Elsevier

Behaviour Research and Therapy

Volume 44, Issue 9, September 2006, Pages 1219-1239
Behaviour Research and Therapy

Risk-factor research and prevention programs for anxiety disorders: A translational research framework☆

https://doi.org/10.1016/j.brat.2006.06.001Get rights and content

Abstract

The aim of the present essay is to discuss the interconnection between risk-factor research and prevention program development for panic-spectrum psychopathology. We argue that prevention of panic-spectrum psychopathology specifically, and anxiety disorders more generally, is likely to be best advanced through active, systematic translation of basic, risk-factor research. After operationalizing key terminology, we present some exemplar risk-factor candidates for panic-spectrum psychopathology, summarize research related to their role as risk-factors for panic problems, and link this discussion to risk-factor nomenclature. We then present a translational framework for extrapolating extant knowledge on these and other potential risk-factors for panic-spectrum psychopathology with respect to the development of preventative interventions. The proposed translational framework is intended to describe a forward-feeding process by which risk-factor research could be used by clinical researchers to inform prevention programs; and reciprocally, how such prevention knowledge could be most effectively utilized to drive new, clinically focused risk-factor research.

Section snippets

Panic-spectrum psychopathology

In this paper, we use the term “panic spectrum” to denote panic attacks, panic disorder, and agoraphobia (with or without panic disorder). To a certain extent, this approach implicitly considers the developmental history of panic problems such that individuals typically first develop panic attacks, subsequently panic disorder, and then, agoraphobia (Barlow, 2002; Klein, 1981).2

Vulnerability terminology

The clarification of terminology is a necessary task for understanding how research on vulnerability factors and processes can inform the development and refinement of prevention intervention programs. Led by the work of Kraemer and her colleagues, groundbreaking conceptual strides have created a clearer understanding of various risk processes (Kazdin, Kraemer, Kessler, Kupfer, & Offord, 1997; Kraemer et al., 1997; Kraemer, Stice, Kazdin, Offord, & Kupfer, 2001). Specifically, Kraemer and

Exemplar risk-factor candidates for panic-spectrum psychopathology

There is a long and well-established history of research focused on understanding vulnerability processes for anxiety and its disorders (Forsyth & Zvolensky, 2002). Historical reviews of this research indicate that such work has its roots in operant and classical conditioning research (e.g., avoidance paradigms; Baum, 1970), but has grown and expanded to involve different branches of study, including epidemiology, psychophysiology, cognitive science, affective neuroscience, behavioral genetics,

Risk-factor—prevention translational research framework

The preceding discussion was intended to illustrate the current status of various exemplar vulnerability factors for panic-spectrum psychopathology in terms of the contemporary risk-factor nomenclature developed by Kraemer et al. (2005). Though purposively not inclusive of all possible variables of ultimate interest in this domain, this discussion nevertheless demonstrates the “different stages” of research related to any one risk variable. In addition to developing more comprehensive and

Summary

The present essay calls attention to the importance of the interconnection between risk-factor research and prevention program development for anxiety psychopathology. To achieve this purpose, we used panic-spectrum psychopathology as a model, but the issues described are theoretically applicable to different anxiety and perhaps other clinical conditions. We reviewed and classified exemplar risk candidates for panic-spectrum psychopathology in relation to their status as risk factors. This

Acknowledgements

We would like to thank Richard Zinbarg for his helpful input on locating some background research related to negative affectivity for this paper. This paper also was influenced by many of the presentations and discussions at the Jay Peak, Vermont Anxiety Prevention Summit (February, 2006).

References (124)

  • D.B. Abrams et al.

    The tobacco dependence treatment handbook: A guide to best practices

    (2003)
  • G.W. Albee

    Revolutions and counterrevolutions in prevention

    American Psychologist

    (1996)
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text...
  • A.J. Baillie et al.

    Panic attacks as risk markers for mental disorders

    Social Psychiatry and Psychiatric Epidemiology

    (2005)
  • D.H. Barlow

    Anxiety and its disorders: The nature and treatment of anxiety and panic

    (2002)
  • D.H. Barlow et al.

    Definitions of panic attacks and panic disorder in the DSM-IV: Implications for research

    Journal of Abnormal Psychology

    (1994)
  • D.H. Barlow et al.

    Behavioral treatment of panic disorder

    Behavior Therapy

    (1989)
  • R.M. Baron et al.

    The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations

    Journal of Personality and Social Psychology

    (1986)
  • M. Baum

    Extinction of avoidance responding through response prevention (flooding)

    Psychological Bulletin

    (1970)
  • Bernstein, A., Zvolensky, M. J., Schmidt, N. B., & Sachs-Ericcson, N. Developmental course(s) of lifetime cigarette use...
  • M.E. Bouton et al.

    A modern learning theory perspective on the etiology of panic disorder

    Psychological Bulletin

    (2001)
  • N. Breslau et al.

    Nicotine dependence in the united states

    Archives of General Psychiatry

    (2001)
  • N. Breslau et al.

    Smoking and panic attacks: An epidemiologic investigation

    Archives of General Psychiatry

    (1999)
  • N. Breslau et al.

    Daily smoking and the subsequent onset of psychiatric disorders

    Psychological Medicine

    (2004)
  • R.A. Brown et al.

    Behavioral treatment of cigarette dependence

  • R.A. Brown et al.

