The present study was designed to test the efficacy of a bibliotherapy-relapse prevention (BT-RP) program for panic attacks in which the active BT-RP condition was compared to a waiting-list control condition. Prior to the administration of the six-month BT-RP program, all participants completed an initial BT intervention (Febbraro, 1997) based on the book Coping with Panic (Clum, 1990). The BT-RP program was designed to: (a) review major components of the initial intervention; (b) increase practice of panic coping skills and therapeutic self-exposure; (c) enhance social support for panic recovery; (d) teach cognitive restructuring skills related to relapse prevention; (e) provide a protocol to follow in the event of a setback; and (f) reduce overall levels of stress. Brief monthly phone contacts were included in the BT-RP condition. Thirty-six participants, 17 in the BT-RP condition and 19 in the WL control condition, completed the study. A 2 (Treatment condition: BT-RP versus WL control) X 2 (Time: Pre-BT-RP assessment versus Post-BT-RP assessment) mixed-model research design was used to analyze the results. Results indicted significant reductions from pre- to post-treatment in the BT-RP condition for panic cognitions, anticipatory anxiety, agoraphobic avoidance, and depression, but not in the WL condition. When statistically controlling for initial levels of these variables via analyses of covariance (ANCOVAs), significant post-treatment differences in the expected direction emerged for these four dependent measure and for state anxiety. In addition, the BT-RP group reported significantly fewer panic attacks during the six-month course of the treatment trial than the WL control group on a measure of retrospective recall of full-blown panic attacks. There was also a statistically significant proportional between-group difference in terms of clinically significant improvement for full-blown panic attacks and agoraphobic avoidance in favor of the BT-RP group. However, no significant between-group differences emerged for the maintenance of initial treatment gains for panic frequency, panic symptoms, panic cognitions, anticipatory anxiety, or agoraphobic avoidance. Results of the present study are discussed in the framework of benefits of the present BT-RP program, limitations of the findings, recommendations for future research in this area, and implications for BT treatments in general. / Ph. D.

Treatment outcome studies investigating potential treatments for panic disorder invariably begin with a lengthy assessment designed to determine whether a potential subject meets criteria for the disorder. Through the process of assessment, subject are usually given some form of feedback about their condition, if only to tell them they meet criteria to enter the study. Assessment and feedback are thought to have therapeutic effects and empirical evidence is beginning to document this (Bien, Miller, & Tonigan, 1993; Finn & Tonsager, 1992). To date, there have been no studies that investigate the effects of assessment plus feedback or assessment alone on individuals with panic attacks. This study investigated whether assessment or assessment plus feedback produced any differential effects on panic attack sufferers. Seventy participants were randomly assigned to one of four groups: 1) assessment with mailed feedback (n=17); 2) assessment with face-to-face feedback (n=14); 3) assessment with no feedback (n=19); and 4) no assessment or feedback (n=20). Assessment consisted of completing a composite self-report instrument that asks about frequency of panic attacks and panic-related symptomatology. Feedback was standardized and computer generated but individualized based on scores on the assessment measure. All groups completed the outcome measures and between group differences were examined. No statistically significant differences were found between these four groups on any dependent measure. However, for a smaller subset of participants (N=35) who had at least one full panic attack at pre-assessment, a significant reduction in frequency of combined (full plus limited-symptom) panic attacks was seen pre to post, F(1,32)=7.47, p<.01, with a marginally significant two-way interaction of Time and Condition, F(2,32)=3.12, p<.06. Basically, both feedback groups showed a reduction in panic attacks while the assessment only condition remained the same. / Master of Science

Anxiety may be experienced in a variety of response modes. There is evidence to suggest that panic disordered individuals differ from individuals with other anxiety diagnoses in that they experience a greater increase in somatic symptoms and catastrophic cognitions. Further it has been suggested that panic disordered individuals, as compared to other anxiety disordered individuals, experience greater global anxiety and depression. The present study compared the total scores of 93 disordered subjects on the Symptom Assessment Questionnaire and the Cognitions Assessment Questionnaire and found that both questionnaires discriminated panic disordered subjects from non-panic disordered subjects. The two questionnaires also discriminated subjects with panic attacks from subjects without panic attacks. Item analyses were conducted on both questionnaires in order to identify specific items which differentiated panic disordered subjects from non-panic disordered subjects and subjects with panic attacks from subjects without panic attacks. Factor analyses were conducted on both questionnaires, resulting in the identification of somatic and cognitive factors salient to the phenomenon of panic. In general, the identified factors supported and expanded upon the panic symptoms listed in DSM-III. Finally, two widely used measures of anxiety and depression were administered to subjects. Panickers scored higher than Non-panickers on measures of state-anxiety, trait-anxiety, and depression. The Panic Disordered Group scored higher than the Non-Panic Disordered Group on the depression scale. However, the Panic Disordered Group scored no differently from the NonPanic Disordered on the state-anxiety and trait-anxiety inventories, suggesting that the presence of panic attacks in all anxiety diagnostic groups weakened the ability of the tradition anxiety measures to distinguish between the comparison groups. / M.S.

