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Evidence-Based Psychological Models for Panic Disorder

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Cognitive Models of Panic Disorder
David Clark (1986) and Aaron Beck (1989) view panic attacks as a catastrophic misinterpretation of harmless bodily sensations. For example, a patient notices an increase in his heart rate and thinks the increased heart race is a sign of a heart attack. The alarming thought, “I am having a heart attack” increases the fear level and the heart races even faster.  The vicious cycle of panic develops.

Barlow’s Integrated Model
David Barlow (1988) proposes that panic suffers have a biological vulnerability to panic attacks under stress conditions. The first panic attack, called “a false alarm,” occurs during or after a period of stress. Approximately one-third of the population has suffered one panic attack.

According to Barlow, what distinguishes panic sufferers is the development of the fear of future attacks and anticipatory anxiety. (“What if I have a panic attack again?”) Through Pavlovian or classical conditioning, physical symptoms become associated with the original “false alarm,” the first attack, and lead to what Barlow calls “learned alarms.”  Learned alarms are triggered by natural increases in feared bodily sensation (e.g., physical exercise, caffeine). The learned alarms spread, activating full-blown panic disorder. Thus, a major treatment component is directed toward planned exposure and reduction of the feared bodily sensations through what Barlow terms Interoceptive Exposure (IE) exercises. For example, Barlow may arrange for a patient to spin around in a chair repeatedly to decrease the fear of dizzy feelings.

The Fear of Fear Model
Claire Weekes (1969), in her pioneering work, “Hope and Help For Your Nerves,” introduced the concept of the ”Fear-Adrenaline-Fear Cycle.”

Joseph Wolpe (1973), in his major clinical work, “The Practice of Behavior Therapy,” stated “endogenous (bodily symptoms) stimuli are as susceptible to fear conditioning as exogenous ones (fear of heights).” He developed the concept of body phobia. Then, Dr. Wolpe applied his treatment procedure, systematic desensitization, to irrational fears of bodily symptoms such as dizziness and heart racing. Through this process, patients imagined feeling the feared bodily sensation, heart pounding (Imaginal Desensitization). Then, the patient applied a counter conditioning, anxiety-lowering response to remove the fear of the symptom, heart pounding. Wolpe always arranged a hierarchy of fear items. For example, he would start with only mild heart pounding. He developed the Subjective Units of Discomfort (SUD) scale, and he taught patients to rate their fear level on the SUD scale from 0 to 10. Through repeated exposure to the imagined low-level feared item, while applying a anxiety reduction tool, the fear level dropped, leading to systematic desensitization.

The WhyPanic Model For Panic Disorder
Attribution Theory

The WhyPanic Model (2010) is the underpinning of panicLINK®. This model was  developed from the field of social psychology and attribution theory.  The founder of attribution theory, Fritz Heider, holds that people are analytical by nature and are constantly driven to find logical explanations or causes (attributions) for their own behavior and the behavior of others.

Schacter and Singer (1962), in their classic social psychological research study, showed that in the absence of accurate information to explain arousal cues such as heart pounding, subjects search for available information to explain their symptoms. The most important finding was that the explanation you arrived at determined your experience.

How does this finding apply to panic attacks?

When your first panic attack strikes “Out of the Blue” and you cannot find a cause for why you arefeeling this way, you are desperate to find the answer. The WhyPanic Model holds that panic-prone individuals  are catastrophic thinkers. They naturally arrive at false catastrophic misattributions of arousal cues. Under conditions of uncertainty, panic sufferers automatically conclude the worst-case scenarios for why they are feeling heart pounding. When physical symptoms like heart pounding occur without a context, you ask what is the cause (attribution)? You have a choice. You can falsely conclude, “I am having a heart attack” (misattribution) and experience escalating symptoms of terror and race to the emergency room (termed the misattribution effect). Or, you can conclude that the heart pounding is harmless and no different than vigorous exercise, and feel invigorated.  The ATTRIBUTION or interpretation of the bodily symptoms determine whether you feel terror or invigoration.

The Exacerbation Model
This finding is termed the misattribution effect in the social psychological literature. Storms and McCaul (1975), in their chapter entitled “Attribution Processes and Emotional Exacerbation of Dysfunctional Behavior,” review a body of research showing how the the false catastrophic cause for physical symptoms accounts for a broad range of “dysfunctional physiological responses,” including sleep onset insomnia and anxiety disorders.

The Reattribution Process and the WhyPanic Model
Phase One and Two of panicLINK® draws from the most recent advances in the evidence based models of cognitive behavior therapy.  The first two phases of the program focus on stopping the misattribution process (wrong explanation) for panic symptoms and eliminating the fear of bodily sensations.

The whyPanic model holds that the first attack strike did not come “Out of the Blue.” There is a direct and immediate connection between ongoing stressors and the onset of panic symptoms that seem “Out of the Blue” for the panic-prone person. People not prone to panic make the connection naturally. The final two phases of the panicLINK program focus on helping you uncover the true cause, THE MISSING LINK, to why you feel heart pounding and all the other physical symptoms.

The eight-step self-discovery method helps you understand your pre-panic profile and helps you see clearly and make the connection between symptoms and the accurate explanation (reattribution) for your symptoms.  Making the connection stops recurring panic and is the link to living panic-free.

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