Panic Disorder Patients Score example essay topic

Clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder but the mechanism responsible for the improvement are lacking. The reduction of fear of fear (FOF), or the tendency to respond fearfully to benign bodily sensations, is believed to underlie the improvement resulting from CBT. Research has provided evidence consistent with the FOF hypothesis. Descriptive studies consistently show that panic disorder patients score significantly higher on self-report measures tapping fear of bodily sensations. Those who score high on measures tapping FOF display heightened emotional responding to challenge compared with those who score low on these same FOF measures (M. Brown, Smits, Powers, & Telch, 2003; Eke & McNally, 1996; Holloway & McNally, 1987; McNally & Eke, 1996; Rape & Me doro, 1994; Telch et al., 2003). Findings from several prospective studies suggest that people score big on the Anxiety Sensititivity Index (ASI) are at greater risk for developing occurring panic attacks (Schmidt, Lerew, & Jackson, 1997; p Schmidt, Lerew, & Joiner, 1998).

Specific procedural components contained in contemporary CBT manuals for panic disorder include education about the nature and physiology of panic and anxiety, breathing retraining designed to assist patients in learning to control hyperventilation, cognitive restructuring aimed at teaching patients to identify and correct faulty threat perceptions that contribute to their panic and anxiety, interceptive exposure aimed at reducing patents' fear of harmless bodily sensations associated with physiological activation, and fading of maladaptive defensive behaviors such as avoidance of external situations (Barlow, Crake, Cern y, & Klosko, 1989; Clark et al., 1994; Telch et al., 199). On the basis of contemporary psychological theories of panic disorder, several findings implicate change in FOF as a mediator of treatment outcome. CBT results in significant reductions on measures broadly tapping FOF (Bouchard et al., 1996; Clark et al., 1997, Poulton & Andrews, 1996). Modifying patients; catastrophic misinterpretations of bodily sensations result in significant reductions in panic (Taylor, 2000). A clinical trial comparing cognitive therapy with guided mastery therapy for panic disorder, changes in catastrophic cognition's predicted differential change in panic disorder symptoms. Of the 130 participants (99 women and 31 men), 40 were randomly assigned to a wait list condition, and 90 participants received treatment previously described by Telch (Telch et al., 1993, 1995).

This multi component group CBT treatment consists of four major treatment components: education and corrective information concerning the nature, causes, and maintenance of anxiety and panic; cognitive therapy techniques helping patient identify, examine, and challenge faulty beliefs of danger and harm associated with panic, anxiety, and phobic avoidance; training in methods of slow diaphragmatic breathing to help patients eliminate hyperventilation symptoms and reduce physiological arousal; interceptive exposure exercises designed to reduce patients' fear of somatic sensations through repeated exposure to various activities; and self-directed exposure to patients; feared situation designed to reduce agoraphobic avoidance. Treatment consisted of twelve 2 hour structured sessions conducted over and 8 week period. Sessions were conducted twice weekly for the first 4 weeks and once each week for the remaining 4 weeks. Patients were required to tape-record each session. Assessment of clinical status and FOF occurred pretreatment and then again post treatment. For the Texas Panic Attack Record Form, participants were provided with daily panic diary forms.

Patients had to record the date, time, duration, severity, symptoms experienced, and setting parameters. Panic attacks with fewer than 3 symptoms were not included in the panic attack count. The SPR AS (Sheehan Patient-Rated Anxiety Scale) is a 35-item self-report scale for assessing the intensity of anxiety symptoms. Each symptom is rated on a 5-point scale ranging from 0 being not at distress to 4 being extremely distressing. The total is found by adding the responses to the 35 items. The Fear Questionnaire was used to assess level of agoraphobia types and consists of 15 items representing the three separate phobia types: agoraphobia, blood-injury phobia, and social phobia.

The SDS (Sheehan Disability Scale) is a four item self-report measure of global impairment assessed by work activities, social life, and leisure activities, and family life and home responsibilities. Items are rated on an 11-point Likert-type scale. The ASI (Anxiety Sensitivity Index) is a 16-item self report instrument designed to assess one's tendency to respond fearfully to anxiety-related symptoms. Score is found by summing responses across the 16 items. BS (Body Sensations Questionnaire) is a 17 item self-report instrument tapping the fear of bodily sensations. Each item represents an anxiety-related bodily sensation.

Items are rated on 1 being not frightened or worried to 5 being extremely frightened Likert-type scale. The total score is computed by averaging the responses to the 17 items. The hypothesis that the effects of CBT would be mediated by changes in FOF was tested in accordance with the analytic steps outlined by Baron and Kenny (1986). Step 1 is testing the effects of treatment on the proposed mediator by performing an ANOVA with treatment group (CBT vs. wait list) as the grouping factor and FOF score as the dependent variable. Step 2 is testing for the presence of a treatment effect by performing the grouping factor and residual ized change scores of the four major clinical status measures as the dependent variables. Step 3 is the relationship between the proposed mediator and the four major clinical status measures was examined.

This step was tested by performing a series of analyses of covariance with treatment group (CBT vs. wait list) as the grouping factor, residual ized change scores of clinical status measures as the dependent variables, and the FOF score as the co variate. The final step is tested by comparing the effect of treatment in the third step with the effect of treatment in the second step.