Cognitive Therapy of Anxiety Disorders

Panic Disorder 295

pretation level and those that occur later at the secondary, elaborative phase. However,
the inability of secondary elaborative thinking to correct the automatic catastrophic
threat appraisals of bodily sensations accounts for the persistence of panic and the
development of panic disorder. Cognitive therapy of panic, then, focuses on redressing
the dissociation between the two levels of processing so that a more benign interpreta-
tion of previously feared interoceptive sensations is accepted.

empiriCal status of the Cognitive moDel

The proposition that panic attacks are caused by the catastrophic misinterpretation of
bodily sensations has generally received strong empirical support from a large num-
ber of correlational and experimental studies conducted over the past two decades,
although inconsistencies and limitations have also been noted (for reviews, see Austin &
Richards, 2001; Casey, Oei, & Newcombe, 2004; D. M. Clark, 1996; Khawaja & Oei,
1998; McNally, 1994). In this section we expand our review of the empirical status of
the cognitive model to include additional cognitive processes that are important in the
pathogenesis of panic. Table 8.5 presents six hypotheses that capture the main tenets of
the cognitive model of panic (see Figure 8.1).

table 8.5. Core hypotheses of the Cognitive model of panic

Hypotheses Statement

1. Interoceptive
   hypersensitivity

Individuals with panic disorder will exhibit selective

attention to and greater vigilance for internal somatic and

mental sensations than individuals without panic disorder.

2. Schematic vulnerability Panic-prone individuals will endorse more beliefs about the
   dangerousness of specific physiological or mental sensations
   than nonpanic comparison groups.


3. Catastrophic
   misinterpretations

Panic attacks are characterized by a misinterpretation of

bodily or mental sensations as signifying an imminent

physical, mental, or social catastrophe. Production of

the catastrophic misinterpretation will increase panic

symptoms in panic disorder individuals, whereas correction

of the misinterpretation will prevent panic attacks.

4. Interoceptive amplification The production of a catastrophic misinterpretation of
   internal cues will heighten the intensity of the feared
   sensations in panic but not in nonpanic states.


5. Dissociation Individuals with panic disorder will exhibit diminished
   ability to employ higher order reflective thinking to
   generate more realistic and benign interpretations of
   their fearful internal sensations compared to nonpanic
   individuals.


6. Safety seeking Avoidance and maladaptive safety-seeking behavior will
   intensify anxiety and panic symptoms in those with panic
   disorder relative to nonpanic controls.