Selective Information Processing, Interoception, and Panic Attacks

  • A. Ehlers
  • J. Margraf
  • W. T. Roth

Abstract

Panic attacks have recently been given a central role in the classification of anxiety disorders (DSM-IIIR, Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, third edition-revised, APA 1987). The etiology of these anxiety attacks is controversial. One of their most puzzling and fascinating features for clinicians and researchers is that panic attacks often occur in the absence of any perceived situational triggers. This apparent spontaneity has led researchers to search for possible causes of panic attacks “within” the patient.

Keywords

Fatigue Lactate Respiration Neuropathy Caffeine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders. Third edition - revised. APA Press, Washington, DCGoogle Scholar
  2. Arnow BA, Taylor CB, Agras WS, Teich MJ (1986) Enhancing agoraphobia treatment outcome by changing couple communication patterns. Behav Ther 16: 452–467CrossRefGoogle Scholar
  3. Barlow D (1986) A psychological model of panic. In: Shaw BF, Cashman F, Segal ZY, Yallis TM (eds) Anxiety disorder: theory, diagnosis, and treatment. Plenum, New YorkGoogle Scholar
  4. Barlow DH, Cohen AS, Waddell Mt, Vermilyea BB, Klosko JS, Blanchard EB, DiNardo PA (1984) Panic and generalized anxiety disorders: Nature and treatment. Behav Ther 15: 431–449CrossRefGoogle Scholar
  5. Bass C, Kartsoumis L, Lelliott P (in press) Hyperventilation and its relationship with anxiety and panic. Integrative PsychiatryGoogle Scholar
  6. Beck AT, Laude R, Bohnert M (1974) Ideational components of anxiety neurosis. Arch Gen Psychiatry 31: 319–325PubMedGoogle Scholar
  7. Beck AT, Emery GD, Greenberg R (1985) Anxiety disorders and phobias: a cognitive perspective. Basic, New YorkGoogle Scholar
  8. Bonn JA, Harrison J, Rees W (1973) Lactate infusion in the treatment of “free-floating” anxiety. Therapeutic application. Br J Psychiatry 119: 468–470CrossRefGoogle Scholar
  9. Bonn JA, Readhead CPA, Timmons BA (1984) Enhanced adaptive behavioral response in agoraphobic patients pretreated with breathing retraining. Lancet 1984: 665–669CrossRefGoogle Scholar
  10. Boulenger JP, Uhde TW, Wolff EA, Post RM (1984) Increased sensitivity to caffeine in patients with panic disorder. Arch Gen Psychiatry 41: 1067–1071PubMedGoogle Scholar
  11. Breggin PR (1964) The psychophysiology of anxiety. J Nery Ment Dis 139: 558–568CrossRefGoogle Scholar
  12. Buller R, Maier W, Benkert O (1978) Das Herzangst-Syndrom–ein Subtyp der Panik-Syndroms. In: Nutzinger DO, Pfersmann D, Welan T, Zapotoczky HG (eds) Herzphobie. Enke, Stuttgart, pp 42–49Google Scholar
  13. Burgess IS, Jones LM, Robertson SA, Radcliff WN, Emerson E (1981) The degree of control exerted by phobic and non-phobic verbal stimuli over the recognition behaviour of phobies and non-phobic subjects. Behav Res Ther 19: 233–243PubMedCrossRefGoogle Scholar
  14. Burns LE, Thorpe GL, Cavallero A, Gosling J (1983) Agoraphobia eight years after behavioral treatment: A follow-up study with interview, questionnaire and behavioral data. World Congress of Behavior Therapy, Washington, DCGoogle Scholar
  15. Chambless DL, Caputo GC, Bright P, Gallagher R (1984) Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. J Consult Clin Psychol 52: 1090–1097PubMedCrossRefGoogle Scholar
  16. Clark DM (1986) A cognitive approach to panic. Behav Res Ther 24: 461–470PubMedCrossRefGoogle Scholar
  17. Clark DM (1988) A cognitive model of panic attacks. In: Rachman S, Maser J (eds) Panic: psychological perspectives. Erlbaum, HillsdaleGoogle Scholar
  18. Clark DM, Salkovskis PM, Chalkley AJ (1985) Respiratory control as a treatment for panic attacks. J Behav Ther Exp Psychiatry 16: 23–30PubMedCrossRefGoogle Scholar
