Prediction of panic attacks and related variables

doi:10.1016/S0005-7894(99)80011-2

Behavior Therapy

Volume 30, Issue 2, Spring 1999, Pages 319-330

https://doi.org/10.1016/S0005-7894(99)80011-2 Get rights and content

Twenty-six participants who met conservative criteria for having experienced one or more panic attacks were compared with 26 nonpanickers on various measures associated with panic attacks. In addition, regression analyses were used to determine if anxiety sensitivity or suffocation fears better predicted panic frequency and panic related phenomena (e.g., agoraphobic avoidance). The results showed the anxiety sensitivity was the better predictor of agoraphobic avoidance and perceived seriousness of the panic attacks. Both suffocation fears and anxiety sensitivity predicted bodily sensations associated with panic attacks with suffocation fears contributing the greater amount of unique variance. The importance and value of using nonclinical panickers (NPAs) is discussed in relation to our understanding of panic attacks and panic disorder. Recommendations for defining NPAs are provided.

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Sleep and physical activity suggestions for panic disorder (PD) are critical but less surveyed. This two-year prospective cohort study aims to predict panic attacks (PA), state anxiety (SA), trait anxiety (TA) and panic disorder severity (PDS) in the upcoming week.
We enrolled 114 PD patients from one general hospital. Data were collected using the DSM-5, the MINI, clinical app questionnaires (BDI, BAI, PDSS-SR, STAI) and wearable devices recording daily sleep, physical activity and heart rate from 16 June 2020 to 10 June 2022. Our teams applied RNN, LSTM, GRU deep learning and SHAP explainable methods to analyse the data.
The 7-day prediction accuracies for PA, SA, TA, and PDS were 92.8 %, 83.6 %, 87.2 %, and 75.6 % from the LSTM model. Using the SHAP explainable model, higher initial BDI or BAI score and comorbidities with depressive disorder, generalized anxiety disorder or agoraphobia predict a higher chance of PA. However, PA decreased under the following conditions: daily average heart rate, 72–87 bpm; maximum heart rate, 100–145 bpm; resting heart rate, 55–60 bpm; daily climbing of more than nine floors; total sleep duration between 6 h 23 min and 10 h 50 min; deep sleep, >50 min; and awake duration, <53 min.
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Deep learning predicts recurrent PA and various anxiety domains with 75.6–92.8 % accuracy. Recurrent PA decreases under adequate daily sleep and physical activity.
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Excessive anxiety and avoidance during provocation of body symptoms are core features of anxiety-related disorders and might contribute to the development and maintenance of these disorders. Previous studies examined psychological (anxiety sensitivity, fear of suffocation and trait anxiety) and biobehavioral (breath-holding time) predictors of reported anxiety during symptom provocation. However, the role of these predictors on avoidance of feared body symptoms remains unclear. Therefore, the present work aimed at investigating the main and interactive effects of psychological and biobehavioral variables in predicting avoidance during provocation of dyspnea that successively increased in severity. 28 of 69 participants prematurely terminated the provocation sequence, thus preventing further progression of symptom provocation. Logistic regressions revealed that higher anxiety sensitivity and lower breath-holding time were significantly associated with avoidance during exposure. Suffocation fear and trait anxiety were not related to avoidance. Moreover, there was a significant interaction between breath-holding time and anxiety sensitivity in predicting avoidance. Participants with a lower breath-holding time showed more avoidance behavior when reporting high as compared to low anxiety sensitivity. The data suggest that anxiety sensitivity and breath-holding time increase the risk to show avoidance and thus might contribute to the development and maintenance of anxiety-related disorders.
Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder
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The present study prospectively evaluated cannabis use, abuse, and dependence in relation to the development of panic attacks and panic disorder. Participants at the start of the study were adolescents (n = 1709) with a mean age of 16.6 years (SD = 1.2; time 1) and were re-assessed 1 year later (time 2) and then again as young adults (time 3; mean age = 24.2 years, SD = 0.6). Results indicated that cannabis use and dependence were significantly prospectively associated with an increased odds for the development of panic attacks and panic disorder. However, cannabis was not incrementally associated with the development of panic after controlling for daily cigarette smoking. The theoretical and clinical implications of these findings are discussed.
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Citation Excerpt :
Participants rate on a five-point Likert type scale anchored from 0 = not at all anxious to 4 = extremely anxious how anxious they would feel in places or situations where one's air supply is threatened (e.g., swimming while wearing a nose plug). The SFS has demonstrated good convergent and predictive validity (McNally & Eke, 1996; Norton et al., 1999; Taylor & Rachman, 1994) as well as good internal consistency (α = 0.78; Zvolensky, Lejuez, & Eifert, 1998). Acceptance and Action Questionnaire-Short version (AAQ; Hayes et al., 2004).
Contemporary models of panic attacks suggest that panic problems exist on a continuum and highlight the need to understand what differentiates persons who have never had a panic attack versus persons who have had panic attacks but have not yet developed panic disorder (i.e., non-clinical panickers). Accordingly, the present study evaluated several theoretically-relevant factors that were expected to distinguish a sample of (conservatively defined) non-clinical panickers (n = 72) from an age and sex-matched comparison sample of non-panicking controls (n = 72). As expected, panickers were characterized by higher levels of anxiety sensitivity, perceived uncontrollability, and state and trait anxiety relative to their non-panic counterparts. Moreover, higher levels of trait anxiety emerged as a predictor of poorer quality of life among panickers. Results are considered within the context of biopsychosocial continuum models of panic attacks and panic disorder and future directions for research are suggested.
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Citation Excerpt :
Whereas previous work has focused on singular effects of panic attacks and physical health problems, these factors also may interact with one another in clinically significant ways. Individuals with panic attacks compared to those without a history of panic attacks are at increased risk for being emotionally responsive to aversive events, particularly bodily sensations (Norton et al., 1999). Such enhanced emotional responsivity is noteworthy from a vulnerability perspective, as it could serve to exacerbate affective reactions to ongoing stressors and thereby promote greater levels of disability and impairment.
Panic attacks may be a risk marker for a variety of psychological problems and are associated with increased impairment in a host of domains. However, previous studies have not investigated the role of physical illness in the panic attack–disability relations, which is striking due to findings that physical illness is linked to both panic attacks and disability. The present investigation examined the singular and interactive effects of panic attacks and physical illness in relation to psychological, interpersonal, and physical types of impairment.
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The present investigation evaluated the associations between lifetime psychedelic use, abuse, and dependence and panic attacks. The study consisted of a representative epidemiological sample from a state wide survey of the Colorado general adult population (n = 4745; 52% female). Consistent with prediction, after controlling for theoretically relevant variables, psychedelic abuse and dependence, but not use, were significantly related to an increased lifetime risk of panic attacks. The results are discussed in terms of better understanding the role of psychedelic use in relation to the occurrence of panic attacks.

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Special SeriesPrediction of panic attacks and related variables

Behaviour Research and Therapy

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Journal of Behavior Therapy and Experimental Psychiatry

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Triggering the false suffocation alarm in panic disorder patients by using a voluntary breath holding procedure

American Journal of Psychiatry

Anxiety and its disorders

Special Series
Prediction of panic attacks and related variables