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The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective

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Abstract

Within the triple vulnerabilities model of anxiety disorders, a genetic contribution to the development of anxiety and negative affect (i.e., generalized biological vulnerability), a diminished sense of perceived control over aversive events and emotional experiences (i.e., generalized psychological vulnerability), and elevated levels of anxiety sensitivity (i.e., specific psychological vulnerability) are posited to increase the risk of developing and maintaining panic disorder (Barlow American Psychologist 55(11):1247–1263, 2000). The purpose of the present study was to investigate the direct and interactive effects of perceived control and anxiety sensitivity on panic disorder symptom severity. Structural equation models (SEM) were conducted in data derived from a sample of 379 adults with panic disorder participating in a multi-site randomized controlled trial. Findings indicated that both perceived control and anxiety sensitivity uniquely predicted panic disorder symptoms. A moderation model examining the interactive effects of perceived control and anxiety sensitivity on panic symptoms indicated that the effect of anxiety sensitivity on panic symptoms increased with greater deficits in perceived control. The present findings suggest that deficits in perceived control and elevated levels of anxiety sensitivity exert unique and shared effects on panic disorder symptoms, thereby illustrating the relationship between putative vulnerability factors and panic disorder symptoms as predicted by the triple vulnerabilities model.

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References

  • Aaronson, C. J., Shear, M. K., Goetz, R. R., Allen, L. B., Barlow, D. H., White, K. S., et al. (2008). Predictors and time course of response among panic disorder patients treated with cognitive-behavioral therapy. The Journal of Clinical Psychiatry, 69, 418–424.

    Article  PubMed  Google Scholar 

  • Alloy, L. B., Kelly, K. A., Mineka, S., & Clements, C. M. (1990). Comorbidity of anxiety and depressive disorders: A helplessness-hopelessness perspective. In J. D. Maser & C. R. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 499–543). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Barlow, D. H. (1991). Disorders of emotion. Psychological Inquiry, 2(1), 58–71.

    Article  Google Scholar 

  • Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55(11), 1247–1263.

    Article  PubMed  Google Scholar 

  • Barlow, D. H. (2002). Anxiety and its disorders. The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Barlow, D. H., & Craske, M. G. (2007). Mastery of your anxiety and panic (4th ed.). New York: Oxford University Press.

    Google Scholar 

  • Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review. doi:10.1037//0033-295X.108.1.4.

  • Brown, T. A., White, K. S., Forsyth, J. P., & Barlow, D. H. (2004). The structure of perceived emotional control: psychometric properties of a revised anxiety control questionnaire. Behavior Therapy, 35, 75–99.

    Article  Google Scholar 

  • Chorpita, B. F., & Barlow, D. H. (1998). The development of anxiety: the role of control in the early environment. Psychological Bulletin, 124, 3–21.

    Article  PubMed  Google Scholar 

  • Ehlers, A. (1993). Somatic symptoms and panic attacks: a retrospective study of learning experiences. Behaviour Research and Therapy, 31, 269–278.

    Article  PubMed  Google Scholar 

  • Gregor, K. L., & Zvolensky, M. J. (2008). Evaluating the singular and interactive effects in the prediction of anxious and fearful responding to bodily sensations. Behaviour Research and Therapy, 46, 1017–1025.

    Article  PubMed  Google Scholar 

  • Houck, P. R., Speigel, D. A., Shear, M. K., & Rucci, P. (2002). Reliability of the self-report version of the panic disorder severity scale. Depression and Anxiety, 15, 183–185.

    Article  PubMed  Google Scholar 

  • Klein, A. G., & Muthén, B. O. (2002). Quasi maximum likelihood estimation of structural equation models with multiple interaction and quadratic effects. Unpublished manuscript, Graduate School of Education, University of California, Los Angeles.

  • Lewis, A. R., Zinbarg, R. E., Mineka, S., Craske, M. G., Epstein, A., & Griffith, J. W. (2010). The relationship between anxiety sensitivity and latent symptoms of emotional problems: a structural equation modeling approach. Behavior Research & Therapy. doi:10.1016/j.brat.2010.05.001.

  • Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: exploring the question, weighing the merits. Structural Equation Modeling, 9(2), 151–173.

    Article  Google Scholar 

  • Maller, R. G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6, 241–247.

    Article  Google Scholar 

  • McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52, 938–946.

    Article  PubMed  Google Scholar 

  • McNally, R. J., & Eke, M. (1996). Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge. Journal of Abnormal Psychology, 105, 146–149.

    Article  PubMed  Google Scholar 

  • Mineka, S., & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiological of anxiety disorders. American Psychologist. doi:10.1037/0003-066X.61.1.10.

  • Muthén, L. K., & Muthén, B. O. (2007). Mplus user’s guide (6th ed.). Los Angeles: Muthén & Muthén.

    Google Scholar 

  • Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128–150.

    Article  PubMed  Google Scholar 

  • Peterson, R. A., & Reiss, S. (1987). Anxiety sensitivity index manual. Worthington: International Diagnostic Systems.

    Google Scholar 

  • Plehn, K., & Peterson, R. A. (2002). Anxiety sensitivity as a predictor of the development of panic symptoms, panic attacks, and panic disorder: a prospective study. Journal of Anxiety Disorders, 16, 455–474.

    Article  PubMed  Google Scholar 

  • Rapee, R., Mattick, R., & Murrell, E. (1986). Cognitive mediation in the affective component of spontaneous panic attacks. Journal of Behavior Therapy and Experimental Psychology, 17, 245–253.

    Article  Google Scholar 

  • Rapee, R. M., Craske, M. G., Brown, T. A., & Barlow, D. H. (1996). Measurement of perceived control over anxiety related events. Behavior Therapy, 27, 279–293.