  19. Chamey DS, Heninger GR (1986) Abnormal regulation of noradrenergic function in panic disorders. Arch Gen Psychiatry 43: 1042–1054Google Scholar
  20. Cohen AS, Barlow DH, Blanchard EB (1985) Psychophysiology of relaxation-associated panic attacks. J Abn Psychol 94: 96–101CrossRefGoogle Scholar
  21. Ehlers A, Margraf J, Roth WT (1986a) Experimental induction of panic attacks. In: Hand I, Wittchen HU (eds) Panic and phobias: empirical evidence of theoretical models and longterm efficacy of behavioral treatments. Springer, Berlin Heidelberg New York, pp 53–66Google Scholar
  22. Ehlers A, Margraf J, Roth WT, Taylor CB, Maddock RJ, Sheikh J, Kopell ML, McClenahan KL, Gossard D, Blowers GH, Agras WS, Kopell BS (1986b) Lactate infusions and panic attacks: do patients and controls respond differently? Psychiatry Res 17: 295–308PubMedCrossRefGoogle Scholar
  23. Ehlers A, Margraf J, Roth WT, Taylor CB (1987) Psychophysiology of panic attacks. 27th Annual meeting of the Society for Psychophysiological Research, AmsterdamGoogle Scholar
  24. Ehlers A, Margraf J, Roth WT, Taylor CB, Birbaumer N (1988a) Anxiety induced by false heart rate feedback in patients with panic. disorder. Behav Res Ther 26: 1–11PubMedCrossRefGoogle Scholar
  25. Ehlers A, Margraf J, Roth WT (1988b) Interaction of expectancy and stressors in a laboratory model of panic. In: Hellhammer C, Florin I, Weiner H (eds) Neurobiological approaches to human disease. Huber, Toronto, pp 379–384Google Scholar
  26. Ehlers A, Margraf J, Davies S, Roth WT (in press). Selective processing of threat cues in subjects with panic attacks. Cognition and Emotion.Google Scholar
  27. Emmelkamp PMG, Kuipers ACM (1979) Agoraphobia: A follow-up study four years after treatment. Br J Psychiatry 143: 352–355CrossRefGoogle Scholar
  28. Epstein S (1972) The nature of anxiety with emphasis on its relationship to expectancy. In: Spielberger CD (ed) Anxiety. Academic, New YorkGoogle Scholar
  29. Evans IM (1972) A conditioning model of common neurotic pattern–fear of fear. Psychother Theor Res Pract 9: 238–241CrossRefGoogle Scholar
  30. Fenichel O (1945) Psychoanalytic theory of the neuroses. Norton, New YorkGoogle Scholar
  31. Fiegenbaum W (1986) Longterm efficacy of exposure therapy in cardiac phobia. In: Hand I, Wittchen HU (eds) Panic and phobias: Empirical evidence of theoretical models and longterm efficacy of behavioral treatments. Springer, Berlin Heidelberg New York, pp 81–89Google Scholar
  32. Foa EB, Kozak MJ (1986) Emotional processing of fear: exposure to corrective information. Psych Bull 99: 20–35CrossRefGoogle Scholar
  33. Foa EB, McNally RJ (1986) Sensitivity to feared stimuli in obsessive-compulsives: a dichotic listening analysis. Cogn Ther Res 10: 477–485CrossRefGoogle Scholar
  34. Frankl VE (1975) Paradoxical intention and dereflection. Psychotherapy 12: 226–237Google Scholar
  35. Freud S (1895) Über die Berechtigung von der Neurasthenie einen bestimmten Symptomkomplex als “Angstneurose” abzutrennen. In: Freud S (1952) Gesammelte Werke, vol 1. (Standard Edition, vol 3, p 85, Hogarth, London )Google Scholar
  36. Gitlin B, Martin J, Shear MK, Frances A, Ball G, Josephson S (1985) Behavior therapy for panic disorder. J Nery Ment Dis 173: 742–743CrossRefGoogle Scholar
  37. Goldstein AJ (1982) Agoraphobia: Treatment successes, treatment failures, and theoretical implications. In: Chambless DL, Goldstein AJ (eds) Agoraphobia: multiple prespectives on theory and treatment. Wiley, New YorkGoogle Scholar
  38. Goldstein AJ, Chambless DL (1978) A reanalysis of agoraphobia. Behav Ther 9: 47–59CrossRefGoogle Scholar
  39. Griez E, van den Hout MA (1983) Treatment of phobophobia by exposure to CO2-induced anxiety symptoms. J Nery Ment Dis 173: 742–743Google Scholar
