Fear of FearEssay title: Fear of FearClinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder but the mechanism responsible for the improvement are lacking. The reduction of fear of fear (FOF), or the tendency to respond fearfully to benign bodily sensations, is believed to underlie the improvement resulting from CBT. Research has provided evidence consistent with the FOF hypothesis. Descriptive studies consistently show that panic disorder patients score significantly higher on self-report measures tapping fear of bodily sensations. Those who score high on measures tapping FOF display heightened emotional responding to challenge compared with those who score low on these same FOF measures (M. Brown, Smits, Powers, & Telch, 2003; Eke & McNally, 1996; Holloway & McNally, 1987; McNally & Eke, 1996; Rapee & Medoro, 1994; Telch et al., 2003). Findings from several prospective studies suggest that people score big on the Anxiety Sensititivity Index (ASI) are at greater risk for developing occurring panic attacks (Schmidt, Lerew, & Jackson, 1997;p Shmidt, Lerew, & Joiner, 1998).
Specific procedural components contained in contemporary CBT manuals for panic disorder include education about the nature and physiology of panic and anxiety, breathing retraining designed to assist patients in learning to control hyperventilation, cognitive restructuring aimed at teaching patients to identify and correct faulty threat perceptions that contribute to their panic and anxiety, interoceptive exposure aimed at reducing patents’ fear of harmless bodily sensations associated with physiological activation, and fading of maladaptive defensive behaviors such as avoidance of external situations (Barlow, Craske, Cerny, & Klosko, 1989; Clark et al., 1994; Telch et al., 199).
On the basis of contemporary psychological theories of panic disorder, several findings implicate change in FOF as a mediator of treatment outcome. CBT results in significant reductions on measures broadly tapping FOF (Bouchard et al., 1996; Clark et al., 1997, Poulton & Andrews, 1996). Modifying patients; catastrophic misinterpretations of bodily sensations result in significant reductions in panic (Taylor, 2000). A clinical trial comparing cognitive therapy with guided mastery therapy for panic disorder, changes in catastrophic cognitions predicted differential change in panic disorder symptoms.
Of the 130 participants ( 99 women and 31 men), 40 were randomly assigned to a waitlist condition, and 90 participants received treatment previously described by Telch (Telch et al., 1993, 1995). This multicomponent group CBT treatment consists of four major treatment components: education and corrective information concerning the nature, causes, and maintenance of anxiety and panic; cognitive therapy techniques helping patient identify, examine, and challenge faulty beliefs of danger and harm associated with panic, anxiety, and phobic avoidance; training in methods of slow diaphragmatic breathing to help patients eliminate hyperventilation symptoms and reduce physiological arousal; interoceptive exposure exercises designed to reduce patients’ fear of somatic sensations through repeated exposure to various activities; and self-directed exposure to patients; feared situation designed to reduce agoraphobic avoidance.
The objective of the treatment was to ensure that all women and men who met the first three main characteristics were not suffering from anxiety disorders. The primary clinical trial studied the efficacy of a CBT treatment in alleviating an anxiety disorder of the amygdala. As such, we used a meta-analysis to determine whether CBT therapy would significantly reduce the incidence of anxiety disorders and related anxiety disorders between 6 weeks and 11 weeks of trial enrollment.
For 9 weeks, in which data are available, we compared participants who met, on average, the criteria of the pre-condition on 1 day after beginning the treatment with controls (2.5% of these were female, and 2.1% were male). This is to reduce the “risk” of anxiety disorder by reducing the amount of attention it takes to identify the most frequent fear-related behaviors in the participants with the primary anxiety disorder. This information will be used to identify the risk of anxiety disorder with all patients, and to assess the safety of a specific experimental technique.
Subjects were excluded and matched for all clinical features and outcome. Patients reported a history of psychiatric disorders. All participants reported feeling uncomfortable in a normal way. Participants who didn’t feel any fear were asked to refrain from the treatment. They also volunteered a set of questions based on fear of possible reactions to the treatment: “How often do you feel embarrassed or angry?” and “How frequently are you afraid?”
