Unexpected arousal, anxiety sensitivity, and their interaction on CO2-induced panic: Further evidence for the context-sensitivity vulnerability model

Laboratory for the Study of Anxiety Disorders, The University of Texas at Austin, USA.
Journal of anxiety disorders (Impact Factor: 2.68). 06/2011; 25(5):645-53. DOI: 10.1016/j.janxdis.2011.02.005
Source: PubMed

ABSTRACT The present experiment tested several predictions derived from the context-sensitivity vulnerability model of panic. Participants (N=79) scoring either high or low in anxiety sensitivity (AS) and with no history of unexpected panic were randomly assigned to one of two instructional sets: expected arousal (EA) or expected relaxation (ER). All participants were administered inhalation of room air and 35% CO(2) in a counterbalanced order. Consistent with theoretical predictions, High-AS participants who received ER instructions showed greater emotional responding compared to High-AS participants who received EA instructions, while instructional set did not affect responding among Low-AS participants. Panic attacks were observed in 52% of the High-AS-ER group compared to 17%, 5%, and 5% in the High-AS-EA, Low-AS-ER, and Low-AS-EA groups respectively. These findings are consistent with the theory's assertion that dispositional tendencies, such as anxiety sensitivity potentiate the panicogenic effects of threat-relevant context variables.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO2 - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO2 max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO2 max ( (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.
    PLoS ONE 08/2014; 9(8):e104932. DOI:10.1371/journal.pone.0104932
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although a great deal of information about the neurobiology of panic disorder is now available, there is a need for an updated etiological model integrating recent findings on the neurobiology of the arousal system and its relationship with higher cortical functions in panic disorder. The current mini-review presents psychophysiological, molecular biological/genetic and functional neuroimaging evidence for dysfunction in major arousal systems of the brain. Such dysfunction may influence the development of panic disorder by precipitating autonomic bodily symptoms and at the same time increasing vigilance to these sensations by modulating cortical attentional networks. A multilevel model of arousal, attention and anxiety—including the norepinephrine, orexin, neuropeptide S and caffeine-related adenosine systems—may be useful in integrating a range of data available on the pathogenesis of panic disorder. Copyright © 2014 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 11/2014; 29(6). DOI:10.1002/hup.2436
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the present vulnerability study individuals with high (n = 35) and low (n = 124) anxiety sensitivity (AS) made ratings of anticipated distress, catastrophic misinterpretations and benign more realistic alternative explanations to 24 hypothetical scenarios involving physical sensations. The physical sensation scenarios were a modification of the Body Sensations Interpretation Questionnaire (Clark et al. in J Consult Clin Psychol 65:203–213, 1997) and varied in level of expectedness across panic-related and nonpanic-related scenarios. Group comparisons revealed that the high AS group reported significantly higher levels of distress and more catastrophic misinterpretations to all physical sensation scenarios, although no group differences were found in ratings of realistic interpretations. A significant Group × Expectedness interaction indicated that high AS individuals generated more catastrophic misinterpretations to all unexpected physical sensation scenarios. The findings support the centrality of catastrophic misinterpretation as the key cognitive construct in panic disorder as well as aspects of Telch et al.’s (J Anxiety Disor 25: 645–653, 2011) context-sensitivity perspective on panic.
    Cognitive Therapy and Research 06/2014; 38(3):343-348. DOI:10.1007/s10608-013-9594-4


Available from
Sep 29, 2014