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

Thesis (M.A.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains v, 51 p. Includes abstract. Includes bibliographical references (p. 37-41).

Thesis (M.A.)--University of Toronto, 2004. / Adviser: Jeanne Watson.

Nonclinical panic attacks have been defined as "panic reported by individuals not seeking treatment" (Norton, Cox, & Malan, 1992). The purpose of this study was to assess the prevalence of nonclinical panic attacks and associated symptomatology in a university sample of 576 late adolescents (ages 18-19), and to compare the effectiveness of two group treatments [Education/Support (ES) and Cognitive-Behavioral (CBT)] and a self-monitoring Waitlist (WL) condition in reducing the frequency and severity of nonclinical panic attacks, daily anxiety, and associated symptomatology. Nonpanickers (71.4% of the sample) reported no history of panic on the Panic Attack Questionnaire (PAQ; Cox, Norton, & Swinson, 1992). Past Panickers (16.5%) reported at least one panic attack prior to the past month. Recent Panickers (12.2%) reported at least one panic attack in the past month. Recent Panickers evidenced higher levels of trait anxiety, state anxiety, and depression, with a trend toward higher levels of anxiety sensitivity and internal negative attributions, relative to both Past Panickers and Nonpanickers, who did not differ. Thirty-four Recent Panickers were randomly assigned to the WL, ES, or CBT conditions. The entire sample, regardless of condition, showed a reduction in frequency of panic attacks, as well as their associated symptoms and cognitions, severity of daily anxiety, and three measures of general psychopathology (Le., depression, trait anxiety, and state anxiety). However, both active treatment groups were superior to the waitlist in producing improvement in panic-related self-efficacy, avoidance, and anxiety sensitivity. There was evidence that ES was slightly more effective than CBT in improving panicrelated self-efficacy, while CBT was somewhat more effective in reducing avoidance. Finally, while both treatment conditions combined fared significantly better than the waidist in producing high endstate functioning, assessed via a constellation of variables conceptually related to panic (i.e., panic-free status, high panic-related self-efficacy, low avoidance, low anxiety sensitivity), ES appeared most effective in promoting high ends tate functioning at Post-Treatment and Follow-Up (two months following treatment). Implications of these findings for the treatment of nonclinical panic attacks in late adolescence are discussed. / Ph. D.

The purpose of this study was to examine children's cognitive interpretations of the physiological symptoms of panic. Children from grades 3, 6, and 9 imagined experiencing the physical symptoms of panic and reported their attributions for these symptoms. Conceptions of common illnesses and panic attacks were assessed. It was hypothesized that girls would make more internal, catastrophic (I/C) attributions to the symptoms of panic than would boys, and that older children would make more I/C attributions relative to younger children. These hypotheses were based on the suggestion that notions of external causality characterize the cognitions of younger children (Nelles & Barlow, 1988), and that girls tend to report higher levels of anxiety and fear relative to boys (Ollendick, King, & Frary, 1989; Ollendick, Yule, & Ollier, 1991). It was also suggested that older children would display more mature conceptions of illness than younger children, and that girls would be more advanced in their understanding of illness than would boys. No differences were predicted between children's level of understanding common illnesses and panic attacks (Nelles & Barlow, 1988). Finally, the contribution of several individual factors to children's cognitive interpretations was investigated. No significant grade or gender differences were found for tendency to make I/C attributions. While no gender differences were evident, a significant main effect for grade was found for conceptions of illness, and understanding of panic attacks was more advanced relative to common illnesses. Finally, internal attributional style in response to negative outcomes and anxiety sensitivity were significant predictors of tendency to make I/C attributions. The relevance of these findings to understanding children's cognitive interpretations of panic symptomatology are discussed. / Master of Science

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.

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).

