270 CHAPTER 7
Cognitive Explanations: Catastrophic Thinking and Anxiety Sensitivity
Cognitive theories, which focus on how a person interprets and then responds to
alarm signals from the body, offer another possible explanation for panic disorder.
People with panic disorder may misinterpret normal bodily sensations as indicating
catastrophic effects (Salkovskis, 1988), which is referred to as catastrophic thinking.
In essence, these interpretations can turn a panic attack into panic disorder. For
instance, an increased heart rate may be (mis)interpreted as a signal of an impend-
ing heart attack. Such thoughts (“I’m going to have a heart attack”) are frightening,
and the fright increases autonomic arousal (faster and shallower breathing, sweating,
increased heart rate), which then leads to more anxiety about a catastrophic bodily
problem, more vigilance for changes in the body, and—as a result of all this anxiety
and vigilance—more changes in the body. This process becomes a vicious cycle.
Evidence for this cognitive explanation comes from laboratory studies: Reading
pairs of words that relate both to the body and catastrophic states or events (such
as the words breathless and suffocate) increases the probability that a person who
has had panic attacks in the past will have a panic attack again (Clark et al., 1988).
Moreover, cognitive therapy that reduces the sort of automatic thoughts that lead
to the vicious cycle can reduce symptoms of panic disorder (Beck & Emery, 1985;
Clark et al., 1994). However, at least some people have panic attacks that are not
a result of catastrophic thoughts, at least not conscious ones (Kenardy et al., 1992;
Kenardy & Taylor, 1999).
A tendency toward catastrophic thinking is related to anxiety sensitivity, which
is a tendency to fear bodily sensations that are related to anxiety, along with the
belief that such sensations indicate that harmful consequences will follow (McNally,
1994; Reiss, 1991; Reiss & McNally, 1985; Schmidt, Lerew, & Jackson, 1997).
For example, a person with high anxiety sensitivity is likely to believe—or fear—
that an irregular heartbeat indicates a heart problem or that shortness of breath
signals being suffocated. People with high anxiety sensitivity tend to know what
has caused their bodily symptoms—for instance, that exercise caused a faster heart
rate—but they become afraid anyway, believing that danger is indicated, even if it is
not an immediate danger (Bouton, Mineka, & Barlow, 2001; Brown et al., 2003).
Many researchers view anxiety sensitivity and being prone to anxiety as endur-
ing traits that leave individuals more vulnerable to develop panic disorder. One bit
of evidence came from a study that followed fi rst-year Air Force Academy cadets
who were enrolled in a 5-week basic training course—training that is both physi-
cally and psychologically stressful. Those cadets who had more anxiety sensitivity
at the beginning of training were the ones who were likely to develop spontaneous
panic attacks later. This fi nding suggests that the mental stressors of basic training,Researchers have shown that the mental stressors
of basic military training are more challenging to
people with preexisting anxiety sensitivity. U.S. Air Force Academy