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Classic conditioning and
dysfunctional cognitions in patients with panic disorder and
agoraphobia treated with an implantable cardioverter/defibrilator.
Psychosomatic Medicine, Volume 63, 2001, Pages 231-238.
F. Godemann, MD; B. Ahrens, MD; S. Behrens, MD; R.
Berthold, MD; C. Gandor, MD; F. Lampe, MD; and M. Linden,
MD. Free University of Berlin; Berlin, Germany.
Summary:
This study offers evidence for the role of classical
conditioning in the development of panic disorder and
agoraphobia.
By the theory of classical conditioning, people develop panic
disorder and agoraphobia when they misinterpret the symptoms
of an initial panic attack (rapid heartbeat, shallow
breathing, dizziness, etc.) and conclude that their
body has experienced a physical catastrophe.They associate
the physical symptoms with the place or situation they were
in at the time of the panic attack. Since they don't
understand what happened to them and think that the panic
attack meant physical danger, they avoid the place or
situation they associate with the panic symptoms.
Fear of having another panic episode, paradoxically, leads
to more panic attacks in other places and situations until
the fear generalizes. As the fear generalizes, people who
develop agoraphobia start avoiding so many places or
situations that eventually, they only feel safe at home.
This study found that of 72 patients with implantable
cardioverter defibrillators (pacemakers), 14 patients
(or 19.4%) met the criteria for panic disorder and/or
agoraphobia (far above the lifetime prevalence for panic
disorder and/or agoraphobia of 2.5% to 3%).
When interviewed, patients that developed panic disorder
and/or agoraphobia reported more fear of shocks from their
pacemakers, experienced more anxiety related to the shocks,
and observed their own bodies more intensively to check for
irregular heartbeats that might lead to shock. In other
words, they were living in a state of shock expectancy
unlike the patients who did not develop panic disorders.
The patients who developed agoraphobia started avoiding any
place or situation they associated with irregular heartbeats
which led to a shocks from their pacemaker.
These patients had learned to associate feelings of panic
and anxiety with shocks from their pacemakers, and then
learned to associate the panic and anxiety with places or
situations in which it occurred - which is classical
conditioning at its core.
Of course, the
dysfunctional thinking also contributed to the onset of
panic disorder and agoraphobia. The panic disorder and
agoraphobia patients perceived the pacemaker shocks as a
physical threat.
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