Several studies targeting individuals with panic disorder have demonstrated that Cognitive-behavioral treatment (CST) is the psychological treatment of choice. CST interventions that include exposure to panic symptoms, along with cognitive restructuring. breathing retraining, and relaxation training are more effective than any of these components administered alone. Past studies have demonstrated the efficacy of imparting the above CBT components in the form of bibliotherapy (BT) in the treatment of panic disorder. The present study examined the differential effectiveness of BT and self-regulatory treatments in the treatment of individuals with panic attacks. The present study examined a much purer version of a self-help bibliotherapy intervention by reducing therapist contact much more than prior studies had done. In addition, the present study examined the additive effectiveness of self-regulatory components-self-monitoring (SM) and feedback (FB)--to BT. Sixty-three participants who experienced a DSM-IV full-blown or limited symptom attack in the two weeks prior to beginning the Self-help Project were assigned via stratified randomization to 1 of 4 experimental conditions: 1) BT alone (N = 17); 2) ST plus DML (daily self-monitoring plus feedback; (N = 15); 3) DML (N = 13); or 4) WL (N = 18). The present study utilized a pre - post treatment assessment design with pre-treatment assessment occurring two weeks prior to treatment and post-treatment assessment occurring approximately two weeks after the end of treatment. Treatment was 8 weeks in duration. Participants were sent pre-treatment assessment and treatment materials via mail in order to minimize therapist contact. At post-treatment assessment, participants were assessed either in-person or via mail/phone depending upon their geographic location. It was expected that participants in all treatment conditions would experience less full-blown panic attacks, limited-symptom attacks, avoidance, fear of having a panic attack, panic cognitions. panic symptoms, state anxiety and depressive symptoms and increases in coping strategies and coping self-efficacy than participants in the WL condition. Furthermore, it was expected that participants in the BT plus DML condition would experience more change on the above dependent variables than participants in the BT alone and DML alone conditions from pre- to post-treatment assessment. A 4 X 2 repeated measures MANOVA revealep no Condition by Time interaction or Condition effect. However, a main effect for time across conditions emerged. Univariate tests revealed significant reductions from pre- to post-treatment assessment for full blown panic attacks, avoidance. fear of having a panic attack. panic cognitions, panic symptoms, depressive symptoms, and state anxiety. In addition, an exploratory 4 X 2 repeated measures ANOVA revealed a Condition by Time interaction with partiCipants in the BT and BT plus DML conditions increasing in coping self-efficacy from pre- to post-treatment. Partial correlations revealed that change in coping self-efficacy was related to lower scores on the Panic Attack Symptoms Questionnaire (PASQ) at post-treatment assessment for participants in the BT and BT plus DML conditions. The results of this study are discussed in terms of motivational issues and the effectiveness of such "pure" self-help interventions with individuals experiencing panic attacks. / Ph. D.

Panikattacken sind mit einer Lebenszeitprävalenz von ungefähr 15% ein relativ häufiges Phänomen im Gegensatz zu einer vollen Panikstörung, die eine Prävalenz von 2,3–3% aufweist. In der vorliegenden epidemiologischen Untersuchung (n = 481) einer bundesweiten repräsentativen Stichprobe wurde geprüft, ob früh (vor dem 25. Lebensjahr) und spat auftretende Panikattacken sich hinsichtlich Symptomatik, Verlaufs- und Komorbiditätsmustern unterscheiden. Neben einer erhöhten Angstsymptomatik, insbesondere bezüglich respiratorischer Beschwerden und der Angst zu sterben, zeigte sich bei Panikattacken mit spätem Beginn ein erhöhtes Risiko für Multimorbidität. Auch entwickelten sich bei dieser Gruppe komorbide Bedingungen schneller. Dagegen waren Panikattacken mit frühem Beginn und einem erhöhten Risiko für Agoraphobie sowie phobische Störungen verbunden. Die Ergebnisse werden im Hinblick auf pathogenetische Mechanismen und Implikationen für die Planung therapeutischer Interventionen diskutiert.

Background: The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG). Methods: Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test. Results: Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks. Conclusions: We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.