Panic attacks are, by definition, frightening experiences. Recent research has attempted to develop efficacious treatments for individuals suffering from these sudden episodes of fear. The current investigation sought to examine the efficacy of a new cognitive-behavioral treatment, Guided lmaginal Coping. This treatment aims to improve the coping repertoires of panic sufferers. Pilot results with this treatment suggest that it is an effective treatment. The current study sought to extend these findings by evaluating the process of change over time. The second purpose of the current investigation was to examine whether the concept of self-efficacy could help explain the process of change over time. Nineteen subjects diagnosed with Panic Disorder or Agoraphobia with panic attacks were assigned to one of two treatment groups: Guided lmaginal Coping or Panic Education, a nondirective treatment. Subjects in each group received six individual and four group therapy sessions. In addition to treatment, each subject met with a trained evaluator before treatment began, the five weeks of treatment, posttreatment, and one and two month follow-up periods. During these evaluations, subjects participated in a taped anxiety induction procedure and completed questionnaires concerning their degree of self-efficacy, level of panic symptoms, catastrophic thoughts, avoidance, and frequency of coping. Results indicated that subjects in both treatment groups had significant reductions in symptoms, catastrophic thoughts, and number of attacks. Guided lmaginal Coping subjects demonstrated reduction in avoidance and showed continued improvement in symptom reduction during the follow-up period, Both groups showed improved coping abilities. Self-efflcacy and rated coping were significantly related at all evaluation periods. Cross-lagged panel analyses revealed that self-efficacy appeared to lead to changes in catastrophic thoughts whereas self-efficacy and symptom level appeared mutually causal. Self-efficacy and avoidance did not appear consistently related nor did self-efficacy and coping frequency. Rated coping effectiveness appeared to improve in both groups although coping frequency did not. Results are discussed related to treatment outcome and to panic not being as refractory a problem as presumed. Implications are discussed in terms of models of panic and the significance of self-efficacy and catastrophic cognitions to these models and to the amelioration of panic. / Ph. D.

A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.

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.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2004. / Härtill 5 uppsatser.

The objective of this study is to see if nonclinical panickers with unexpected panic attacks (NCPs-U) may be a more useful panic disorder (PD) analogue than nonclinical panickers with expected panic attacks (NCPs-E).

[pt] A matéria cinzenta periaquedutal dorsal (MCPD) é associada com comportamento defensivo e ataques de pânico em humanos. Estimulações elétricas da MCPD induzem a um repertório de defesa: o congelamento pré fuga, reação de fuga e congelamento pós fuga. Evidências já apresentadas suportam a hipótese que enquanto o congelamento pré fuga seria um modelo de ataque de pânico o congelamento pós fuga seria um modelo de transtorno de pânico. Os resultados no experimento 1 indicaram que as duas linhagens de animais selecionadas para alto (Carioca alto congelamento) e baixo (Carioca baixo congelamento) congelamento em resposta ao contexto associado com choque nas patas, demonstraram que embora a ansiedade antecipatória possa exercer um efeito inibitório na expressão do congelamento pré fuga e na reação de fuga, pode por sua vez facilitar o congelamento pós fuga. No experimento 2, o efeito de lesões eletrolíticas no Córtex Cingulado Anterior Rostral não alteraram o congelamento pré fuga e a reação de fuga, porém as mesmas exercem um efeito inibitório no congelamento pós fuga demonstrando que os tipos de congelamento no medo incondicionado são mediados por circuitarias de defesa independentes. No experimento 3, o efeito de lesões eletrolíticas no Córtex Cingulado Anterior Rostral (CCAr) aumentou a sensibilidade a dor (comportamento recuperativo) de animais submetidos ao teste de formalina no paradigma de analgesia condicionada demonstrando a importância do CCAr na modulação da circuitaria de dor. / [en] The dorsal portion of the periaqueductal Gray (DPAG) is notably associated with defensive behavior and panic attacks in humans. Electrical stimulation of the DPAG induces a repertoire of defense: dPAG-evoked freezing, escape reaction and dPAG post-stimulation freezing. Past evidence support the hypothesis that whereas dPAG-evoked freezing would serve as model of panic attack, the dPAG post-stimulation freezing appears to be a model of panic disorder. The experiment 1 used two lines of animals selectively bred for high (Carioca High-Freezing) and low (Carioca Low-Freezing) freezing in response to contextual cues associated with footshock. The results suggest that although anticipatory anxiety might exert an inhibitory effect on the dPAG-evoked freezing and escape reaction, it might also facilitate the dPAG post-stimulation freezing. The experiment 2 studied the effect of electrolytic lesions on rostral anterior cingulated cortex (rACC). The results of electrolytic lesions on rACC suggest that although rACC lesions did not change the dPAG-evoked freezing and escape threshold, it might exert an inhibitory effect on the dPAG post-stimulation freezing, reinforcing the hypothesis that dPAG-evoked freezing and dPAG post- stimulation freezing are modulated by two independent circuitry of defense. The experiment 3 studied pain sensibility of rACC lesioned animals submitted to formalin test on conditioned analgesia paradigm. The results suggest that rACC lesions might exert an inhibitory effect on conditioned analgesia and consequently exacerbates recuperative behavior. The results also support the hypothesis of the rule of rACC on pain modulation.

Previous research demonstrated the phenomenon of moral panics on “dangerous” games mostly from Western perspectives, regarding media violence and deviant behaviour. With the development of media technology, the term “media panic” has evolved from moral panic, representing the debates and fearful emotion from the public when a new media technology has been created. Digital games as a form of media technology have been developed to be widely played on various platforms in recent decades, which have not only brought concerns to the Western but also to Chinese society. The present study will introduce media panic on digital games in China by analyzing news reports from three Chinese mainstream news media: People’s Daily, Xinhua Daily Telegraph and Wen Wei Po (Shanghai). Content analysis will be adopted as the main method to process the news data (N = 445) which are collected from five periods between 2002 and 2020 (2002-2004, 2007-2009, 2012-2014, 2017-2019, 2020). Different phases and features of the panic will be analyzed through the classical moral panic theories of Cohen, Goode and Ben-Yehuda, and the media panic theory of Drotner. Topics of game addiction, Internet cafes, policies on the game industry, cultural innovation, development of esports will be explored when investigating the changing media attitudes toward digital games in the Chinese context.