Cognitive mediation of panic attacks induced by biological challenge tests

A variety of pharmacological and physiological procedures reliably induce panic attacks in panic disorder patients but rarely do so in controls. Some biologically orientated researchers have described these procedures as biological challenge tests and have assumed that pharmacological and physiological manipulations have a direct panic-inducing effect and that individuals who are susceptible to these manipulations have a neurochemical disorder. An alternative explanation is provided by the cognitive theory of panic which proposes that the challenge tests induce panic because they produce bodily sensations that panic patients are prone to misinterpret and that it is the misinterpretation which is responsible for the induced attack. Experiments that have attempted to test the cognitive mediation account of biological challenge induced panic are reviewed. Overall, the results of these experiments provide strong support for the cognitive mediation hypothesis. In addition, it is suggested that the crucial cognitive variable is likely to be interpretation of challenge induced sensations, not expected affect or perceived control of the sensations. © 1993