People with a history of panic episodes appear to be more sensitive to changes in their bodily sensations. This seems to leave them more vulnerable to misinterpreting the sensations and thus more prone to the experience of panic.
Professor David M. Clark, a psychologist and director of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital in the UK, suggests there are at least three types of vulnerability. The first is a predisposition to experience intense or frequent bodily sensations. The second is a predisposition to make ‘catastrophic misinterpretations' of these sensations. The third is a combination of the first and second types. Most research has focused on the second type and in particular the circumstances that can lead to catastrophic thought processes.
People who have been successfully treated show a marked reduction in their tendency to misinterpret bodily sensations. Such is the level of sensitivity prior to treatment that volunteers have been seen to come close to panic simply by being asked to read from cards on which are written negative words like dying or choking.
Hyperventilation is a classic sign of panic so quite a lot of early research focused on this. Hyperventilation, it was suggested, was both a feature and a cause of panic. Overventilation itself causes an increase in bodily sensations. The banging of the heart for example could lead the person to believe they are about to have a heart attack; in turn this leads to a state of panic.
More recent research however, has tended to play down the role of hyperventilation and ask questions about why, for example, people should only begin to catastrophize in early adulthood and why women are four times more likely to catastrophize? Also, why do so few elderly people develop panic when on the face of it they have most reason to be concerned about bodily sensations?
Martin Seligman, a psychologist and director of the Positive Psychology Center at the University of Pennsylvania, feels the concept of catastrophic misinterpretation is too loose. Why, he asks, after several hundred episodes of panic does a person fail to learn they are not about to have a heart attack?
Other questions have been raised about so-called ‘non-cognitive panics', in which the person reports having a panic but without fearful thoughts. It's possible that the person simply hasn't identified the fearful thoughts although in cases where this has occurred the same people have previously identified ‘cognitive panics'.
Vulnerability to panic and response to treatment forces additional questions. If panic is purely a cognitive process why can medications significantly reduce panic without the need for cognitive therapy? Controlled trials do show a placebo effect but this is not sufficiently strong to put it forward as the explanation. At the moment, and for reasons we can't explain, medication and cognitive therapy appear to be two independent yet effective methods of treatment.
This leads us to a point of evaluation. The fact that cognitive therapy seems unable to answer various questions should not undermine the fact that it remains an effective treatment method. In this regard it seems no better or worse than medication except for the fact that cognitive therapy carries no side-effects. As psychologists we have a pretty good idea of why panic occurs and the processes necessary to spark off, maintain and reduce the sensation of panic. We do however still need to find out more about the psychological characteristics that predispose certain people towards a state of panic in order to establish ways of reducing vulnerability.
Rachman S (2004) Anxiety (2nd ed) Clinical Psychology. Psychology Press
Published On: October 12, 2009