Interpretation paradigms and panic

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Having extolled the virtues of information-processing paradigms to examine basic cognitive processes associated with emotion, we shall nevertheless begin with a brief look at some self-report data. As we have seen in our discussion of theoretical approaches to panic, the idea that individuals suffering from panic disorder cata-strophically misinterpret bodily sensations is a central claim within the literature (Clark, 1986). To examine such biases in interpretation, McNally and Foa (1987), inspired by the work of Butler and Mathews (1983, see below), gave people with agoraphobia with panic attacks, recovered agoraphobic people, and "healthy" controls a series of ambiguous scenarios involving either internal or external stimuli (e.g., "You feel discomfort in your chest area. Why?"). Participants were required to write down the first explanation that came to mind for each scenario and then to rank order three candidate explanations of the scenarios provided by the experimenter. In each case, only one of these candidate explanations was threat-related. The results revealed that agoraphobia with panic participants, in contrast to the other two groups, tended to interpret the ambiguous scenarios as threat-related. This was the case for interpretations of both internal stimuli (that is, bodily sensations) and external stimuli. A related study by Clark et al. (1997) showed that panic attack sufferers have catastrophic beliefs about cardiovascular and respiratory sensations as revealed by the Body Sensations Intepretation Questionnaire.

A similar study was carried out by Clark and his colleagues (cited in Clark, 1988), this time investigating panic patients without agoraphobia. These participants did not provide threatening interpretations for scenarios involving external stimuli, nor for bodily stimuli that would indicate slow changes in bodily state (for example, a new spot on the back of one's hand). However, for scenarios involving sudden changes in internal body state, there was threat-related interpretation bias in the panic participants. These studies show that panic patients, whether or not they have agoraphobia, seem to interpret ambiguous scenarios involving internal bodily sensations in a threat-related way; however, only those patients with concomitant agoraphobic symptoms interpret more general scenarios in a threat-related fashion (Mathews & MacLeod, 2005). These findings on interpretation biases converge with studies summarised earlier on anxiety sensitivity (e.g., Teachman, 2005; Schmidt et al., 1997) and point to a heightened vulnerability and sensitivity to threat in panic and panic-related disorders.

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