BackgroundTreatments for anxiety disorders are among the most effective in psychiatry. Yet, there is considerable room for improvement.AimIn this paper, we discuss the value of ecological momentary assessment as a research method and clinical tool.MethodsWe begin by describing ecological momentary assessment and its advantages, including the ability to collect ecologically valid information about mental disorders, in real time, in individual patients. We then illustrate the value of this approach for anxiety disorder treatment using two patients with panic disorder who completed ecological momentary assessments for 2 weeks before and after a cognitive-behavioural therapy intervention. We focus especially on two key pieces of information provided by ecological momentary assessment data: information about symptom dynamics and information about the relationships among symptoms as they unfold over time within individual patients.PerspectiveAlthough considerable work is needed to further develop this methodology in the context of anxiety disorder treatment, we believe that these pieces of information may ultimately inform our understanding of how anxiety disorder treatments have their effect and how those treatments can be tailored to individual patients.
BackgroundCognitive–behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO2 inhalation) and their relation to subsequent panic attacks and panic disorder.MethodWe searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder.ResultsWe identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder.ConclusionsThese findings provide support for the prediction derived from cognitive–behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development.Trial registration number135908.
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