Automatic associations and panic disorder: Trajectories of change over the course of treatment.

Abstract

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...

Treatment sensitivity of implicit threat evaluation, avoidance tendency and visual working memory bias in specific phobia

“…This would be in line with neuroimaging research showing that while both low and high anxious individuals respond to taskrelevant threat stimuli with increased activity in the amygdala, which has been shown to play a key role in the acquisition and extinction of fear (Davis, 2002;LeDoux, 2000), only anxious participants also show amygdala hypersensitivity for task-irrelevant threat (Bishop, Duncan, & Lawrence, 2004). This explanation would also be consistent with previous studies reporting CBT induced bias changes, having used implicit evaluation tasks (Teachman et al, 2008;Teachman & Woody, 2003) or emotional stroop tasks, where participants name the colour of threat-related words (Mogg et al, 1995;Van den Hout et al, 1997).…”

“…Foa, Huppert, & Cahill, 2006;Williams, Watts, MacLeod, & Mathews, 1997). This assumption is supported by a large number of studies showing an association between heightened states of anxiety and bias, using paradigms that tap into different aspects of information processing: compared to non-anxious controls, anxious individuals show threat-favouring processing biases in attention (for a review, see Mathews & MacLeod, 2005) and visual working memory (VWM; Reinecke, Becker, & Rinck, 2009;Reinecke, Rinck, & Becker, 2006;Reinecke, Rinck, & Becker, 2008), more negative implicit evaluation of fear material (Huijding & de Jong, 2009;Reinecke, Becker, Hoyer, & Rinck, 2010;Teachman, Marker, & Smith-Janik, 2008), and stronger avoidance tendencies in reaction-time based approach-avoidance tasks (Reinecke, Becker, Hoyer, & Rinck, 2010).…”

Pathways to change in one-session exposure with and without cognitive intervention: An exploratory study in spider phobia

“…This is the first study that compares the level of cognitive mediation in purely behavioral versus cognitive-behavioral treatment of specific phobia. Previous studies have already demonstrated cognitive mediation of treatment in purely behavioral exposure formats and cognitive-behavioral treatments separately (Hofmann, 2004;Hofmann et al, 2007;Teachman, Marker, & Smith-Janik, 2008;Vögele et al, 2010). Therefore, we expect significant cognitive mediation of treatment outcome in both the BE and the EXP group.…”

Consider the Source

“…Therefore, the notion that "implicit cues" (heuristic information) are more likely to affect implicit evaluations, whereas "explicit cues" (elaborative processing) are more likely to affect explicit evaluations -while intuitively satisfying -may be wrong. The key insight is that as a predictor, implicit evaluations may influence behavior through subtle, heuristic means, but as an outcome, implicit evaluations may also be shaped more by overt, elaborative efforts to create, change, or override existing associations (see also Teachman, Marker, & Smith-Janik, 2008 More speculatively, the current results may shed some light on the longevity of attitude change. Specifically, although source characteristics have been shown to operate both at more and less thoughtful levels, the resultant evaluations are stronger (i.e., longer lasting, more resistant, more predictive of behavior) when people engage in more elaboration during the persuasion attempt (Petty, Haugtvedt, & Smith, 1995).…”