Attentional Fixation in Panic Disorder

Abstract

According to Beck's (1988) clinical observations, patients with panic disorder describe a fixation on their distressing physical and psychological symptoms and an inability to access corrective information during panic attacks. The present study sought to evaluate empirically the notion that attentional fixation is characteristic of these patients. A subset of panic patients participating in 3 cognitive therapy clinical trials completed the Attentional Fixation Questionnaire (AFQ) at intake, during treatment and at termination. The AFQ had adequate internal consistency at all time intervals, and it correlated positively with measures of depression, anxiety and distorted cognitive content. At termination, the AFQ total score and nearly all single items decreased significantly, and patients who continued to meet diagnostic criteria for panic disorder scored higher on most items than patients who no longer met diagnostic criteria for panic disorder. These preliminary data suggest that attentional fixation is an important dimension of cognition relevant to panic disorder.

Keywords:

• panic disorder
• attentional fixation
• self‐report
• assessment.

Acknowledgements

We thank Blair Wisco and Gregory Brown for their assistance with this research.

Notes

1. The Beck et al. (1992) study was a cross‐over design, in which 17 patients received cognitive therapy, and 16 patients received supportive psychotherapy for 8 weeks and cognitive therapy thereafter. Only data from the 17 patients who were initially assigned to receive cognitive therapy were included in this study.

2. Patients in the Sokol et al. (1989) and Beck et al. (1992) studies received focused cognitive therapy, a cognitive intervention for panic disorder designed specifically to evoke distressing physiological or psychological sensations and to modify catastrophic misinterpretations of these sensations (c.f. Clark & Salkovskis, 1986). Patients in the Brown et al. (1997) study were randomly assigned to focused cognitive therapy or standard cognitive therapy. Standard cognitive therapy comprised cognitive and behavioral strategies for managing general anxiety and worry but did not focus on the reappraisal of catastrophic misinterpretations. Brown et al. study failed to detect significant differences in the efficacy of these two cognitive approaches in treating panic disorder, and there were no differences between groups in their AFQ scores at any assessment interval. Thus, data from both patient groups were combined in the present study in order to increase statistical power.

3. In an early description of this measure, Beck (1988) regarded the item, “My mind goes blank,” as a test for an acquiescent response style rather than as an item that should be included in the total score, as his clinical observation suggested that this characteristic is not descriptive of a panic attack.