Cognitive flexibility mediates the relation between intolerance of uncertainty and safety signal responding in those with panic disorder

ABSTRACT

There is a growing literature associating anxiety disorders with an inability to inhibit defensive responding during safety conditions of threatening tasks. However, investigations on the relation between panic disorder (PD) and defensive responding to safety have yielded mixed results. A recent study from our laboratory revealed that intolerance of uncertainty (IU) moderates this association, such that only individuals with PD and a high IU exhibit heightened startle potentiation during safety. The mechanism underlying this relationship is unknown. Given that safety conditions typically alternate with periods of threat, cognitive flexibility (i.e., the ability to adjust one's habitual responding to a situation, given the input of new information) may be involved in the ongoing reappraisal of danger and adjustment of defensive responding. Thus, the present study sought to investigate whether deficits in cognitive flexibility mediate the association between IU and defensive responding to safety among a sample of 71 adults diagnosed with PD. As hypothesised, cognitive flexibility mediated the relationship between IU and heightened startle potentiation during safety conditions. This finding suggests that within this subgroup, a failure to inhibit defensive responding during safety conditions may be due to deficits in cognitive flexibility.

KEYWORDS:

• Panic disorder
• intolerance of uncertainty
• cognitive flexibility
• safety signals
• defensive responding

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹Although self-ratings of anxiety/nervousness were also obtained from participants (Gorka et al., 2014; Shankman et al., 2013), we chose not to include these measures in the present manuscript because IU did not moderate the association between PD and subjective ratings of anxiety/nervousness. Therefore, we could not examine a mediator of this association.

Additional information

Funding

This work was supported by National Institute of Mental Health under Grants [R21 MH080689], [R01 MH098093] awarded to Dr Stewart Shankman.