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panic disorder psychological factors

Psychological Factors
Despite certain specific differences, most psychological models of panic disorder see the central problem as the individuals’ fear of their own physical sensations. In this way, panic disorder is seen as almost a phobic disorder, and the feared (phobic) stimuliare internal (somatic symptoms) rather than external.
Basically, these models suggest that somatic symptoms are experienced for a number of possible reasons such as normal activities (e.g., exercise), hyperventilation, or normal bodily fluctuations. Individuals with panic disorder are especially likely to notice any such symptoms because they are hypervigilant for bodily sensations. In other words, such individuals constantly scan their bodies (not necessarily consciously) for any possible internal danger, in much the same way that persons with GAD scan the environment for potential external danger.
Thus, whenever a physical symptom occurs, those with panic disorder will notice it far more quickly and efficiently than other people, in turn triggering panic. A large amount of research supports these psychological models of panic attacks. We can briefly mention only some of this research; the reader is encouraged to consult more detailed reviews. As mentioned earlier, questionnaire studies have shown that individuals with panic disorder are more likely than those with GAD to have thoughts related to dramatic outcomes such as death or insanity. Related studies demonstrated that individuals with panic disorder find that these catastrophic outcomes have high emotional salience and preferentially allocate attentional resources to them. It has also been shown that individuals with panic disorder experience greater anxiety when they undergo procedures that produce bodily sensations such as breathing carbon dioxide and hyperventilating than subjects with other anxiety disorders. Further, for people with panic disorder, simply believing that their heart rates have increased is sufficient to produce considerable anxiety regardless of any actual change in their heart rates.
Importantly, several studies demonstrated the role of psychological factors in these procedures by showing that the degree of anxiety in response to physical sensations can be altered by manipulating various psychological parameters. Putting these two areas of research together, it has been found that when individuals with panic disorder are given part of an ambiguous sentence relating to physical sensations, they are more likely than normal controls to complete the sentence with catastrophic outcomes. Similarly, using a questionnaire measure, people with panic disorder report misinterpreting their physical sensations as indicators of extreme catastrophe.
However, some recent research has questioned whether, at an automatic level, people with panic disorder associate somatic sensations with threat to a greater extent than nonclinical controls. Finally, some recent research has begun to indicate that a tendency to interpret somatic sensations as a sign of threat may actually precede the f irst panic attack. Such a finding suggests that this cognitive style may cause the development of panic disorder. There has been considerably less research examining reasons for agoraphobic avoidance. First, many studies failed to demonstrate differences between people with panic disorder who do not avoid external situations and those with extensive avoidance (agoraphobia) on several parameters to do with the actual panic attack, such as the frequency of attacks or the location of the first attack. Differences have been found in the mental association between attacks and external situations. Subjects who show more extensive avoidance report a greater expectancy of experiencing a panic attack in particular situations.
In addition, marked avoiders also score higher on measures of social anxiety and lower on assertiveness and extraversion than minimal avoiders.

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