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Anticipatory Anxiety as a Function of Panic Attacks and Panic-Related Self-Efficacy: An Ambulatory Assessment Study in Panic Disorder

Published online by Cambridge University Press:  29 February 2012

Sylvia Helbig-Lang ,
Thomas Lang ,
Franz Petermann  and
Jürgen Hoyer
Sylvia Helbig-Lang*
Affiliation:
University of Bremen, Germany
Thomas Lang
Affiliation:
Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany
Franz Petermann
Affiliation:
University of Bremen, Germany
Jürgen Hoyer
Affiliation:
Technical University Dresden, Germany
*
Reprint requests to Sylvia Helbig-Lang, University of Hamburg, Department for Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany. E-mail: [email protected]
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Abstract

Background: Panic attacks and anticipatory anxiety are considered to be inter-correlated, yet distinctive, features of panic disorder, both contributing to its onset and maintenance as well as to the associated impairment. Given the difficulty to yield ecologically valid data on these fluctuating symptoms the natural course of anticipatory anxiety and its correlates have seldom been addressed with adequate methods. Aims: The current study aimed at further exploring the natural variance of anticipatory anxiety and its interdependence with panic-related variables. In addition, impact of anxiety sensitivity, and perceived ability to cope with panic on the relation between panic attacks and subsequent anxiety was inspected. Method: Based on an Ecological Momentary Assessment approach, 21 patients with panic disorder rated study variables continuously over one week; 549 question sets were completed. Results: Anticipatory anxiety followed a diurnal pattern and was associated with situational and internal variables typically linked to panic experiences. Preceding panic attacks intensified anticipatory anxiety and associated negative emotional states; however, perceived ability to cope attenuated these effects. Conclusion: Based on natural observation data, results largely support the importance of cognitive appraisals for anticipatory anxiety, and its interplay with panic attacks as it has been suggested by cognitive theory and recent findings in extinction learning research.

Keywords

Panic disordercognitive appraisalsecological momentary assessmentanticipatory anxiety
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 40 , Issue 5 , October 2012 , pp. 590 - 604
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

