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Cognitive Therapy and Research

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25.06.2016 | Original Article

Cognitive Bias Modification to Enhance Resilience to a Panic Challenge

verfasst von: Jessica R. Beadel, Andrew Mathews, Bethany A. Teachman

Erschienen in: Cognitive Therapy and Research | Ausgabe 6/2016

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Abstract

This study tested an intervention to enhance resilience among people at risk for developing panic disorder. Participants (N = 50) high in anxiety sensitivity (fear of anxiety symptoms) were randomly assigned to either four sessions of resilience-enhancing interpretation bias modification (CBM-I) or a control (Sham) condition. Following the intervention, participants engaged in a 7.5 % steady state carbon dioxide (CO₂) breathing challenge, an established panic stressor. In line with hypotheses, CBM-I resulted in an increase in resilience-congruent interpretations (though no change for general panic interpretation bias) at post-training, and a trend for a greater reduction in anxiety sensitivity at 2-month follow-up. Additionally, CBM-I resulted in less intense cognitive symptoms of panic during the CO₂ challenge, though not less intense physical or total panic symptoms. These results, though somewhat mixed, provide preliminary support for the value of training resilience using CBM-I.

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The Panic Attack Coping Questionnaire was administered after the CO₂ challenge, but is not included in the analyses because it is not central to the current hypotheses. Similarly, an exploratory assessment of willingness to volunteer for future studies that involve participation in the CO₂ challenge is not discussed here, but full details are available from the first author.

This measure was initially conceptualized as an outcome measure, but multiple readers of an earlier draft raised questions about the validity of construing a general measure of resilience that is designed to reflect long-standing patterns of adapting to stress as an outcome measure in this context where outcomes are assessed immediately following training and training is specific to anxiety sensitivity/panic resilience.

PDSS was administered at baseline, post-training, and follow-up, but due to the skip pattern in the measure (i.e., you do not provide severity ratings if you have not had a past history of a full-blown panic attack), only 16 participants completed the full measure at all three time points, so the measure could not be used to assess outcomes. However, the baseline assessment is retained for the information it provides about the presence of reported panic attack history in this high-risk sample.

The overall pattern of results without trait resilience as a covariate remained mostly the same with some differences. Consistent with the current findings, there was no condition by time interaction for the BBSIQ-Phys, but the four-way interaction for Recognition Ratings was significant with the direction of follow-up remaining the same. When not including the covariate, there was no interaction between condition and time for the ASI. The results from the CO₂ breathing challenge were also largely the same, with a significant quadratic time by condition interaction for the SUDS variable and a main effect of condition for the DSQ cognitive variable, while no effects involving condition were detected for the DSQ sum variable. Additionally, when not including the covariate, there was a non-significant trend for a main effect for the DSQ physical variable.

Secondary analyses were conducted on the full sample with the ASI score at Session 1 as a covariate, and findings were less pronounced. While the condition by time interactions for both positive and negative Recognition Ratings were significant in the expected directions (p’s <.05), there was no longer an effect involving condition for the ASI. With regard to the CO₂ challenge, there was no longer an effect of training for the DSQ cognitive variable, though the interaction for SUDS was still present (at the level of a trend).

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Titel: Cognitive Bias Modification to Enhance Resilience to a Panic Challenge
verfasst von: Jessica R. Beadel
Andrew Mathews
Bethany A. Teachman
Publikationsdatum: 25.06.2016
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 6/2016
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-016-9791-z

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