Introduction
The term “panic disorders” refers to an anxiety disorders which are characterized by repeated and unexpected cases of intense fear accompanied by some physical symptoms such as dizziness, chest pain, abdominal distress and hear palpitations (Last and Strauss, 1989). The cognitive model of panic disorder state that individuals who suffer from the disorders usually have distortions in their thoughts that they may be not be aware of, an issue that results to a cycle of fear. The model supports the notion that individuals with panic disorder can be able to recognize the earliest thoughts and feelings that trigger attacks often with the assistance of skilled therapists. Panic disorders interfere with an individual’s reality of life and have negative impacts on their psychosocial functioning (Root, 2000). The cognitive model of panic disorder therefore aims at exploring ways through which the disorders can be well understood and individuals suffering from the disorder effectively treated. This paper will discuss the cognitive model of panic with focus on its advantages as well as its limitations.
Discussion
The conceptualization of panic disorder is based on a medical illness model whose assumption lies on the existence of distinct and exclusive syndromes with inherent organic etiology and specific treatment indicators. The cognitive model of panic disorder focuses on the ways through which cognitive processes are related to panic attacks. Some of the advantages of the model include that it provides a cognitive framework for understanding biological challenges, plays an important role in the mediation of responses to panic provocation procedures and the prospective studies, it outlines the treatment of disorders with agoraphobia, promote non-pharmacological approach of therapy, supports cognitive-behavioral therapy which is an effective method of treatment and it permits the development of intervention packages that are effective in the treatment of the disorder.However,the cognitive model since its formulation in 1980s has been criticized for its limitations. The limitations of the model include that the catastrophic misinterpretation of bodily sensations is not a necessary criterion for experiencing panic attacks, it provides a scientific theory that is difficult to test, the success of the cognitive behavior therapy does not necessarily make the model valid because not much is known about the ingredients of the treatment approach and it fails to explain the differences that exist in prevalence rates as well as the phenomenology of panic between various subgroups of people(Clark and Reinecke,2003).
Clark’s model tries to explain the phenomenology of panic disorder which includes the spontaneous nature of panic attacks by postulating that in panic attacks, patients are unable to distinguish between the triggering body sensation and panic attack (Blankley and Millon, 2008). This makes the attacks to be perceived as lacking a cause. The model provides a cognitive framework for understanding biological challenges such as provocation of attacks in patients versus control subjects. The Clark’s model support can be attributed to the effects of cognitive therapy and the importance of cognitive mediators in biological induction procedures. The Clark’s model has been influential in the study of panic and its success in effective treatment for panic disorder is acknowledged. The Clark’s model does not completely discard biological factors. However, it is the cognitive factors that determine whether there is catastrophic misinterpretation for the arousal sensations. The Clark’s cognitive model of panic disorder states that individuals who experience panic attacks show a relatively enduring tendency to interpret bodily sensations in a catastrophic manner and the misinterpreted sensations are involved in normal anxiety responses such as dizziness and palpitations (Nally, 1994). As a result, individuals perceive catastrophic misinterpretations to be more dangerous than they are.
However, criticism of the model has been made in relation to the difficulty experienced in refuting the model when proposed cognitive processes occur at a non-conscious level, cognitive factors that are involved in panic may become susceptible to modification by non cognitive therapies such as pharmacotherapy. In addition, the model is not clear about the proposed “enduring tendency” nature, focuses on catastrophic misinterpretation process rather than the underlying trait and fails to include the development of agoraphobia which is associated with panic The Barlow’s false alarm theory describes panic to be the basic emotion of fear which is viewed as an acute reaction to perceived danger. The model includes a psychological vulnerability and a biological diathesis. Individuals who are psychologically vulnerable do not develop a sense of competence in relation to themselves and the world around them (Swede and Jaffe, 2000).
The Anxiety sensitivity model differs form Clark’s model in that rather than having the misinterpretation of sensations associated with anxiety seen as a sign of immediate catastrophe, it focuses on the fear of anxiety. The AS is considered to exist independently of panic attacks although panic experiences may amplify the anxiety. Empirical evidence supports the anxiety sensitivity in construct. Scores on anxiety sensitivity index and the related measures are able to differentiate anxiety disorder groups from panic disorder patients when measures are elevated in panic disorder samples. Trait anxiety does not measure the differentiation and an indication that AS is not a consequence of panic attacks is the fact that high levels of anxiety sensitivity exist independently of the attacks. The advantage of this model is that it plays an important role in the mediation of responses to panic provocation procedures and the prospective studies. For example, panic provocation studies that have been conducted based on this model indicate that individuals who have high levels of anxiety reported more anxiety and dizziness following the procedure as compared to the individuals with low ASI scores. .The limitations of the cognitive model therefore is that the catastrophic misinterpretation of bodily sensations is not a necessary criterion for experiencing panic attacks, nocturnal panic disorders with the model are inconsistent, patients may panic in response to lactate even without fears of going crazy or dying and some attacks are not always accompanied by catastrophic misinterpretations.
The cognitive models of panic disorders such as Barlow’s and Clark’s theories outline the treatment of disorders with agoraphobia. The traditional protocol focuses on a mixture of behavioral and cognitive techniques which aim at assisting the patients to both identify and modify the dysfunctional anxiety-related beliefs, thoughts and behavior (Vincelli et al, 2000).The treatment protocol includes exposure to the feared situation, cognitive restructuring, interoceptive exposure and applied relaxation .Based on DSM-IV, the occurrence of panic attacks is the essential feature of panic disorder. Panic disorder is associated with phobic disorders such as social and specific phobias. Agoraphobia is an example of phobia that consists of a group of fear of public places such as using public transportation, going outside or appearing in public places such as supermarkets or churches. This causes serious interference with an individual’s daily life. Other fears may arise from phobia of crossing bridges, going through tunnels or using elevators, intense fear of panic attacks, anxiety or excessive worry about physical sensations (Barlow,2004).As a result of the symptoms, patients of panic disorders tend to avoid the feared situation or to carry the avoidance into other situations.