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References

Adler, C. M., Craske, M. G., Kirshenbaum, S. K. and Barlow, D. H. (1989). Fear of panic: an investigation of its role in panic occurrence, phobic avoidance, and treatment outcome. Behaviour Research and Therapy, 27, 391–396.CrossRefGoogle ScholarPubMed
Alpers, G. W. (2009). Ambulatory assessment in panic disorder and specific phobia. Psychological Assessment, 21, 476–485.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders – DSM-IV-TR (4th edn, Text rev.). Washington, DC: American Psychiatric Association.Google Scholar
Barlow, D. H. (2000). Unraveling the mystery of anxiety and its disorders from the perspective of emotion theory. The American Psychologist, 55, 1247–1263.CrossRefGoogle ScholarPubMed
Barlow, D. H. (2004). Fear, anxiety and theories of emotion. In Barlow, D. H. (Ed.), Anxiety and its Disorders: the nature and treatment of anxiety and panic (2nd ed. (pp. 37–63). New York: Guilford Press.Google Scholar
Basoglu, M., Marks, I., Kilic, C., Swinson, R. P., Noshirvani, H., Kuch, K. et al. (1994). Relationship of panic, anticipatory anxiety, agoraphobia and global improvement in panic disorder with agoraphobia treated with alprazolam and exposure. British Journal of Psychiatry, 164, 647–652.CrossRefGoogle ScholarPubMed
Basoglu, M., Marks, I. and Sengün, S. (1992). A prospective study of panic and anxiety in agoraphobia with panic disorder. British Journal of Psychiatry, 160, 57–64.CrossRefGoogle ScholarPubMed
Bouton, M. E., Mineka, S. and Barlow, D. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108, 4–32.CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle ScholarPubMed
Craske, M. G., Glover, D. and DeCola, J. (1995). Predicted versus unpredicted panic attacks: acute versus general distress. Journal of Abnormal Psychology, 104, 214–223.CrossRefGoogle ScholarPubMed
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J. L., Chowdhury, N. and Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behavior Research and Therapy, 46, 5–27.CrossRefGoogle ScholarPubMed
Craske, M. G., Rapee, R. M. and Barlow, D. H. (1988). The significance of panic expectancy for individual patterns of avoidance. Behavior Therapy, 19, 577–592.CrossRefGoogle Scholar
Deacon, B. J., Abramowitz, J. S., Woods, C. M. and Tolin, D. F. (2003). The Anxiety Sensitivity Index-Revised: psychometric properties and factor structure in two non-clinical samples. Behaviour Research and Therapy, 41, 1427–1449.CrossRefGoogle Scholar
Greaves-Lord, K., Ferdinand, R. F., Oldehinkel, A. J., Sondeijker, F. E. P. L., Ormel, J. and Verhulst, F. C. (2007). Higher cortisol awakening response in young adolescents with persistent anxiety problems. Acta Psychiatrica Scandinavica, 116, 137–144.CrossRefGoogle ScholarPubMed
Helbig, S., Lang, T., Swendsen, J., Hoyer, J. and Wittchen, H.-U. (2009). Feasibility, compliance and information content of an Ecological Momentary Assessment approach in patients with panic disorder and agoraphobia. Zeitschrift für Klinische Psychologie und Psychotherapie, 38, 108–117.CrossRefGoogle Scholar
Hox, J. J. and Maas, C. J. (2001). The accuracy of multilevel structural equation modeling with pseudobalanced groups and small samples. Structural Equation Modeling, 8, 157–174.CrossRefGoogle Scholar
Hoyer, J., Ruhl., U., Scholz, D. and Wittchen, H.-U. (2006). Patients´ feedback after computerized clinical diagnostic interviews for mental disorders. Psychotherapy Research, 16, 357–363.CrossRefGoogle Scholar
Johnson, E. I., Barrault, M., Nadeau, L. and Swendsen, J. (2009). Feasibility and validity of computerized ambulatory monitoring in drug-dependent women. Drug and Alcohol Dependence, 99, 322–326.CrossRefGoogle ScholarPubMed
Johnson, E. I., Grondin, O., Barrault, M., Faytout, M., Helbig, S., Husky, M., et al. (2009). Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity. International Journal of Methods in Psychiatric Research, 18, 48–57.CrossRefGoogle ScholarPubMed
Katon, W., Vitaliano, P. P., Anderson, K., Jones, M. and Russo, J. (1987). Panic disorder: residual symptoms after the acute attacks abate. Comprehensive Psychiatry, 28, 151–158.CrossRefGoogle ScholarPubMed
Kenardy, J., Fried, L., Kraemer, H. C. and Taylor, C. B. (1992). Psychological precursors of panic attacks. British Journal of Psychiatry, 160, 668–673.CrossRefGoogle ScholarPubMed
Lang, P. J., Bradley, M. M. and Cuthbert, B. N. (1998). Emotion, motivation, and anxiety: brain mechanisms and psychophysiology. Biological Psychiatry, 44, 1248–1263.CrossRefGoogle ScholarPubMed
Lang, T. (2008). Theorie und Praxis der Behandlung von Panikstörung und Agoraphobie [Theory and practice of CBT for panic disorder with agoraphobia]. Verhaltenstherapie und Psychosoziale Praxis, 40, 635–649.Google Scholar
Margraf, J., Taylor, B., Ehlers, A., Roth, W. T. and Agras, W. S. (1987). Panic attacks in the natural environment. The Journal of Nervous and Mental Disease, 175, 558–565.CrossRefGoogle ScholarPubMed
