Inhibiting the Automatic Panic Response by Changing Cognitions

Inhibiting the Automatic Panic Response by Changing Cognitions

A Review of:
Teachman, B.A., Marker, C.D., & Smith-Janik, S.B. (2008). Automatic associations and panic disorder: Trajectories of change over the course of treatment. Journal of Consulting and Clinical Psychology, 76(6), 988-1002.
by Lauren C. Alexander

No matter what the fear, humans are almost always able to attend to cues related to that specific fear despite being amidst a multitude of stimuli competing for attention. Likewise, the maladaptive schemata of panic describes how individuals are hyper vigilant to danger cues, remember those cues related to their fears, and will assign threatening interpretations to ambiguous cues. Moreover, there is mounting evidence of the likelihood that automatic panic associations are operating in individuals with panic disorder, however, these associations seem to be absent in nonanxious individuals.

Unfortunately, the massive body of anxiety research is lacking in studies that can demonstrate that changes in automatic panic associations are the variables driving treatment response. A few researchers have studied whether the effectiveness of CBT could be at least partially explained by changes in cognition, but no research thus far has examined the temporal relationship between changes in cognition and CBT effectiveness. Accordingly, this research examined whether changes in automatic panic associations were temporally related to changes in panic symptoms.

In order to explore this hypothesized relationship, Teachman, Marker, and Smith-Janik recruited 43 participants who met criteria for panic disorder and reported having a panic attack in the past month. Comorbidities were present in many of the participants, but only those that were likely to influence treatment response (e.g. current psychosis) were exclusion criteria. All participants completed the Anxiety Sensitivity Index (ASI), Beck Depression Inventory II (BDI-II), Fear Questionnaire-Agoraphobia Subscale (F-Q Agoraphobia), and the Panic Disorder Severity Scale (PDSS). Also, the Implicit Association Test (IAT) was used to measure automatic panic associations. In addition, the IAT appears to be able to measure some of the qualities associated with automatic panic schemata through measuring an individual’s interwoven cognitive panic associations. The treatment protocol was completed in 12 weeks with a highly-structured 90- minute session occurring each week. Also, the IAT and the four other questionnaire measures were completed prior to Session 1 and then following Sessions 3, 6, 9, and 12.

Results indicated significant effects of treatment over time for the PDSS, ASI, BDI-II, and F-Q Agoraphobia and suggest that treatment was generally effective. However, individual variability was considerable and additional statistical techniques were used that would more accurately address their hypothesis. The authors used an advanced statistical technique that is able to model one variable as a leading indicator of change in another variable. Accordingly, this technique showed that automatic panic associations do change over time in CBT and that these changes are correlated with symptom reduction.

These findings allow for inferences to be made that changes in maladaptive schemata precede and contribute to symptom change. Likewise, this research provides the anxiety field with one of the first pieces of evidence demonstrating that automatic interpreting and responding to feared stimuli can actually change with CBT. Thus, being able to change this cognitive processing could aid in the recovery of individuals disabled by panic disorder.

To cite this review, please use this reference:
Alexander, L. C. (2009). Inhibiting the Automatic Panic Response by Changing Cognitions (3).