Cognitive models of anxiety and panic suggest that symptom reduction during treatment should be preceded by changes in cognitive processing, including modifying the anxious schema. The current study tests these hypotheses by using a repeated measures design to evaluate whether the trajectory of change in automatic panic associations over the course of 12-week cognitive behavior therapy (CBT) is related to the trajectory of change in panic symptoms. Individuals with panic disorder (N=43) completed a measure of automatic panic associations (the Implicit Association Test, which reflects elements of the schema construct) every three weeks over the course of therapy, and measures of panic symptoms each week. Dynamic bivariate latent difference score modeling indicated that automatic panic associations not only changed over the course of CBT for panic disorder, but showed these changes were correlated with symptom reduction. Moreover, change in automatic panic associations was a significant predictor of change in panic symptom severity. These findings permit inferences about the temporality of change, suggesting that cognitive change does in fact precede and contribute to symptom change. Keywords panic disorder; implicit associations; schema; cognitive behavior therapy The cognitive model of panic suggests that panic attacks occur because certain bodily sensations are misinterpreted as indicating a catastrophe, such as a heart attack or loss of control (Clark, 1986). This panic-specific model derives from more general cognitive theories to explain anxiety disorders. The general model proposes that maladaptive schemata or cognitive frameworks influence information processing so that the individual preferentially attends to danger cues, interprets ambiguous cues as threatening, and selectively remembers cues relevant to fear (e.g., Beck & Emery with Greenberg, 1985). Evidence for these different types of information processing biases have been established in panic disorder, including attentional (e.g., Beck, Stanley, Averill, Baldwin, & Deagle, 1992;Ehlers, Margraf, Davies, & Roth, 1988;Hope, Rapee, Heimberg, & Dombeck, 1990), interpretation (e.g., Clark et al., 1997;McNally & Foa, 1987), and memory biases (e.g., Becker, Rinck, & Margraf, 1994;Cloitre, Correspondence concerning this paper should be addressed to Bethany A. Teachman at the Department of Psychology, University of Virginia, P.O. Box 400400, Charlottesville, VA 22904-4400. Phone: bteachman@virginia.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journa...

To test cognitive models of panic disorder, a range of information processing biases were examined among persons with panic disorder (N=43) and healthy control participants (N=38). Evidence for automatic associations in memory was assessed using the Implicit Association Test, interference effects related to attention biases were assessed using a modified supraliminal Stroop task, and interpretation biases were assessed using the Brief Body Sensations Interpretation Questionnaire. In addition, the relationship between information processing biases and clinical markers of panic (including affective, behavioral, and cognitive symptom measures) was investigated, along with the relationships among biases. Results indicated more threat biases among the panic (relative to control) group on each of the information processing measures, providing some of the first evidence for an implicit measure of panic associations. Further, structural equation modeling indicated that the information processing bias measures were each unique predictors of panic symptoms, but that the bias indicators did not relate to one another. These findings suggest that cognitive factors may independently predict panic symptoms, but not covary. Results are discussed in terms of their support for cognitive models of panic and the potential for automatic versus strategic processing differences across the tasks to explain the low relationships across the biases.

The current study investigates sudden gains (rapid symptom reduction) in group cognitive-behavioral therapy for panic disorder. Sudden gains occurring after session 2 of treatment predicted overall symptom reduction at treatment termination and some changes in cognitive biases. Meanwhile, sudden gains occurring immediately following session 1 were not associated with symptom reduction or cognitive change. Together, this research points to the importance of examining sudden gains across the entire span of treatment, as well as the potential role of sudden gains in recovery from panic disorder.Keywords sudden gains; anxiety; panic disorder; cognitive bias Many clinicians have worked with patients who improve tremendously from one session to the next. This abrupt improvement is often surprising for therapists -accompanied by amazement or even disbelief. However, it is increasingly clear that symptoms do not always improve in a gradual, linear fashion. Instead, research suggests that "sudden gains" (i.e., large improvements in symptoms that occur in a single between-session interval) may account for a sizeable percentage of total symptom improvement (Tang & DeRubeis, 1999).In their influential paper, Tang and DeRubeis (1999) first demonstrated that sudden gains were prevalent in individual cognitive-behavioral therapy (CBT) for depression, accounting for approximately 50% of total improvement. Individuals who experienced a sudden gain (versus those who did not) displayed better outcomes at treatment termination and at 6-and 18-month follow-ups. Furthermore, results indicated that substantial changes in cognition predicted the gains. Since then, a variety of studies have examined sudden gains. While the focus has typically been on sudden gains in individual, time-limited treatment for depression, researchers have also examined gains in the context of group CBT for depression (Kelly, Roberts, & Ciesla, 2005), group CBT for social phobia (Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006), and individual treatment in clinical settings for individuals with mixed psychiatric diagnoses (Stiles et al., 2003). In general, studies confirmed the existence of sudden gains, and demonstrated that individuals who experienced sudden gains, when compared to those who did not, had greater overall symptom reduction at treatment termination.Correspondence concerning this paper should be addressed to Elise Clerkin at the University of Virginia, P.O. Box 400400, Charlottesville, VA 22904-4400. Phone: 434-243-7646, Fax: 434-982-4766, E-mail: emc2t@virginia.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to ...

There is inconsistent evidence for memory biases in anxiety disorders, perhaps because memory biases require activation of the relevant fear schema to be observable. Cognitive theories predict this will occur when exposure to the feared stimulus is combined with semantic and affective activation. The current study examined the impact of priming (having a live spider present) on explicit memory among individuals who were low (N = 53) or high (N = 51) in spider fear. As predicted, only participants who were both high in spider fear and primed (spider present) exhibited preferential recall of spider words (but not of other words). Findings are discussed in terms of how priming may enhance the expression of information processing biases among vulnerable individuals.

These results suggest that scores on the WNSSP may be related to the return of communication skills in adolescents in low response states as one part of assessing their therapeutic participation and ultimate rehabilitation readiness. This ability may assist in making decisions regarding care planning.