Piasecki, T. M., Hufford, M. R., Solhan, M. and Trull, T. J. (2007). Assessing clients in their natural environments with electronic diaries: rationale, benefits, limitations, and barriers. Psychological Assessment, 19, 25–43.CrossRefGoogle ScholarPubMed
Rachman, S. and Lopatka, C. (1986) Match and mismatch in the prediction of fear-I. Behaviour Therapy and Research, 24, 387–393.CrossRefGoogle ScholarPubMed
Rapee, R., Craske, M., Brown, T. and Barlow, D. (1996). Measurement of perceived control over anxiety-related events. Behavior Therapy, 27, 279–293.CrossRefGoogle Scholar
Raudenbush, S., Bryk, A. and Congdon, R. (2000). Hierarchical Linear and Non-Linear Modelling: HLM for Windows (Version 6.04). Lincolnwood, Ill.: Scientific Software International Inc.Google Scholar
Rodebaugh, T. L., Curran, P. J. and Chambless, D. L. (2002). Expectancy of panic in the maintenance of daily anxiety in panic disorder with agoraphobia: a longitudinal test of competing models. Behavior Therapy, 33, 315–336.CrossRefGoogle Scholar
Rosenthal, R., Rosnow, R. L. and Rubin, D. B. (2000). Contrasts and Effect Sizes in Behavioural Research: a correlational approach. Cambridge: Cambridge University Press.Google Scholar
Salkovskis, P. M., Clark, D. M. and Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34, 453–458.CrossRefGoogle Scholar
Samo, J. A., Tucker, J. A. and Vuchinich, R. E. (1989). Agreement between self-monitoring, recall, and collateral observation measures of alcohol consumption in older adults. Behavioral Assessment, 11, 391–409.Google Scholar
Sanderson, W. C., Rapee, R. M. and Barlow, D. H. (1989). The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air. Archives of General Psychiatry, 46, 157–162.CrossRefGoogle ScholarPubMed
Schmidt, N. B., Lerew, D. R. and Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106, 355–364.CrossRefGoogle ScholarPubMed
Schmidt, N. B., Lerew, D. R. and Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of Abnormal Psychology, 108, 532–537.CrossRefGoogle ScholarPubMed
Schmidt, N. B., Lerew, D. R. and Trakowski, J. H. (1997). Body vigilance in panic disorder: evaluating attention to bodily perturbations. Journal of Consulting and Clinical Psychology, 65, 214–220.CrossRefGoogle ScholarPubMed
Shiffman, S., Engberg, J. B., Paty, J. A., Perz, W. G., Gnys, M., Kassel, J. D. and Hickcox, M. (1997). A day at a time: predicting smoking lapse from daily urge. Journal of Abnormal Psychology, 186, 104–116.CrossRefGoogle Scholar
Stone, A., Broderick, J. E., Shiffman, S. S. and Schwartz, J. E. (2004). Understanding recall of weekly pain from a momentary assessment perspective: absolute agreement, between- and within-person consistency, and judged change in weekly pain. Pain, 107, 61–69.CrossRefGoogle ScholarPubMed
Stone, A. A. and Shiffman, S. (1994). Ecological Momentary Assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine, 16, 199–202.CrossRefGoogle Scholar
Taylor, S. and Cox, B. J. (1998). An expanded Anxiety Sensitivity Index: evidence for a hierarchical structure in a clinical sample. Journal of Anxiety Disorders, 12, 463–483.CrossRefGoogle Scholar
Telch, M. J., Brouilard, M., Telch, C. F., Agras, S. and Taylor, B. (1989). Role of cognitive appraisal in panic-related avoidance. Behaviour Research and Therapy, 27, 373–383.CrossRefGoogle ScholarPubMed
Telch, M. J., Silverman, A. and Schmidt, N. B. (1996). Effects of anxiety sensitivity and perceived control on emotional responding to caffeine challenge. Journal of Anxiety Disorders, 10, 21–35.CrossRefGoogle Scholar
Telch, M. J., Smits, J. A. J., Brown, M., Dement, M., Powers, M. B., Lee, H. and Pai, A. (2010). Effects of threat context and cardiac sensitivity on fear responding to a 35% CO2 challenge: a test of the context-sensitivity panic vulnerability model. Journal of Behavior Therapy and Experimental Psychiatry, 41, 365–372.CrossRefGoogle ScholarPubMed
Tellegen, A. (1985). Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In Tuma, A. H. and Master, J. D. (Eds.), Anxiety and the Anxiety Disorders (pp. 681–706). Hilsdale, NJ: Erlbaum.Google Scholar
White, K. S., Brown, T. A., Somers, T. J. and Barlow, D. H. (2006). Avoidance behavior in panic disorder: the moderating influence of perceived control. Behaviour Research and Therapy, 44, 147–57.CrossRefGoogle ScholarPubMed
Wittchen, H.-U. and Pfister, H. (1997). DIA-X-Interview: Manual für Screening-Verfahren und Interview (inkl. PC-Programm) [Instruction Manual for the DIA-X Interview]. Frankfurt: Swets & Zeitlinger.Google Scholar
Zvolensky, M. J., Eifert, G. H., Lejuez, C. W. and McNeil, D. W. (1999). The effects of offset control over 20% carbon-dioxide-enriched air on anxious responding. Journal of Abnormal Psychology, 108, 624–632.CrossRefGoogle ScholarPubMed
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