary care settings frequently hinder effective mental health screening procedures, the use of time-and cost-effective screening instruments may aid professionals in detection efforts. With this in mind, the current study sought to validate a brief screening tool previously studied with adults for use with adolescents seen at pediatrics primary care practices. The screening instrument was evaluated both in terms of its ability to effectively detect adolescents with PD and in terms of the association between positive screen status and cognitive, symptom, and broader impairment variables associated with PD. Participants included 165 adolescents (57% male) ages 12 to 17 (M = 14.40; SD = 1.77) recruited from two general pediatrics clinics in Miami-Dade County, Florida. The sample was 42.3% White, Non-Hispanic, 41.1% Hispanic, 7.9% Black (African-American and Caribbean American), 1.2% Asian American, 7.4% mixed ethnicity or other, and 1.2% unknown. At Time 1, while in the waiting room of a pediatrics clinic, participants completed the Autonomic Nervous System Questionnaire (ANS; Stein et al., 1999), a five-item screening measure of panic symptoms. Of this larger sample, 45 participants (25 screening positive for potential panic disorder and 20 with negative screens, matched by age and gender to the positive screen group) completed telephone-administered follow-up measures at Time 2. Follow-up measures included a more comprehensive diagnostic assessment of PD and agoraphobia, as well as adolescent-report measures of anxiety sensitivity, interpretive biases, overall anxiety and depression, and functional impairment. At Time 1, 65 participants (39.4%) screened positive on the ANS, as indicated by endorsing the first and/or second item on the measure. Of those screening positive, roughly one-third of participants (33.84% of positive screens) endorsed moderate to severe anticipatory anxiety about future panic attacks. The ANS displayed excellent sensitivity (Se = 1.00), with two participants from the positive screen group meeting criteria for PD, and no control participants meeting criteria. However, as expected, specificity of the ANS was lower (Sp = .43), indicating a high degree of false positives (e.g., those screening positive but not meeting criteria for PD). In addition, as hypothesized, the ANS demonstrated good test-retest reliability (r = .74). Independent samples t-tests revealed that positive screen participants had significantly higher self-reported anxiety sensitivity, interpretive biases, anxious and depressive symptoms (including panic), and functional impairment than negative screen participants. This difference remained significant for overall symptom T-scores on the Revised Child Anxiety and Depression Scales (RCADS; Chorpita et al., 2000), even after controlling for group differences in anxiety sensitivity and interpretive biases. Finally, further analyses revealed that participants endorsing both starter items on the ANS (n = 7) had higher elevations on self-reported anxiety sensitivity and panic symptoms, compared to those not endorsing either item or those endorsing the first item (e.g., "In the past six months, did you ever have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy?"), but not higher than those endorsing only the second item ("In the past six months, did you ever have a spell or attack when for no reason your heart suddenly began to race, you felt faint, or you couldn't catch your breath?"). These findings offer preliminary validation for the ANS as a screening measure for PD in adolescence, given its high sensitivity and ability to adequately "catch" patients with PD (e.g., low false negative rate). Perhaps even more importantly, those screening positive on the ANS demonstrated higher scores on cognitive correlates of PD and elevated internalizing symptoms and functional impairment, compared to participants screening negative. Based on these analyses, current recommendations for physicians and medical staff are to monitor and follow-up with adolescents screening positive on the ANS for the development of anxiety and panic disorder symptoms, particularly among those who endorse both starter items. However, given the relatively small sample size, replication of these findings in a larger sample is needed to further validate these recommendations. Finally, implications for prevention and intervention within pediatrics settings are discussed.

Master of Science / The current study aimed to test the efficacy of individual, synchronous Internet Therapy for panic disorder compared to traditional face-to-face therapy. Thirty participants diagnosed with panic disorder were randomly allocated to either Internet Therapy or face-to-face therapy, and received a manualised cognitive-behavioural treatment program. When analysed separately, results indicated that face-to-face treatment significantly reduced panic symptomatology overall, however significant gains were not shown for the Internet Therapy condition. However, a direct comparison of the two active treatments failed to show significant differences, as measured by a Multivariate Analysis of Variance (MANOVA) on pre- and post-treatment variables. Internet Therapy did, however, significantly reduce certain symptoms of panic disorder, indicating that Internet Therapy may be useful as an adjunctive treatment to face-to-face therapy. Intention-to-treat analyses suggested that face-to-face treatment may be more effective than Internet Therapy for treating panic disorder. Additionally, there were no differences between treatment conditions in levels of working alliance, indicating that among those who stay in treatment, working alliance can be established online at a similar level to that of face-to-face therapy. However a high number of dropouts in the Internet Therapy condition warranted consideration. A thorough explanation of the results is offered in addition to recommendations for the future directions of the research and clinical implementation of Internet Therapy.

