Background
The learning perspective of panic disorder distinguishes between acute panic and anxious
apprehension as distinct emotional states. Following animal models, these clinical
entities reflect different stages of defensive reactivity depending upon the imminence
of interoceptive or exteroceptive threat cues. The current study tested this model
by investigating the dynamics of defensive reactivity in a large group of patients
with panic disorder and agoraphobia (PD/AG).
Methods
Three hundred forty-five PD/AG patients participated in a standardized behavioral
avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense
reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety
and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation
of the startle reflex before and during exposure of the behavioral avoidance test.
Results
Panic disorder and agoraphobia patients differed substantially in their defensive
reactivity. While 31.6% of the patients showed strong anxious apprehension during
this task (as indexed by increased reports of anxiety, elevated physiological arousal,
and startle potentiation), 20.9% of the patients escaped from the test chamber. Active
escape was initiated at the peak of the autonomic surge accompanied by an inhibition
of the startle response as predicted by the animal model. These physiological responses
resembled the pattern observed during the 34 reported panic attacks.
Conclusions
We found evidence that defensive reactivity in PD/AG patients is dynamically organized
ranging from anxious apprehension to panic with increasing proximity of interoceptive
threat. These data support the learning perspective of panic disorder.
Key Words
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Article info
Publication history
Published online: May 24, 2012
Accepted:
March 28,
2012
Received in revised form:
February 22,
2012
Received:
September 21,
2011
Identification
Copyright
© 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
