A multi-factor model of panic disorder: Results of a preliminary study integrating the role of perfectionism, stress, physiological anxiety and anxiety sensitivity
Supporting Agencies
- Ministry of Science and Innovation MICINN (ref. PSI 2008-05332).
Abstract
Background: Panic disorder (PD) is a highly prevalent and disabling mental health problem associated with different factors including perfectionism, stress, physiological anxiety, and anxiety sensitivity regarding physical concerns; however, no studies have analyzed the joint relationship between these factors and PD in a multi-factor model using structural equation modeling. Method: A cross-sectional study was carried out to collect data on these factors and self-reported DSM-IV past-year PD symptoms in a large sample of the general population (N=936). Results: Perceived stress had a significant effect in increasing physiological anxiety, which in turn had an important association with physical concerns. Perfectionism and perceived stress had an indirect relation with past year PD via the mediator role of physiological anxiety and physical concerns. Physical concerns, on one hand, seemed to mediate the impact between perfectionism and PD and, on the other, partially mediated the role between physiological anxiety and PD. Conclusions: Although there is considerable evidence on the association between each of these factors and PD, this model can be considered a broader and productive framework of research on the nature and treatment of PD.
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References
Aldea, M. A., Rice, K. G., Gormley, B., & Rojas, A. (2010). Telling perfectionists about their perfectionism: Effects of providing feedback on emotional reactivity and psychological symptoms. Behaviour Research and Therapy, 48, 1194-1203. Doi:10.1016/j.brat.2010.09.003
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998). Dimen-sions of perfectionism across the anxiety disorders. Behaviour Research and Therapy, 36, 1143-1154. Doi:10.1016/S0005-7967(98)00083-7
Antony, M. M., & Swinson, R. P. (1998). When perfect isn’t good enough. Strategies for coping with perfectionism. Oakland, CA: New Harbinger.
Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55, 1247-63. Doi:10.1037/0003-066X.55.11.1247
Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford.
Brown, M., Smits, J. A., Powers, M. B., & Telch, M. J. (2003). Differential sensitivity of the three ASI factors in predicting panic disorder patients’ subjective and behavioral response to hyperventilation challenge. Journal of Anxiety Disorders, 17, 583-591. Doi:10.1016/S0887-6185(02)00231-1
Byrne, B. M. (1998). Structural equation modeling with Lisrel, Prelis and Simplis: Basic concepts, applications, and programming. Mahwah, NJ: Lawrence Erlbaum.
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.
Clark, C., Pike, C., McManus, S., Harris, J., Bebbington, P., Brugha, T., ...Stansfeld (2012). The contribution of work and non-work stressors to common mental disorders in the 2007 Adult Psychiatric Morbidity Survey. Psychological Medicine, 42, 829-842. Doi:10.1017/S0033291711001759
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203-212. Doi:10.1016/j.cpr.2010.04.009
Ehlers, A. (1995). A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. Journal of Abnormal Psychology, 104, 164–72. Doi:10.1037/0021-843X.104.1.164.
El Alaoui, S., Hedman, E., Ljotsson, B., Bergstrom, J., Andersson, E., Ruck, C.,…Lindefors, N. (2013). Predictors and moderators of internet- and group-based cognitive behaviour therapy for panic disorder. PLoS One, 8, e79024. Doi: 10.1371/journal.pone.0079024
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured Clinical Interview for Axis I DSM-IV Disorders—Patient Edition (SCID-I/P Version 2.0). New York: Biometrics Research Department.
Flora, D., & Curran, P. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491. Doi:10.1037/1082-989X.9.4.466
Frost, R. O. Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimen-sions of perfectionism. Cognitive Therapy and Research, 19, 195-206. Doi:10.1007/BF01172967
Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive-compulsive disorder patients. Behaviour Research and Therapy, 35, 291-296. Doi:10.1016/S0005-7967(96)00108-8
Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., & Barlow, D. (2013). Mechanisms of change in cognitive behavioral therapy for panic disorder: the unique effects of self-efficacy and anxiety sensitivity. Behaviour Research and Therapy, 51, 767-777. Doi: 10.1016/j.brat.2013.09.001
Grant, D. M., Beck, J. G., & Davila, J. (2007). Does anxiety sensitivity predict symptoms of panic, depression, and social anxiety? Behaviour Research and Therapy, 45, 2247-2255. Doi:10.1016/j.brat.2007.02.008
Hoehn-Saric, R., McLeod, D. R., Funderburk, F., & Kowalski, P. (2004). Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: an ambulatory monitor study. Archives of General Psychiatry, 61, 913-921. Doi:10.1001/archpsyc.61.9.913
Hu, L. T., & Bentler, P. M. (1999). Cut off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. Doi:10.1080/10705519909540118
Kawamura, K. Y., Hunt, S. L., Frost, R. O., & Di Bartolo, P. M. (2001). Perfectionism, anxiety, and depression: Are the relationships independent? Cognitive Therapy and Research, 25, 291–301. Doi:10.1023/A:1010736529013
MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. Mahwah: Erlbaum.
McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52, 938-46. Doi:10.1016/S0006-3223(02)01475-0
McNally, R. J., Hornig, C. D., Hoffman, E. C., & Han, E. M. (1999). Anxiety sensitivity and cognitive biases for threat. Behavior Therapy, 30, 51-61. Doi:10.1016/S0005-7894(99)80045-8
Miguel-Tobal, J. J., & Cano-Vindel, A. (2007). Inventario de situaciones y res-puestas de ansiedad (ISRA): Manual (6 rev. ed.) [Inventory of Situations and Responses of Anxiety: Manual]. Madrid: TEA.
Muthén, B.O., & Muthén, L.K. (2007). Mplus (Version 5). Los Angeles: California.
Muthén, B. O., & Satorra, A. (1995). Technical aspects of Muthen’s LIS-COMP approach to estimation of latent variable relations with a comprehensive measurement model. Psychometrika, 60, 489–503. Doi:10.1007/BF02294325
O'Connor, R. C., Rasmussen, S., & Hawton, K. (2010). Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress. Behaviour Research and Therapy, 48, 52-59. Doi:10.1016/j.brat.2009.09.008
Oros, L. (2005). Implicaciones del perfeccionismo infantil sobre el bienestar psicológico: orientaciones para el diagnóstico y la práctica clínica. Anales de Psicología, 21, 294-303. Doi:10.6018/26951
Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index Manual (2nd ed.). Worthington, OH: International Diagnostic Systems.
Plehn, K., & Peterson, R. A. (2002). Anxiety sensitivity as a predictor of the development of panic symptoms, panic attacks, and panic disorder: a prospective study. Journal of Anxiety Disorders, 16, 455-474. Doi:10.1016/S0887-6185(02)00129-9
Rapee, R. M., Litwin, E. M., & Barlow, D. H. (1990). Impact of life events on subjects with panic disorder and on comparison subjects. American Journal of Psychiatry, 147, 640-644.
Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic Disorder. Lancet, 368, 1023-1032. Doi:10.1016/S0140-6736(06)69418-X
Saboonchi, F., Lundh, L. G., & Ost, L. G. (1999). Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 799-808. Doi:10.1016/S0005-7967(98)00183-1
Sandin, B., Valiente, R. M., Chorot, P., & Santed, M. A. (2007). ASI-3: nueva escala para la evaluación de la sensibilidad a la ansiedad. Revista de Psicopatología y Psicología Clínica, 12, 91-104.
Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106, 355-364. Doi:10.1037//0021-843X.106.3.355
Scocco, P., Barbieri, I., & Frank, E. (2007). Interpersonal problem areas and onset of panic disorder. Psychopathology, 40, 8-13. Doi:10.1159/000096384
Spatola, C. A., Scaini, S., Pesenti-Gritti, P., Medland, S. E., Moruzzi, S., Ogliari, A., . . . Battaglia, M. (2010). Gene-environment interactions in panic disorder and CO2 sensitivity: Effects of events occurring early in life. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 156B, 79-88. Doi:10.1002/ajmg.b.31144
Taylor, S. (1999). Anxiety Sensitivity: Theory, Research, and Treatment of the Fear of Anxiety. Mahwah, NJ: Erlbaum.
Taylor, S. (2000). Understanding and treating panic disorder: Cognitive behavioural approaches. Chichester, UK: Wiley.
Taylor, S., & Cox, B. J. (1998). An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. Journal of Anxiety Disorders, 12, 463-83. Doi:10.1016/S0887-6185(98)00028-0
Wirtz, P. H., Elsenbruch, S., Emini, L., Rudisuli, K., Groessbauer, S., & Ehlert, U. (2007). Perfectionism and the cortisol response to psychosocial stress in men. Psychosomatic Medicine, 69, 249-255. Doi:10.1097/PSY.0b013e318042589e
Woud, M. L., Zhang, X. C., Becker, E. S., McNally, R. J., & Margraf, J. Don't panic: Interpretation bias is predictive of new onsets of panic disorder. Journal of Anxiety Disorders, 28, 83-87. Doi: 10.1016/j.bbr.2011.03.031
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