The cognitive model of panic disorders therefore supports a treatment strategy for panic disorder with a multicomponent cognitive-behaviouaral element .For example, cognitive therapy protocol with a multicomponent approach can be offered through Experiential-Cognitive Therapy (ECT).This protocol aims at reconditioning fear reactions so that the misinterpretation cognitions related to panic symptoms are modified. This is done through the integration of virtual experience and cognitive behavioral therapy as well as traditional techniques through treatment sessions, assessment phase and booster sessions. The employment of such techniques is due to their high levels of efficacy in treatment.
Cognitive model supports cognitive therapy in the treatment of panic disorders .The use of non pharmacological approach of therapy has its advantages. Cognitive therapy focuses on the identification and changing of misinterpretations of bodily sensations. Beneficial effects of cognitive therapy have been confirmed by studies that have been carried out to determine the effectiveness of cognitive therapy to patients. For instance, a study that was conducted to determine the effectiveness of cognitive therapy in individuals with panic disorders involved 17 adults (Sokol et al, 1989).These individuals who were involved in the cognitive therapy sessions were encouraged to experience the symptoms of panic attacks. The patients were able to learn how to interpret the sensations as threatening and less pleasant that they were earlier perceived to be. This assisted the patients to control techniques such as breathing exercises. As a result, practicing these techniques in real life situations becomes easier. Cognitive therapy reduces incidences of episodes significantly and some patients experience reduced depression and general anxiety. Such studies have confirmed that the cognitive model of panic disorder through the cognitive therapy increases the effectives of treatment that is given to panic disorders patients. In addition, therapy that is supported by the cognitive model is effective in both the treatment and maintenance of long term remission in panic disorder.
The cognitive behavior therapy puts emphasis on the recognition of distorted thinking and unhelpful behavior which are evaluated and identified through behavioral and cognitive tasks (Taylor, 2004).The advantage with the application of the model is that patients are able to participate in the treatment process by developing insight into their irrational and rational thinking that may be causing their problems. This method of treatment with a cognitive approach is effective in treating panic disorders as compared to the use of medication which may lead to increased drug dependence and abuse or undermine psychosocial treatment. Medication is provided to patients as anti-depressants, monoamine oxidase inhibitors and anti-anxiety drugs. On the other hand, the success of cognitive behavior therapy does not necessarily validate the model. The limitation of the model is that although the treatment approach based on the model is effective, there is more room for improvement. In addition, minimal knowledge on the mediators of change or ingredients of treatment and mechanism is a limitation.
A study carried out to evaluate the cognitive model of panic and cognitive behavioral therapy brought out the advantages and limitations of the cognitive model of panic disorder (Goldberg, 2004).Based on the study, the cognitive model of panic disorders was considered to lack clear definition of threat where panic is evoked by the fear of dissolution itself. Controlled studies have shown that the cognitive model through cognitive-behavioral therapy is more superior that other methods of treatment. Studies have shown that about 85 per cent of patients who are treated based on methods based on cognitive model are panic-free at the post treatment stage. Improvements are maintained through follow-up.
The proliferation of cognitive model of panic disorder has permitted the development of intervention packages that are effective for the treatment of the disorder. Although the intervention packages differ in theoretical importance, they resemble each other from certain details in relation to the importance that is attributed to cognitions about panic as the causal agent. The general objective of change is to assist the user to get self control over the symptoms, eliminating or appreciably reducing the frequency of the symptoms (Weinstock and Gilman, 1998).Although there is notable therapeutic success of programs which justify the theoretical framework upon which they are based, it is possible for panic disorder to be treated from a radical behaviorist point of view. This is referred to as Acceptance and Commitment Therapy (ACT).
From this perspective, assumption that focusing on therapeutic efforts is solely on the operationally-defined response topographies (hyperventilation of thoughts that are linked to causal role) obscures the factors that may be critical in the etiology of panic disorder. This may include setting/contextual factors or socioverbal contexts.For example, catastrophic thoughts that may be related to acceleration in heart rate acquire causal role in relation to a conventional framework or setting form a contingent relationship with class of behavior at a given time framed in past user setting interactions. The development of this argument puts emphasis on response topography or content more that the function or form of behavior leads to the suspicion that therapeutic efforts in panic disorder amount to nothing more than having the user trained in the development of more sophisticated avoidance strategies. This is one of the limitations or problems of the cognitive model that has been pointed out (Lopez, 2000).Furthermore, the model validity for various subgroups of panic patients is not clear and there lacks clarification on the contribution of biological factors.
Conclusion
Panic disorders are anxiety disorders which are characterized by repeated and unexpected cases of intense fear accompanied by some physical symptoms .Through epidemiologic studies development, a certain number of individuals within the general population is confirmed to suffer from panic disorder with serious social and personal repercussions such as substance abuse, depression and suicidal tendencies. The cognitive model of panic disorder has its advantages and limitations. Examples of cognitive model of panic disorder include the Clark’s, Barlow’s false alarm and anxiety sensitivity theories. Due to the fact that psychological and biological vulnerabilities many be non-specific and the development of anxiety disorders may involve various experiences at different developmental stages, theoretical models in future will be expected to be more complex than the linear models undergoing evaluation.
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