Information regarding the primary outcomes was reviewed by the investigators and a systematic review was initiated. The authors made available data relating to patients, their management, their anxiety symptoms, symptom categories, and treatments. Also, the investigators reviewed the literature with regard to the question of the effect of CBT on the treatment of anxiety disorders and related anxiety disorders on the outcomes. In all that was included, anxiety and panic symptoms were defined as symptoms of anxiety, depression, and anxiety withdrawal (eg, having a feeling uncomfortable at night) with the use of a standard anxiety test and psychological or physiological assessment. The primary outcome measures were the percentage of anxiety and panic disorders and the percentage of anxiety and panic disorders with the use of self-directed (interoceptive) exposure exercises (2.5%) as a means to measure the extent or severity of symptoms following the use of different types of CBT (eg, non-hearing aids (other than sleep aids) and drugs); and the number of patients using CBT (eg, taking anxiety medication as opposed to other types of medication). Information on the subjective symptoms of anxiety and panic disorders ranged from 0 to 23. Participants were asked where they were and when they were at or near their own hospital with a range of 5 to 30 visits of CBT or a different CBT technique (1, 2, 3, 4), 1 visit being a follow-up visit for the first anxiety disorder, 3 visits being a follow-up visit for the second anxiety disorder, 5 visits being a follow-up visit for the third anxiety disorder, and 6 visits being a follow-up visit for the fourth anxiety disorder. The primary outcomes of the study included anxiety and panic symptoms (as defined in Table 2), frequency, activity, intensity, and severity of anxiety and panic symptoms over time. At the end of this phase (a 9 week period between the 11th and 12th in the study), these three aspects of these variables were examined.
All variables were categorized in the following ways: 1) (1) a. The proportion of the male participants who met the above criteria was 20% in the CBT group: this included both age-standardized 18-19 year olds of the same sex (15.9%) 2) b. The proportion of male participants who met the above criteria was 40% in
The objective of the treatment was to ensure that all women and men who met the first three main characteristics were not suffering from anxiety disorders. The primary clinical trial studied the efficacy of a CBT treatment in alleviating an anxiety disorder of the amygdala. As such, we used a meta-analysis to determine whether CBT therapy would significantly reduce the incidence of anxiety disorders and related anxiety disorders between 6 weeks and 11 weeks of trial enrollment.
For 9 weeks, in which data are available, we compared participants who met, on average, the criteria of the pre-condition on 1 day after beginning the treatment with controls (2.5% of these were female, and 2.1% were male). This is to reduce the “risk” of anxiety disorder by reducing the amount of attention it takes to identify the most frequent fear-related behaviors in the participants with the primary anxiety disorder. This information will be used to identify the risk of anxiety disorder with all patients, and to assess the safety of a specific experimental technique.
Subjects were excluded and matched for all clinical features and outcome. Patients reported a history of psychiatric disorders. All participants reported feeling uncomfortable in a normal way. Participants who didn’t feel any fear were asked to refrain from the treatment. They also volunteered a set of questions based on fear of possible reactions to the treatment: “How often do you feel embarrassed or angry?” and “How frequently are you afraid?”
Information regarding the primary outcomes was reviewed by the investigators and a systematic review was initiated. The authors made available data relating to patients, their management, their anxiety symptoms, symptom categories, and treatments. Also, the investigators reviewed the literature with regard to the question of the effect of CBT on the treatment of anxiety disorders and related anxiety disorders on the outcomes. In all that was included, anxiety and panic symptoms were defined as symptoms of anxiety, depression, and anxiety withdrawal (eg, having a feeling uncomfortable at night) with the use of a standard anxiety test and psychological or physiological assessment. The primary outcome measures were the percentage of anxiety and panic disorders and the percentage of anxiety and panic disorders with the use of self-directed (interoceptive) exposure exercises (2.5%) as a means to measure the extent or severity of symptoms following the use of different types of CBT (eg, non-hearing aids (other than sleep aids) and drugs); and the number of patients using CBT (eg, taking anxiety medication as opposed to other types of medication). Information on the subjective symptoms of anxiety and panic disorders ranged from 0 to 23. Participants were asked where they were and when they were at or near their own hospital with a range of 5 to 30 visits of CBT or a different CBT technique (1, 2, 3, 4), 1 visit being a follow-up visit for the first anxiety disorder, 3 visits being a follow-up visit for the second anxiety disorder, 5 visits being a follow-up visit for the third anxiety disorder, and 6 visits being a follow-up visit for the fourth anxiety disorder. The primary outcomes of the study included anxiety and panic symptoms (as defined in Table 2), frequency, activity, intensity, and severity of anxiety and panic symptoms over time. At the end of this phase (a 9 week period between the 11th and 12th in the study), these three aspects of these variables were examined.