    Article  Google Scholar 

  • Reiss, S. (1980). Pavlovian conditioning and human fear—An expectancy model. Behavior Therapy, 11, 380–396.

    Article  Google Scholar 

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.

    Article  PubMed  Google Scholar 

  • Sanderson, W. C., Rapee, R. M., & Barlow, D. H. (1989). The influence of an illusion of control on panic attacks via inhalation of 5.5 % carbon dioxide-enriched air. Archives of General Psychiatry, 46, 157–162.

    Article  PubMed  Google Scholar 

  • Schmidt, N. B., Trakowski, J. H., & Staab, J. P. (1997). Extinction of panicogenic effects of a 35 % CO-sub-2 challenge in patients with panic disorder. Journal of Abnormal Psychology, 106, 630–638.

    Article  PubMed  Google Scholar 

  • Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of Abnormal Psychology, 108, 532–537.

    Article  PubMed  Google Scholar 

  • Schmit, N. B., & Lerew, D. R. (2002). Prospective evaluation of perceived control, predictability, and anxiety sensitivity in the pathogenesis of panic. Journal of Psychopathology and Behavioral Assessment, 24(4), 207–214.

    Article  Google Scholar 

  • Schneewind, K. A. (1995). Impact of family processes on control beliefs. In A. Bandura (Ed.), Self-efficacy in changing societies (pp. 114–148). New York: Cambridge University Press.

    Chapter  Google Scholar 

  • Shear, M. K., Rucci, P., Williams, J., Frank, E., Grochocinski, V., Vander Bilt, J., Houck, P., & Wang, T. (2001). Reliability and validity of the panic disorder severity scale: replication and extension. Journal of Psychiatry Research, 35, 293–296.

    Article  Google Scholar 

  • Smits, J. A. J., Berry, A. C., Tart, C. D., & Powers, M. B. (2008). The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: a meta-analytic review. Behaviour Research and Therapy, 46, 1047–1054.

    Article  PubMed  Google Scholar 

  • Taylor, S., & Fedoroff, I. C. (1999). The expectancy theory of fear, anxiety, and panic: A conceptual and empirical analysis. In S. Taylor (Ed.), Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 17–31). Hillsdale: Erlbaum.

    Google Scholar 

  • Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., LaNae Jaimez, T., & Lucas, R. A. (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31, 279–287.

    Article  PubMed  Google Scholar 

  • Telch, M. J., Silverman, A., & Schmidt, N. B. (1996). Effects of anxiety sensitivity and perceived control on emotional responding to caffeine challenge. Journal of Anxiety Disorders, 10(1), 21–35.

    Article  Google Scholar 

  • White, K. S., & Barlow, D. H. (2002). Panic disorder and agoraphobia. In D. H. Barlow (Ed.), Anxiety and its disorders (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • White, K. S., Brown, T. A., Somers, T. J., & Barlow, D. H. (2006). Avoidance behavior in panic disorder: the moderating influence of perceived control. Behavior Research and Therapy, 44, 147–157.

    Article  Google Scholar 

  • White, K. S., Allen, L. B., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2010). Attrition in a multicenter clinical trial for panic disorder. The Journal of Nervous and Mental Disease, 198, 665–671.

    Article  PubMed  Google Scholar 

  • Wolpe, J., & Rowan, V. (1988). Panic disorder: a product of classical conditioning. Behaviour Research and Therapy, 26, 441–450.

    Article  PubMed  Google Scholar 

  • Zinbarg, R. E., Brown, T. A., Barlow, D. H., & Rapee, R. M. (2001). Anxiety sensitivity, panic, and depressed mood: a re-analysis teasing apart the contributions of the two levels in the hierarchical structure of the anxiety sensitivity index. Journal of Abnormal Psychology, 110, 372–377.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Eifert, G. H., Lejuez, C. W., & McNeil, D. W. (1999). The effects of offset control over 20 % carbon dioxide-enriched air on anxious responding. Journal of Abnormal Psychology, 108, 624–632.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Eifert, G. H., & Lejuez, C. W. (2001a). Offset control during recurrent 20 % carbon dioxide-enriched air induction: relation to individual difference variables. Emotion, 1, 148–165.

    Article  Google Scholar 

  • Zvolensky, M. J., Feldner, M. T., Eifert, G. H., & Stewart, S. H. (2001b). Evaluating differential predictions of emotional reactivity during repeated 20 % carbon dioxide-enriched air challenge. Cognition Emotion, 15, 767–786.

    Article  Google Scholar 

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Authors and Affiliations

  1. Center for Anxiety and Related Disorders, Boston University, 648 Beacon St, 6th Floor, Boston, MA, 02215, USA

    Kate H. Bentley, Matthew W. Gallagher, James F. Boswell & David H. Barlow

  2. Franklin Behavioral Healthcare Consultants, Bronx, NY, USA

    Jack M. Gorman

  3. Columbia University School of Social Work, New York, NY, USA

    M. Katherine Shear

  4. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Scott W. Woods

Authors
  1. Kate H. Bentley
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  2. Matthew W. Gallagher
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  3. James F. Boswell
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  4. Jack M. Gorman
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  5. M. Katherine Shear
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  6. Scott W. Woods
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  7. David H. Barlow
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Corresponding author

Correspondence to Kate H. Bentley.

Additional information

The original study was supported by the National Institute of Mental Health with grants R01 MH45963, MH45964, MH45965, and MH45966.

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Bentley, K.H., Gallagher, M.W., Boswell, J.F. et al. The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective. J Psychopathol Behav Assess 35, 57–64 (2013). https://doi.org/10.1007/s10862-012-9311-8

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  • DOI: https://doi.org/10.1007/s10862-012-9311-8

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