Cardio-respiratory symptoms in panic disorder: a contribution from cognitive-behaviour therapy

Objective: To compare patients with panic disorder with agoraphobia treated with cognitive-behavioural therapy (CBT) associated with the medication with patients treated only with medication and verify the behaviour of the cardio-respiratory symptoms of both groups. Methods: Randomized sample in the Psychiatry Institute of the Federal University of Rio de Janeiro, divided in two groups of 25 participants each. Group 1 undertook 10 weekly sessions of CBT with one hour of duration each together with medication. Group 2, Control, were administered medication that only consisted of tricyclic anti-depressants and selective inhibitors of the re-uptake of serotonin. Evaluation instruments were applied at the beginning and to the end of the interventions. Results: According to the applied scales, group 1 showed statistically more significant results than group 2, with: reduction of panic attacks, cardio-respiratory symptoms, anticipatory anxiety, agoraphobia avoidance and fear of bodily sensations. Conclusion: Exposures (in vivo and interoceptive), especially for induction symptom exercises and relaxation, were considered essential to prepare patients with panic disorder to handle future cardio-respiratory symptoms and panic attacks with agoraphobia.

A randomized trial of sertraline, self-administered cognitive behavior therapy, and their combination for panic disorder

BackgroundSelf-administered cognitive behavior therapy (SCBT) has been shown to be an effective alternative to therapist-delivered treatment for panic disorder (PD). However, it is unknown whether combining SCBT and antidepressants can improve treatment. This trial evaluated the efficacy of SCBT and sertraline, alone or in combination, in PD.MethodPatients (n=251) were randomized to 12 weeks of either placebo drug, placebo drug plus SCBT, sertraline, or sertraline plus SCBT. Those who improved after 12 weeks of acute treatment received treatment for an additional 12 weeks. Outcome measures included core PD symptoms (panic attacks, anticipatory anxiety, agoraphobic avoidance), dysfunctional cognitions (fear of bodily sensations, agoraphobic cognitions), disability, and clinical global impression of severity and improvement. Efficacy data were analyzed using general and generalized linear mixed models.ResultsPrimary analyses of trends over time revealed that sertraline/SCBT produced a significantly greater rate of decline in fear of bodily sensations compared to sertraline, placebo/SCBT and placebo. Trends in other outcomes were not significantly different over time. Secondary analyses of mean scores at week 12 revealed that sertraline/SCBT fared better on several outcomes than placebo, with improvement being maintained at the end of continuation treatment. Outcome did not differ between placebo and either sertraline monotherapy or placebo/SCBT. Moreover, few differences emerged between the active interventions.ConclusionsThis trial suggests that sertraline combined with SCBT may be an effective treatment for PD. The study could not confirm the efficacy of sertraline monotherapy or SCBT without concomitant medication or therapist assistance in the treatment of PD.

Specificity of Childhood Learning Experiences in Relation to Anxiety Sensitivity and Illness/Injury Sensitivity: Implications for Health Anxiety and Pain

Health anxiety refers to the preoccupation with and fear of bodily sensations arising from catastrophic misinterpretations about the significance of these sensations (Hadjistavropoulos, Asmundson, & Kowalyk, 2004). Constructs theoretically relevant to the development of both health anxiety and chronic pain are two of the putative “fundamental fears” identified by Reiss (1991)—anxiety sensitivity (AS) and illness/injury sensitivity (IS) (Cox, Borger, & Enns, 1999; Vancleef, Peters, Roelofs, & Asmundson, 2006). The learning history origins of AS have been examined in a series of studies (Stewart et al., 2001; Watt & Stewart, 2000; Watt, Stewart, & Cox, 1998); however, no studies have examined the learning history antecedents of IS. The present retrospective study compared the relative specificity of learning experiences related to the development of AS and IS in a sample of 192 undergraduates (143 women and 49 men). Structural equation modeling supported nonspecific paths from both anxiety-related and aches/pains-related childhood learning experiences to AS and a more specific path from aches/pain-related childhood learning experiences to IS. Results suggest that the developmental antecedents of IS are more specific to learning experiences around aches and pains, whereas the developmental origins of AS are more broadly related to learning experiences around bodily sensations.

Anxiety Sensitivity and Performance Anxiety in College Music Students

The role of individual differences in anxiety sensitivity was explored in a sample of 67 college-level music students. Individuals high in anxiety sensitivity report greater fear of bodily sensations. Although developed in research on panic disorder, anxiety sensitivity was hypothesized to predict performance anxiety. Anxiety sensitivity was found to predict performance anxiety and was a better predictor than trait anxiety. Overall, anxiety sensitivity was a better predictor of performance anxiety in women than men, and sensitivity to cognitive symptoms was a better predictor of performance anxiety than sensitivity to physiologic symptoms for both men and women. Gender differences emerged in the patterns of anxiety sensitivity, with men having stronger associations between fears of cognitive dyscontrol and performance anxiety than women, while women alone had associations between fears of cardiovascular and respiratory symptoms and performance anxiety. Those highest in anxiety sensitivity were found also to report less enjoyment while playing and more pain. Suggestions for future research are made, and implications for treatment programs are explored.

Early Maladaptive Schemas in Patients With Panic Disorder With Agoraphobia

The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about loss of control, a fear of bodily sensations, and avoidance in patients undergoing cognitive therapy. Fifty-nine patients (43 women and 16 men) being treated for panic disorder with agoraphobia (PDA) participated in the study. Two EMS that are seen as being central in PDA [vulnerability to harm (VH) and functional incompetence/dependency (DI)], beliefs about loss of control, a fear of bodily sensations, and avoidance were measured at treatment start and at six months follow-up. The data were analyzed using structural modeling techniques. The VH schema influenced beliefs about loss of control, a fear of bodily sensations, and avoidance. Beliefs about loss of control, in turn, predicted a fear of bodily sensations. DI was predicted by VH and did not influence other aspects of PDA. The results were largely in consort with the theoretical suppositions of schema theory and indicated that the VH schema may contribute to the maintenance of PDA.