Changes in the unconscious processing of emotional information in panic patients after cognitive-behaviour therapy

Patients with anxiety disorders automatically attend to threat-related stimuli. This is seen not only in an attentional bias for consciously available stimuli, but also in effects of subliminally exposed (i.e., masked) stimuli. The effects of treatment on cognitive biases have been examined in a variety of anxiety disorders, and the results commonly indicate that attentional biases disappear as a function of treatment. There is a lack of knowledge, however, about if this also occurs with subliminally exposed emotional stimuli. In the present study, attentional biases for threat-related information disappear were investigated in patients who underwent cognitive-behavioural treatment for panic disorder with agoraphobia. An emotional Stroop task with three types of words (panic-related words, interpersonal threat words, and neutral words) and two exposure conditions (subliminal, supraliminal) was administered to 23 patients with panic disorder at three occasions: before cognitive-behaviour treatment, after treatment, and at 1-year follow-up. The patients showed no effects immediately after treatment. At one-year follow-up, however, they showed a complete annihilation of Stroop interference for subliminal threat words. This suggests the possibility that biases in the automatic, unconscious processing of emotional information takes time to change, and that such change occurs after rather than during cognitive-behavioural treatment