All variables were categorized in the following ways: 1) (1) a. The proportion of the male participants who met the above criteria was 20% in the CBT group: this included both age-standardized 18-19 year olds of the same sex (15.9%) 2) b. The proportion of male participants who met the above criteria was 40% in
The objective of the treatment was to ensure that all women and men who met the first three main characteristics were not suffering from anxiety disorders. The primary clinical trial studied the efficacy of a CBT treatment in alleviating an anxiety disorder of the amygdala. As such, we used a meta-analysis to determine whether CBT therapy would significantly reduce the incidence of anxiety disorders and related anxiety disorders between 6 weeks and 11 weeks of trial enrollment.
For 9 weeks, in which data are available, we compared participants who met, on average, the criteria of the pre-condition on 1 day after beginning the treatment with controls (2.5% of these were female, and 2.1% were male). This is to reduce the “risk” of anxiety disorder by reducing the amount of attention it takes to identify the most frequent fear-related behaviors in the participants with the primary anxiety disorder. This information will be used to identify the risk of anxiety disorder with all patients, and to assess the safety of a specific experimental technique.
Subjects were excluded and matched for all clinical features and outcome. Patients reported a history of psychiatric disorders. All participants reported feeling uncomfortable in a normal way. Participants who didn’t feel any fear were asked to refrain from the treatment. They also volunteered a set of questions based on fear of possible reactions to the treatment: “How often do you feel embarrassed or angry?” and “How frequently are you afraid?”
Information regarding the primary outcomes was reviewed by the investigators and a systematic review was initiated. The authors made available data relating to patients, their management, their anxiety symptoms, symptom categories, and treatments. Also, the investigators reviewed the literature with regard to the question of the effect of CBT on the treatment of anxiety disorders and related anxiety disorders on the outcomes. In all that was included, anxiety and panic symptoms were defined as symptoms of anxiety, depression, and anxiety withdrawal (eg, having a feeling uncomfortable at night) with the use of a standard anxiety test and psychological or physiological assessment. The primary outcome measures were the percentage of anxiety and panic disorders and the percentage of anxiety and panic disorders with the use of self-directed (interoceptive) exposure exercises (2.5%) as a means to measure the extent or severity of symptoms following the use of different types of CBT (eg, non-hearing aids (other than sleep aids) and drugs); and the number of patients using CBT (eg, taking anxiety medication as opposed to other types of medication). Information on the subjective symptoms of anxiety and panic disorders ranged from 0 to 23. Participants were asked where they were and when they were at or near their own hospital with a range of 5 to 30 visits of CBT or a different CBT technique (1, 2, 3, 4), 1 visit being a follow-up visit for the first anxiety disorder, 3 visits being a follow-up visit for the second anxiety disorder, 5 visits being a follow-up visit for the third anxiety disorder, and 6 visits being a follow-up visit for the fourth anxiety disorder. The primary outcomes of the study included anxiety and panic symptoms (as defined in Table 2), frequency, activity, intensity, and severity of anxiety and panic symptoms over time. At the end of this phase (a 9 week period between the 11th and 12th in the study), these three aspects of these variables were examined.
All variables were categorized in the following ways: 1) (1) a. The proportion of the male participants who met the above criteria was 20% in the CBT group: this included both age-standardized 18-19 year olds of the same sex (15.9%) 2) b. The proportion of male participants who met the above criteria was 40% in
Treatment conststed of twelve 2 hour structured sessions conducted over and 8 week period. Sessions were conducted twice weekly for the first 4 weeks and once each week for the remaining 4 weeks. Patients were required to tape-record each session. Assessment of clinical status and FOF occurred pretreatment and then again post treatment. For the Texas Panic Attack Record Form, participants were provided with daily panic diary forms. Patients had to record the