  40. Griez E, van den Hout MA (1986) CO2 inhalation in the treatment of panic attacks. Behav Res Ther 24: 145–150PubMedCrossRefGoogle Scholar
  41. Guttmacher LB, Nelles C (1984) In vivo desensitization of lactate-induced panic: a case study. Behav Ther 15: 369–372CrossRefGoogle Scholar
  42. Hand I, Lamontagne Y, Marks I (1974) Group exposure (flooding) in vivo for agoraphobies. Br J Psychiatry 124: 588–602PubMedCrossRefGoogle Scholar
  43. Hand I, Angenendt J, Fischer M, Wilke C (1986) Exposure in vivo with panic management: Treatment rationale and longterm outcome. In: Hand I, Wittchen HU (eds) Panic and phobias: empirical evidence of theoretica models and longterm efficacy of behavioral treatments. Springer, Berlin Heidelberg New York, pp 104–128Google Scholar
  44. Harbauer-Raum U (1987) Wahrnehmung von Herzschlag and Herzarrhythmien–Eine Labor-Feldstudie an Patienten mit Herzphobie. In: Nutzinger DO, Pfersmann D, Welan T, Zapotoczky Hg (eds) Die Herzphobie, Enke, Stuttgart, pp 84–91Google Scholar
  45. Hibbert GA (1984) Ideational components of anxiety. Br J Psychiatry 144: 618–624PubMedCrossRefGoogle Scholar
  46. Jacob RG, Rapport MD (1984) Panic disorder: medical and psychological parameters. In: Turner SM (ed) Behavioral theories and treatment of anxiety. Plenum, New YorkGoogle Scholar
  47. Jacob RG, Moller MB, Turner SM, Wall C (1985) Otoneurological examination in panic disorder and agoraphobia with panic attacks: a pilot study. Am J Psychiatry 142: 715–720PubMedGoogle Scholar
  48. Katkin ES (1985). Blood, sweat and tears: individual differences in autonomic self-perception. Psychophysiology 22: 125–137PubMedCrossRefGoogle Scholar
  49. King R, Margraf J, Ehlers A, Maddock R (1986) Panic disorder–overlap with somatization disorder. In: Hand I, Wittchen HU (eds) Panic and phobias: empirical evidence of theoretical models and longterm efficacy of behavioral treatments. Springer, Berlin Heidelberg New York, pp 72–77Google Scholar
  50. Klein DF (1980) Anxiety reconceptualized. Compreh Psychiatry 21: 411–427CrossRefGoogle Scholar
  51. Lader MH, Mathews AM (1968) A physiological model of phobic anxiety and desensitization. Behav Res Ther 6: 411–421PubMedCrossRefGoogle Scholar
  52. Lader MH, Mathews AM (1970) Physiological changes during spontaneous panic attacks. J Psychosom Res 14: 377–382PubMedCrossRefGoogle Scholar
  53. Lazarus RS, Averill JR (1972) Emotion and cognition: With special reference to anxiety. In: Spielberger CD (ed) Anxiety. Academic, New YorkGoogle Scholar
  54. Lelliott PT, Marks IM, Monteiro WO, Tsakiris F, Noshirvani H (1987) Agoraphobia 5 years after imipramine and exposure. Outcome and predictors. J Nery Ment Dis 175: 599–605CrossRefGoogle Scholar
  55. Ley R (1985) Agoraphobia, the panic attack and the hyperventilation syndrome. Behav Res Ther 23: 79–81PubMedCrossRefGoogle Scholar
  56. Ley R (1987) Panic disorder: a hyperventilation interpretation. In: Michelson L, Ascher M (eds) Cognitive-behavioral assessments and treatment of anxiety disorders. Guilford, New YorkGoogle Scholar
  57. MacLeod C, Mathews A, Tata P (1986) Attentional bias in emotional disorders. J Abn Psychol 95: 15–20CrossRefGoogle Scholar
  58. Marchione KE, Michelson L, Greenwald M, Dancu C (1987) Cognitive behavioral treatment of agoraphobia. Behav Res Ther 25: 319–328PubMedCrossRefGoogle Scholar
  59. Margraf J, Ehlers A (in press) Biological models of panic disorder and agoraphobia: Theory and evidence. In: Roth M, Burrows GD, Noyes R (eds) Handbook of anxiety, Vol. III. Elsevier, AmsterdamGoogle Scholar
  60. Margraf J, Ehlers A, Roth WT (1986a) Biological models of panic disorder and agoraphobia: a review. Behav Res Ther 24: 553–567PubMedCrossRefGoogle Scholar
  61. Margraf J, Ehlers A, Roth WT (1986b) Sodium lactate infusions and panic attacks: a review and critique. Psychosom Med 48: 23–51PubMedGoogle Scholar
