Cognitive factors in panic attacks: Symptom probability and sensitivity
Psychological models of panic disorder propose that panic attacks result from the patient's fear response to certain body sensations. In the present study, we assessed three aspects of the fear of body sensations: subjective symptom probability, symptom sensitivity, and perceived coping ability (Symptom Probability and Cost Questionnaire, SPCQ). One-hundred-and-ten patients with panic disorder (88 with current panic attacks, 22 in remission), 81 infrequent panickers, 37 patients with other anxiety disorders, and 61 normal controls without a history of psychiatric disorders answered the SPCQ for three groups of bodily sensations: general anxiety, panic, and nonanxiety control symptoms. Significant group differences were found for the anxiety and panic scales, and for control symptom probability. With the exception of panic symptom sensitivity in the patient control group, all anxiety groups differed from normal control subjects on the anxiety and panic scales. Overall, group differences in anxiety and panic symptom appraisal could not be accounted for by differences in trait anxiety or depression scores. Even when these variables were controlled for by analysis of covariance, panic disorder patients and infrequent panickers differed significantly from normal controls. Panic patients endorsed a higher probability of anxiety and panic symptoms and a higher sensitivity and lower coping ability for panic symptoms than infrequent panickers, and higher anxiety and panic symptom probabilities and sensitivities than patients with other anxiety disorders. Subjects with infrequent panic attacks gave similar ratings on the anxiety symptom scales as patients with other anxiety disorders, but had higher probability and sensitivity scores for panic symptoms. The present study provides evidence that a fear of body sensations associated with anxiety is a prominent characteristic of patients with panic disorder, but is also found to a lesser degree in infrequent panickers and patients with other anxiety disorders.