The Relative Contributions of Negative Cognitions and Self-efficacy to Severity of Panic Attacks in Panic Disorder

Abstract

The aim of this study was to determine the degree to which fearful and catastrophic cognitions, and self-efficacy for managing panic predicted various panic attack characteristics in panic disorder. The cognitive variables consisted of anxiety sensitivity, the frequency of fearful agoraphobic cognitions and measures of catastrophic misinterpretation of symptoms. The panic parameters were number and severity of panic symptoms, distress associated with panic attacks, worry about future panics, duration of panic disorder, and life interference due to panic disorder. These variables were measured in 40 people with panic disorder, 31 of whom also had significant agoraphobia. The frequency of fearful agoraphobic cognitions was the strongest predictor of panic attack symptomatology, predicting number of symptoms, symptom severity and degree of anticipatory fear of panic. Catastrophic misinterpretation of symptoms and anxiety sensitivity did not independently predict any panic parameters. Only self-efficacy for managing the rapid build-up of panic symptoms was specifically related to panic severity. The results therefore suggest that cognitive behaviour therapy for panic symptoms in panic disorder should reduce fearful cognitions rather than focus on panic coping strategies. The results offer little support for the contribution of the expectancy or catastrophic misinterpretation theories to the maintenance of panic disorder.