The number of reported students with psychiatric disabilities who are seeking services and/or accommodations is steadily increasing on college campuses. Much of the research and documentation that surround the study of college students with psychiatric disorders is extremely broad in focus and tends to group all psychiatric diagnoses together when reporting outcome studies. The research literature that is devoted to the study of the college student diagnoses with Panic Disorder with Agoraphobia is limited in scope and nature. The majority of the literature is devoted to the physiological and behavioral ramifications of the disorder or treatment modalities. a review of the extant literature reveals that there is no substantive research available that provides insight into the college experiences of the student diagnoses with Panic Disorder with Agoraphobia. In summary, it is safe to say that there is not enough pertinent information readily available to enlighten college and university faculty and staff about the experiences of college students diagnosed with Panic Disorder with Agoraphobia. specifically, little is known about: (1) the academic, psychosocial, and environmental needs of these students (2) what disability related barriers these student may have experienced (3) what coping mechanisms are typically employed, and (4) what services and accommodations these students have found to be the most effective while they were enrolled in college. The purpose of this study was to examine the nature and the scope of the college experiences of students who were diagnosed with Panic Disorder with Agoraphobia. The subjects for this study consisted of a select group of upperclassmen at Virginia Tech. Gender or age was not a factor in the selection process. For purposes of this study, the qualitative in-depth interview method was considered the most appropriate form of data collection. Analysis of the data revealed the following common experiences among the subjects in the study: (1) All subjects experienced difficulties in the classroom due to their Panic Disorder. (2) All of the subjects had concerns with the physical setting of the campus (i.e. preferential seating, avoidance of large classrooms and auditoriums, and anxiety-like symptoms as the result of bright or fluorescent lighting). (3) A lack of social contacts both in and out of the classroom was a common experience. (4) While all subjects had tried medication to control their Panic Disorder, two of the subjects stopped their medication even though they reported an improvement I their symptoms. The majority of the subjects stated that they did not want to remain on the medication for fear of addiction or using the medication as a "crutch." (5) All of the subjects sought out counseling while attending Virginia Tech. All of the subjects, with the exception of one, did not seek any treatment for their anxiety of Panic Attacks until after they arrived at Virginia Tech. (6) All of the subjects, with the exception of one suffered with either chronic anxiety, or Panic Attacks for over one year before seeking any medical relief or counseling. (7) All of the subjects reported that counseling was helpful and for the most part, they all tried to use relaxation techniques when experiencing a Panic Attack. (8) All of the subjects are still having difficulty with chronic anticipatory anxiety and occasional Panic Attacks. (9) While the majority of the subjects interviewed were optimistic about their career options, it was evident that all of the subjects have encountered significant anxiety-related barriers that have impacted their choice of major and possible future jobs. the majority of the subjects reported that it was important to have a job where the workload was not too stressful and the workplace was viewed as a "safe" environment. / Ph. D.

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Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.

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No description available.

Following a review of treatment outcome study methodology, a comparative study of psychological versus pharmacological treatments was conducted; subsidiary studies investigated aspects of treatment outcome in more detail. 193 patients with DSM III-R panic disorder with or without agoraphobia were randomly allocated to; fluvoxamine, placebo, fluvoxamine + CBT (cognitive behaviour therapy), placebo + CBT, or CBT alone. Patients received no concurrent treatments and were treated to the same schedule, with therapist contact balanced across groups. Treatments were conducted in the primary care setting. Outcome at treatment end-point and 6 month follow-up, assessed in terms of both statistical and clinical significance, showed patients receiving active treatments improved significantly, with improvement better preserved over follow-up in the groups receiving CBT. The CBT alone and fluvoxamine + CBT groups showed the most consistent gains, the latter group showing gains earliest in treatment. Outcome was also investigated using brief global ratings of symptom severity, change in symptoms following treatment, general wellbeing and social disruption, completed by psychologist, referring GPs, and patients. Using these measures all active treatments showed statistical advantage over placebo with the groups employing CBT showing the most robust and consistent response. Overall there were no significant differences in drop-out rates between groups although the drop-out rate for patients receiving CBT alone was higher than that for placebo + CBT. Agreement with main outcome measures was demonstrated for psychologist and patient ratings, but not for GP ratings. An investigation of panic attack variables as treatment outcome measures indicated that these did not function as discriminative treatment outcome measures with all treatment groups showing significant reductions in panic attack variables over treatment with few significant differences between treatment groups on any variable throughout treatment. An investigation of prognostic indicators of treatment outcome indicated good prediction of post treatment response using pre-treatment measures of anxiety level, frequency of panic attacks, extroversion and treatment group. Predictions of outcome at 6 month follow-up were less robust. Results are discussed in terms of their relevance to wider clinical practice.