The role of dysfunctional associations and interpretations in panic disorder: An etiological approach.
Final Report Abstract
An individual’s response towards a certain situation is influenced by what kind of association the situations triggers and how the individual interprets the situation. Put differently, not the situation itself, but the cognitive processing of the situation is the key determinant. For example, for a patient suffering from panic disorder, a fast-beating heart immediately triggers a threat-related association and is interpreted as a sign of an upcoming heart attack. Various psychological disorders are characterized by dysfunctional interpretational processing styles, and such processes are given a central role in many theories of psychopathology and treatment models. Via analogue, experimental, and clinical studies, the present project aimed to advance our understanding of dysfunctional cognitive processes in the context of panic disorder, with a specific focus on panic-related associations and interpretations. Further, a review and metaanalysis was conducted, to examine the psychometric properties of a frequently used task to assess biased interpretational processing. Our main findings can be summarized as follows. Across two samples, i.e., an at-risk and a diagnosed clinical sample, we found positive correlations between panic-related interpretations and panic symptoms. Specifically, a stronger tendency to interpret panic-related information in a dysfunctional manner was related with higher levels of panic symptoms. Further, in the at-risk sample, we found that panic-related interpretations were predictive of stress reactivity, and the relationship between anxiety sensitivity, a risk factor for developing panic disorder, and stress reactivity was mediated by panic-related interpretations. Regarding the patient sample, we found that panic patients, compared to anxious control patients, showed stronger panic-related interpretations. Further, panic-related interpretations correlated with an increase in panic symptoms following a hyperventilation. Results of panic-related associations, however, did not show such a consistent pattern, neither in the clinical nor the risk sample. By means of an online study we tested three different versions of a reaction time task, each version targeting specific panic-relevant associations. Contrary to our expectations, the correlational evidence between specific associations and symptom scores was very limited. We also conducted an experimental study: Via a computerized training, participants had a panic-related interpretation bias induced versus reduced, compared to a control condition. Results showed that the training to reduce panic-related interpretation biases indeed led to more functional interpretations, compared to the other two conditions, and this effect partly generalized to another cognitive task. However, there were no differential training effects on panic-related symptomatology. Finally, we conducted a systematic review and meta-analysis on the Scrambled Sentences Task (SST), a frequently used task to assess interpretational processing biases. Results indicated good convergent validity and reliability, albeit in the context of substantial heterogeneity. To conclude, our data provide additional evidence that panic-related interpretations but not associations are a correlate and predictor of panic-relevant symptomatology, and this is important information for both theory refinement and clinical application.
Publications
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Cognitive Vulnerability in the Context of Panic: Assessment of Panic-Related Associations and Interpretations in Individuals with Varying Levels of Anxiety Sensitivity. Cognitive Therapy and Research, 44(4), 858-873.
Zahler, Lisa; Sommer, Katharina; Reinecke, Andrea; Wilhelm, Frank H.; Margraf, Jürgen & Woud, Marcella L.
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Using Three Indirect Measures to Assess the Role of Sexuality-Related Associations and Interpretations for Women’s Sexual Desire: An Internet-Based Experimental Study. Archives of Sexual Behavior, 50(6), 2471-2484.
Zahler, Lisa; Meyers, Milena; Woud, Marcella L.; Blackwell, Simon E.; Margraf, Jürgen & Velten, Julia
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Scrambled but valid? The scrambled sentences task as a measure of interpretation biases in psychopathology: A systematic review and meta-analysis. Clinical Psychology Review, 93, 102133.
Würtz, Felix; Zahler, Lisa; Blackwell, Simon E.; Margraf, Jürgen; Bagheri, Mahdi & Woud, Marcella L.
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Effects of Training Body-Related Interpretations on Panic-Related Cognitions and Symptoms. Cognitive Therapy and Research, 47(3), 494-509.
Würtz, Felix; Steinman, Shari; Blackwell, Simon E.; Wilhelm, Frank H.; Reinecke, Andrea; Adolph, Dirk; Margraf, Jürgen & Woud, Marcella L.
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Measuring Symptom-Specific Panic-Relevant Associations Using Single-Target Implicit Association Tests. Cognitive Therapy and Research, 47(5), 720-731.
Blackwell, Simon E.; Wilhelm, Frank H.; Reinecke, Andrea; Margraf, Jürgen & Woud, Marcella L.