    Anxiety sensitivity: Relationship to negative affect smoking and smoking cessation in smokers with past major depressive disorder

    Addictive Behaviors

    (2001)
  • T.A. Brown et al.

    The phenomenon of panic in nonclinical populations: Further evidence and methodological considerations

    Journal of Anxiety Disorders

    (1989)
  • R.A. Bryant et al.

    The role of panic in acute dissociative reactions following trauma

    British Journal of Clinical Psychology

    (2005)
  • K.C. Burke et al.

    Age at onset of selected mental disorders in five community populations

    Archives of General Psychiatry

    (1990)
  • Centers for Disease Control and Prevention. (2004). State-specific prevalence of current cigarette smoking among...
  • B.F. Chorpita et al.

    The development of anxiety: The role of control in the early environment

    Psychological Bulletin

    (1998)
  • L.A. Clark et al.

    Temperament, personality, and the mood and anxiety disorders

    Journal of Abnormal Psychology. Special Issue: Personality and Psychopathology

    (1994)
  • M.G. Craske et al.

    Uncued and cued emotions and associated distress in a college sample

    Journal of Anxiety Disorders

    (1995)
  • M.G. Craske et al.

    Paths to panic disorder/agoraphobia: An exploratory analyses from age 3 to 21 in an unselected birth cohort

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2001)
  • C.A. Donnell et al.

    Anxiety sensitivity and history of panic as predictors of response to hyperventilation

    Behaviour Research and Therapy

    (1989)
  • A. Ehlers

    A 1-year prospective study of panic attacks: Clinical course and factors associated with maintenance

    Journal of Abnormal Psychology

    (1995)
  • H.J. Eysenck

    ß

    (1981)
  • G.A. Fava et al.

    Prodromal symptoms in panic disorder with agoraphobia

    American Journal of Psychiatry

    (1988)
  • M.T. Feldner et al.

    A critical review of the literature on coping and panic disorder

    Clinical Psychology Review

    (2004)
  • M.T. Feldner et al.

    Prevention of anxiety psychopathology: A critical review of the empirical literature

    Clinical Psychology: Science and Practice

    (2004)
  • M.C. Fiore

    A clinical practice guideline for treating tobacco use and dependence: A US public health service report

    Journal of the American Medical Association

    (2000)
  • J.P. Forsyth et al.

    Experimental psychopathology, clinical science, and practice: An irrelevant or indispensable alliance?

    Applied and Preventive Psychology: Current Scientific Perspectives

    (2002)
  • C.A. Gardenswartz et al.

    Prevention of panic disorder

    Behavior Therapy

    (2001)
  • R.E. Glasgow et al.

    A brief smoking cessation intervention for women in low-income planned parenthood clinics

    American Journal of Public Health

    (2000)
  • R. Goodwin et al.

    Cigarette smoking and panic: The role of neuroticism

    American Journal of Psychiatry

    (2002)
  • R.D. Goodwin et al.

    Association between anxiety disorders and substance use disorders among young persons: Results of a 21-year longitudinal study

    Journal of Psychiatric Research

    (2004)
  • R.D. Goodwin et al.

    Panic attacks and psychopathology among youth

    Acta Psychiatrica Scandinavica

    (2004)
  • R.D. Goodwin et al.

    Panic attack as a marker of core psychopathological processes

    Psychopathology

    (2001)
  • R.D. Goodwin et al.

    Panic attack as a risk factor for severe psychopathology

    American Journal of Psychiatry

    (2004)
  • J.A. Gray

    Three fundamental emotion systems

  • Gray, J. A., & McNaughton, N. (1996). The neuropsychology of anxiety: A reprise. In D. A. Hope (Ed.), Nebraska...
  • C. Hayward et al.

    Pubertal stage and panic attack history in sixth- and seventh-grade girls

    American Journal of Psychiatry

    (1992)
  • C. Hayward et al.

    Predictors of panic attacks in adolescents

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2000)
  • C. Hayward et al.

    The relationship between agoraphobia symptoms and panic disorder in a non-clinical sample of adolescents

    Psychological Medicine

    (2003)
  • C. Hayward et al.

    Parent-reported predictors of adolescent panic attacks

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2004)
  • H. Hiss et al.

    Relapse prevention program for treatment of obsessive–compulsive disorder

    Journal of Consulting and Clinical Psychology

    (1994)
  • G.N. Holmbeck

    Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations

    Journal of Pediatric Psychology

    (2002)
  • B. Isensee et al.

    Smoking increases the risk of panic: Findings from a prospective community study

    Archives of General Psychiatry

    (2003)
  • J.G. Johnson et al.

    Association between cigarette smoking and anxiety disorders during adolescence and early adulthood

    Journal of the American Medical Association

    (2000)
  • J. Kagan

    Distinction among emotions, moods, and temperamental qualities

    • Cited by (0)

    ☆

    This paper was supported by National Institute on Drug Abuse research grants (1 R01 DA018734-01A1, R03 DA16307-01, and 1 R21 DA016227-01) awarded to Dr. Zvolensky and MH62056-01A2 awarded to Dr. Schmidt. This work also was supported by a National Research Service Award (F31 MH073205-01) awarded to Amit Bernstein.

    View full text
    Copyright © 2006 Elsevier Ltd. All rights reserved.