  62. Margraf J, Ehlers A, Roth WT (1987a) Panic attack associated with perceived heart rate acceleration: a case report. Behav Ther 18: 84–89CrossRefGoogle Scholar
  63. Margraf J, Taylor CB, Ehlers A, Roth WT, Agras WS (1987b) Panic attacks in the natural environment. J Nery Ment Dis 175: 558–565CrossRefGoogle Scholar
  64. Margraf J, Ehlers A, Roth WT (in press) Expectancy effects and hyperventilation as laboratory stressors. In: Florin I, Weiner H, Hellhammer D (eds) Frontiers of stress research. Huber, TorontoGoogle Scholar
  65. Marks I (1987) Fears, phobias and rituals. Oxford University Press, New YorkGoogle Scholar
  66. Mathews AM, MacLeod C (1985) Selective processing of threat cues in anxiety states. Behav Res Ther 23: 563–569PubMedCrossRefGoogle Scholar
  67. Mathews AM, MacLeod C (1986) Discrimination of threat cues without awareness in anxiety states. J Abn Psychol 95: 131–138CrossRefGoogle Scholar
  68. Mathews AM, Teasdale J, Munby M, Johnston DW, Shaw P (1977) A home-based treatment program for agoraphobia. Behav Ther 8: 915–925CrossRefGoogle Scholar
  69. McFarland RA (1975) Heart rate perception and heart rate control. Psychophysiology 12: 402–405PubMedCrossRefGoogle Scholar
  70. McNally RJ, Foa EB (1987) Cognition and agoraphobia: bias in the interpretation of threat. Cogn Ther Res 11: 567–582CrossRefGoogle Scholar
  71. McNally RJ, Lorenz M (1987) Anxiety sensitivity in agoraphobies. J Behav Ther Exp Psychiatry 18: 3–11PubMedCrossRefGoogle Scholar
  72. McPherson FM, Brougham I, McLaren S (1980) Maintenance of improvement of agoraphobic patients treated with behavioural methods–four year follow-up. Behav Res Ther 18: 150–152PubMedCrossRefGoogle Scholar
  73. Melzack R, Wall PD (1973) The challenge of pain. Basic, New YorkGoogle Scholar
  74. Michelson L, Mavissakalian M, Marchione K (1985) Cognitive and behavioral treatments of agoraphobia: Clinical and behavioral, and psychophysiological outcomes. J Consult Clin Psychol 53: 913–925PubMedCrossRefGoogle Scholar
  75. Mogg K, Mathews A, Weinman J (1987) Memory bias in clinical anxiety. J Abn Psychol 96: 94–98CrossRefGoogle Scholar
  76. Munby M, Johnston DW (1980) Agoraphobia: the long-term follow-up of behavioral treatment. Br J Psychiatry 137: 418–427PubMedCrossRefGoogle Scholar
  77. Öst LG (1988) Applied relaxation vs progressive relaxation in the treatment of panic disorder. Behav Res TherGoogle Scholar
  78. Ottavani R, Beck AT (1987) Cognitive aspects of panic disorder. J Anxiety Disorders 1: 15–28CrossRefGoogle Scholar
  79. Porges SW, Raskin DC (1969) Respiratory and heart rate components of attention. J Exp Psychol 81: 497–503PubMedCrossRefGoogle Scholar
  80. Rachman S, Levitt K, Lopatka C (1987) Panic: the links between cognitions and bodily symptoms–I. Behav Res Ther 25: 411–423PubMedCrossRefGoogle Scholar
  81. Rapee RM (1985a) A case of panic disorder treated with breathing retraining. J Behav Ther Exp Psychiatry 16: 63–65PubMedCrossRefGoogle Scholar
  82. Rapee RM (1985b) Distinction between panic disorder and generalised anxiety disorder: clinical presentation. Aust N Z J Psychiatry 19: 227–232PubMedCrossRefGoogle Scholar
  83. Rapee RM (in press) The psychological treatment of panic attacks: theoretical conceptualization and review of evidence. Clin Psychol ReviewGoogle Scholar
  84. Rapee RM, Mattick R, Murrell E (in press) Cognitive mediation in the affective component of spontaneous panic attacks. J Behav Ther Exp PsychiatryGoogle Scholar
  85. Reiss S, McNally RJ (1985) Expectancy model of fear. In: Reiss S, Bootzin RR (eds) Theoretical issues in behavior therapy. Academic, New York, pp 107–121Google Scholar
  86. Salkovskis PM, Jones DRO, Clark DM (1986) Respiratory control in the treatment of panic attacks: replication and extension with concurrent measurement of behaviour and pCO2. Br J Psychiatry 148: 526–532PubMedCrossRefGoogle Scholar
