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Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views, particularly those that emphasize the role of catastrophic misinterpretation of somatic sensations, is discussed.

The ascendance of emotion theory, recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts the development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.

Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and profession of psychology. But methods to transport treatments to service delivery settings have developed independently without strong evidence for, or even a consensus on, best practices for accomplishing this task or for measuring successful outcomes of training. This article reviews current leading efforts at the national, state, and individual treatment developer levels to integrate evidence-based interventions into service delivery settings. Programs are reviewed in the context of the accumulated wisdom of dissemination and implementation science and of methods for assessment of outcomes for training efforts. Recommendations for future implementation strategies will derive from evaluating outcomes of training procedures and developing a consensus on necessary training elements to be used in these efforts.

Current developments in cognitive and emotion theory suggest that anxiety plays a rather central role in negative emotions. This article reviews findings in the area of anxiety and depression, helplessness, locus of control, explanatory style, animal learning, biology, parenting, attachment theory, and childhood stress and resilience to articulate a model of the environmental influences on the development of anxiety. Evidence from a variety of sources suggests that early experience with diminished control may foster a cognitive style characterized by an increased probability of interpreting or processing subsequent events as out of one's control, which may represent a psychological vulnerability for anxiety. Implications for research are discussed.

The Panic Disorder Severity Scale is a simple, efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder. However, further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed.

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The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. Lilienfeld, Turner, and Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures.In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed.Reiss and his colleagues (Reiss, 1987;Reiss & McNally, 1985;Reiss, Peterson, Gursky, & McNally, 1986) have defined the construct of anxiety sensitivity (AS) as fear of anxiety and physical sensations related to anxiety, and they hypothesize that this fear arises from beliefs that anxiety and related physical sensations have harmful somatic, psychological, or social consequences. AS and closely related constructs have played a central role in recent theorizing about the nature and etiology of the anxiety disorders in general and panic disorder in particular (e.g.,