Emotional control & the occurrence of panic attacks

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An experimental study of emotional processing in panic attacks
A vulnerability model to explain the occurrence of the first panic attack
  Panic attacks Chinese version
References
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Methodology

Patients who fulfilled a DSM IIIR diagnosis of Panic Disorder made after the first initial interview were referred to the Clinical Psychology Department, Royal Cornhill Hospital, Aberdeen by Medical Practitioners.  They were independently screened by two clinical psychologists for the presence of panic disorder or agoraphobia.  They were seen for a research interview including DSM IIIR diagnosis.  We also included data from patients with other Anxiety disorders routinely referred to Roger Baker for treatment.  After the first clinical interview, a DSM IIIR diagnosis was made.  The data from this latter group had not been included in the article ‘Emotional Processing & Panic’ (Baker, Holloway, Thomas, Thomas & Owens in press) due for publication in Behaviour Research & Therapy.  It included conditions such as patients with phobias who also have panic attacks but only in the presence of a phobic object, and patients with Anxiety Disorder, PTSD and OCD.

Sample Characteristics

Assessment Measures

Courtauld Emotional Control Scale (Watson & Greer 1983). A 21 item self report questionnaire designed to measure emotional control in patients with physical disorders.  It yields a total emotional control score ranging from 21-84.  (High = greater degrees of emotional control/suppression).

Modified Panic Frequency & Intensity Scale (Chambles, Caputo, Bright & Callaher 1984)

This self report scale defines panic attacks for the person and asks them if they have ever had a panic attack, the time of the last attack, its frequency and severity.  The modifications to the scale were to provide more detailed information about timing of panic attacks and the degree of certainty the person held about having attacks.  The categories measured are:

1. Never had a panic attack
2. Not sure if I’ve had a panic attack
3. I have had a panic attack but not in the last 7 days<
4. I have had a panic attack in the last 7 days

Procedure

The Courtauld Emotional Control Scale and the Chambless Panic Frequency & Intensity Scale were initially given to all patients (and also to a normal group of volunteers n=115).

Figure 2 shows the relationship of the reported presence of panic and emotional control scores for the patient sample.  Those patients reporting the presence of panic attacks in the last 7 days (n=26) had significantly higher emotional control scores than those patients who had never had a panic attack (n=5), (t-3.6, p< .001).  They had significantly higher scores than those patients who had had a panic attack at some time but not in the last 7 days (n=26), (t = 2.7, p< .001) but did not have higher scores than those patients who were not sure about whether they had had a panic attack (n=6), (t = .28, n = 6, ns).

GRAPH to be published shortly

Interpretation

Within the Anxiety Disorder groups, patients currently experiencing panic attacks showed greater (and very high) degrees of emotional control compared with patients who had never experienced a panic attack.  They showed no difference to those who were not sure whether or not they had had a panic attack.  Our model of emotional processing suggests that poor ability to label and understand emotions is part of poor emotional processing and would explain why a group who were uncertain about having panic attacks (and presumably uncertain about other internal events) should have high (poor) emotional control scores.

In general, the study shows that the presence of panic attacks in an anxiety disorder group is related to difficulties in emotional control and emotional processing.  However, one should be cautious of this data because the numbers in some groups are very small. The research to be published in the journal Behaviour Research & Therapy (Baker, Holloway, Thomas, Thomas & Owens) which presents data on much larger samples, suggests patients with panic disorder have significantly poorer emotional processing than non-patient normals.  The smaller study described above suggests anxiety disorder patients with panic attacks show more emotional processing difficulties than anxiety disorder patients without attacks.