  87. Sanderson WC, Rapee RM, Barlow DH (submitted) The influence of an illusion of control on panic attacks via inhalation of 5,5% carbon dioxideenriched air.Google Scholar
  88. Sartory G (1985) Vagal innervation techniques in the treatment of panic attacks. 15th Annual meeting of the European Association for Behaviour therapy, MunichGoogle Scholar
  89. Schandry R (1981) Heart beat perception and emotional experience. Psychophysiology 18: 483–488PubMedCrossRefGoogle Scholar
  90. Schandry R (1983) On the relation between the improvement of cardiac perception and the increase of emotional experience. Psychophysiology 20: 468Google Scholar
  91. Shands HC, Schor N (1982) The modern syndrome of phobophobia and its management. In: Dupont RL (ed) Phobia: a comprehensive summary of modern treatments. Brunner and Mazel, New YorkGoogle Scholar
  92. Shear MK, Fyer A (1987) Effects of cognitive-behavioral treatments on sodium-lactate response of panic patients. Preliminary findings. Symposium treatments of panic and phobias, RingbergGoogle Scholar
  93. Stalmann H, Hartl L, Pauli P, Strian F (1987) Perception of pathological cardiac activity. Psychophysiology 24: 614Google Scholar
  94. Streblow H, Hoffmann J, Kasielke E (1985) Experimentalpsychologische Analyse von Gedächtnisprozessen bei Phobikern. Z Psychol 193: 147–161PubMedGoogle Scholar
  95. Taylor CB, Sheikh J, Agras WS, Roth WT, Margraf J, Ehlers A, Maddock RJ, Gossard D (1986) Ambulatory heart rate changes in patients with panic attacks. Am J Psychiatry 143: 478–482PubMedGoogle Scholar
  96. Taylor CB, King R, Ehlers A, Margraf J, Clark D, Roth WT, Agras WS (in press) Treadmill exercise test and ambulatory monitoring in patients with panic attacks. Am J CardiolGoogle Scholar
  97. Teich MJ, Agras WS, Taylor CB, Roth WT, Gallen CC (1985) Combined pharmacological and behavioral treatment for agoraphobia. Behav Res Ther 23: 325–335CrossRefGoogle Scholar
  98. Tyrer P, Lee I, Alexander J (1980) Awareness of cardiac function in anxious, phobic and hypochondriacal patients. Psychol Med 10: 171–174PubMedCrossRefGoogle Scholar
  99. van den Hout MA (1988) The explanation of experimental panic. In: Rachman S, Maser J (eds) Panic: psychological perspectives. Erlbaum, HillsdaleGoogle Scholar
  100. van den Hout MA, Griez E (1982) Cognitive factors in carbon dioxide therapy. J Psychosom Res 26: 209–214PubMedCrossRefGoogle Scholar
  101. van den Hout MA, Griez E (1983) Some remarks on the nosology of anxiety states and panic disorder. Acta Psychiat Belg 83: 33–42Google Scholar
  102. van der Molen GM, van den Hout MA, Vroemen J, Lousberg H, Griez E (1986) Cognitive determinants of lactate-induced anxiety. Behav Res The 24: 677–680CrossRefGoogle Scholar
  103. Waddell MT, Barlow DH, O’Brien GT (1984) A preliminary investigation of cognitive and relaxation treatment of panic disorder: effects on intense anxiety vs “background” anxiety. Behav Res Ther 22: 393–402PubMedCrossRefGoogle Scholar
  104. Watts FN, McKenna FP, Sharrock R, Trezise L (1986a) Colour naming of phobia-related words. Br J Psychol 77: 97–108PubMedCrossRefGoogle Scholar
  105. Watts FN, Trezise L, Sharrock R (1986b) Processing of phobic stimuli. Br J Clin Psychol 25: 253–259PubMedCrossRefGoogle Scholar
  106. Westphal C (1871) Die Agoraphobie, eine neuropathische Erscheinung. Arch Psychiat Nervenkrankh 3: 138–161CrossRefGoogle Scholar
  107. Whitehead WE, Drescher VM, Heriman P, Blackwell B (1977) Relation of heart rate, heart rate control and heart rate perception. Biodfeed Self-Reg 2: 371–392CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • A. Ehlers
  • J. Margraf
  • W. T. Roth

There are no affiliations available

Personalised recommendations