The Role of Early Experience and Cognitive Vulnerability: Presenting a Unified Model of the Etiology of Panic

Abstract

Cognitive vulnerability models have been developed to explicate the etiology of panic and other anxiety disorders. This study takes a step forward by presenting a unified vulnerability model that incorporates a continuum of proximal and distal factors involved in the etiology of panic. The present study tested distal elements of the model, including childhood histories of vicarious and instrumental learning, and cognitive constructs such as anxiety sensitivity and perceived control. Our study found that parental modeling of the dangerousness of anxiety symptoms accounted for more model variance than from direct experiences with arousal-reactive symptoms or from parental reinforcement of the child's own sick role behavior when experiencing arousal reactive symptoms. We found that parental modeling independently predicted model variance even when perceived control was included in the model. Our results indicated that low perceived anxiety control and anxiety about bodily symptoms uniquely accounted for variance in the model. Our findings add to the growing body of research and suggest that anxiety about bodily symptoms and low perceived control together may interact to create a stronger distal vulnerability construct for panic than either construct alone in individuals whose childhood caregivers may have modeled fear of anxiety symptoms. The results of this study provide support for the inclusion of distal factors in unified cognitive vulnerability models of panic disorder as well as for future prospective research of these constructs.

Response: Commentary: Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

“…This is further supported by numerous studies showing that BSQ total scores and scores on measures directly assessing the severity of panic attacks, such as the Panic Attack Questionnaire-Revised (PAQ-R), are significantly associated. For instance, McGinn et al ( 2015 ) reported a correlation of −0.44 between ACQ and PAQ-R and a correlation of 0.40 between the BSQ and the PAQ-R. In addition, a panic-related interpretation bias, as indexed with the ACQ, is not merely predictive of panic attacks, but even of new onsets of panic disorder (Woud et al, 2014 ).…”