The Role of Safety Behaviors in Panic Disorder Treatment: Self-Regulation or Self-Defeat?

The cognitive theory of panic disorder: A systematic narrative review

BACKGROUND

The cognitive theory of panic disorder proposes that individuals with panic disorder have a relatively enduring tendency to catastrophically misinterpret bodily sensations resulting in panic attacks.

AIMS

We investigated whether the evidence is consistent with the theory and its predictions, if updates are required and sought to identify future research considerations.

METHODS

We searched Scopus, Web of Science, PsycInfo, EMBASE, MEDLINE and CINAHL (1986 to July 2024). Inclusion criteria were studies collecting quantitative data derived from panic disorder patients, testing one of the predictions and using appropriate outcome measures. Exclusion criteria were non-English language publications, all participants under the age of 18 and studies that were not published in a peer-reviewed journal. Quality was assessed using 'QualSyst' and synthesis was based on each prediction tested. PROPSERO registration #CRD42022332211.

RESULTS

53 studies were identified amongst 49 publications. There was substantial evidence for all predictions. Three studies did not support the prediction tested and none were inconsistent.

LIMITATIONS

Most studies were 'medium' in quality and were predominately from female samples.

CONCLUSIONS

Findings are consistent with the theory and its predictions. Higher quality research is needed and implications for future research are discussed.

Behavior and emotion regulation of socially inhibited individuals in uncomfortable social situations: A mixed methods study

The current study aimed to identify patterns of emotion regulation and behaviors in specific uncomfortable situations using a sequential exploratory mixed methods design and to examine how the trait social inhibition (SI) is related to these patterns. The sample (N = 451, 66% female, Mage = 34 (SD=17.2)) collected in 2016-2017 completed the social inhibition questionnaire (SIQ15) and open-ended questions on self-indicated uncomfortable situations and the regulation of emotions and behaviors in those situations. The open-ended questions were analyzed and coded into quantitative data, after which a latent profile analysis (LPA) was performed to (A) identify latent profiles of emotion regulation and behaviors in specific situations, and (B) to examine how SI and facets are related to these profiles. LPA revealed seven profiles that differed in the type of situation described and how people regulated their emotions and behaved in the situation. The results show that it is the type of situation which determines regulation style and behavior. Additionally, SI was found to rely on active avoidance to deal with uncomfortable social situations, while not using emotion regulation to modify how they feel in that situation. In conclusion, our findings show that context seems to be the most important factor that drives the choice or decision of how emotions are regulated. SI individuals tend not to use emotion regulation strategies but rely on active avoidance in dealing with uncomfortable situations. Importantly, the sample was mainly female and highly educated, suggesting that our results may not generalize to other populations.

Elevated depression and anxiety predict future patterns of individualistic and collectivistic cultural values: A cross-lagged longitudinal network analysis

BACKGROUND

Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal effects in understanding the association between self-construal and psychopathology components.

METHODS

Middle-aged and older community-dwelling adults (n = 3294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates.

RESULTS

Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race.

LIMITATIONS

DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups.

CONCLUSIONS

Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.

Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE)

BACKGROUND

Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness.

METHODS

A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment.

DISCUSSION

The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach.

TRIAL REGISTRATION

ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.

A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran

BACKGROUND AND OBJECTIVES

The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders.

DESIGN AND METHODS

Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases.

RESULTS

At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up.

CONCLUSION

Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.

The panic buying behavior of consumers during the COVID-19 pandemic: Examining the influences of uncertainty, perceptions of severity, perceptions of scarcity, and anxiety

The lack of a vaccine for COVID-19 and the limited amount of reliable data on the cessation of the disease have made people feel more vulnerable to the disease. As a result, people in many countries have been found to engage in panic purchasing, which has adversely affected the supply system for the retail market. Applying behavioral inhibition system theory, reactance theory, and expectancy theory, this research examines how psychological factors such as uncertainty, perceptions of severity, perceptions of scarcity, and anxiety affected the panic purchasing behavior of consumers. This study was conducted in Malaysia in light of the 2020 outbreak of the COVID-19 pandemic. The results from structural equation modeling indicate that uncertainty, and perceptions of scarcity are positively associated with anxiety but not with the panic purchasing behavior of consumers. In addition, anxiety fully mediates the relationship among these variables and the panic purchasing behavior of consumers. Taken together, these findings provide support for doing more empirical research in order to develop a more resilient retail strategy and to improve consumer service.

Situation selection and modification in social inhibition: a person-centered approach

OBJECTIVES

The current study aimed to identify patterns of situation selection and modification behaviors using a person-centered approach, and to examine to what extent the trait social inhibition (SI) is associated with these patterns of situation-targeted emotion regulation.

METHODS

The sample comprised 504 participants (M_age= 21.5, SD = 8.2; 82% women), who completed questionnaires on situation selection and modification behaviors, and the social inhibition questionnaire (SIQ15). A three-step latent profile analysis (LPA) was performed to (A) identify existing latent profiles of situation avoidance and approach and situation modification behaviors, and (B) to examine the association of SI and facets with the latent class posteriors.

RESULTS

LPA revealed the presence of four profiles that differed in how situation selection and modification were applied. SI, behavioral inhibition, and social withdrawal were significantly associated with a higher odds of belonging to the profile characterized by avoidance selection and modification. Interpersonal sensitivity was associated with using more conversational modification behaviors, which may illustrate that interpersonal sensitive individuals are motivated to approach, but use avoidance behaviors to prevent confrontation.

CONCLUSIONS

SI individuals particularly rely on avoidance selection and modification behaviors, which may be considered maladaptive emotion regulation.