Panic Disorder 291
Schematic Activation
In the cognitive model recurrent panic attacks occur because of the activation of endur-
ing schemas (beliefs) about the dangerousness of particular physiological changes.
These physiological and mental threat schemas are consistent with the primal threat
mode that dominates in anxiety. Some examples of panicogenic schemas are “My heart
palpitations and chest pain might be signs that I am having a potentially fatal heart
attack,” “My episodes of breathlessness could lead to suffocation and death,” “Dizzy
spells might be caused by a brain tumor,” “This feeling of nausea could cause me to be
violently sick and vomit controllably,” “Feeling tense and a little nervous could lead to
loss of control and overwhelming panic,” or “I could lose control of my emotions and
go crazy.” The physiological and mental threat schemas predispose certain individu-
als to experience recurrent panic attacks and involve themes of personal vulnerability,
helplessness, the dangerousness of particular internal states, and the rapid escalation of
anxiety (Beck & Greenberg, 1988).
There is a close association between specific bodily or mental sensations and the
panicogenic beliefs that underlie the catastrophic misinterpretation of interoceptive
cues. Table 8.4 presents connections between some common internal sensations and the
corresponding physiological or mental threat schemas often seen in panic disorder.
Panic- relevant schemas are quite idiosyncratic and can be highly variable so that
some individuals will hold exaggerated threat beliefs for only certain internal sensations,
others will misinterpret a wide range of somatic and mental phenomena as threatening,
table 8.4. links between panic-relevant internal sensations and their Corresponding
physiological or mental threat schema
Internal sensation Physiological/mental threat schema
Chest tightness, pain, heart palpitations Belief of vulnerability to heart attacks.
Breathlessness, smothering sensation,
irregular breathing
Belief of possible suffocation and death.Dizziness, lightheadedness, faintness Belief of losing control and doing something embarrassing or
of going crazy, or presence of a brain tumor.
Nausea, abdominal cramps Belief of vomiting uncontrollably.
Numbness, tingling in extremities Belief in the possibility of having a stroke or losing one’s
san it y.
Restless, tense, agitation Belief that these symptoms are an indication of losing control
which could lead to a severe panic attack and eventual loss of
function.
Feel shaky, trembling Belief these symptoms indicate a loss of control and are often a
precursor to severe panic.
Forgetful, inattentive, loss of
concentration
Belief of losing control over one’s mental functioning and
ending up losing cognitive function.Feelings of unreality, depersonalization Belief that these symptoms may indicate a seizure or of going
craz y.
Note. Based on Taylor (2000).