Studies O f Self-Focus And Panic

To summarise the argument so far, both somatic and cognitive self-focus are o f theoretical and therapeutic interest in relation to the onset and maintenance of panic. There have been only three studies which have explicitly addressed self-focus in panic disorder and all of these are subject to methodological criticisms. The following section will review the previous relevant work before showing how the present study extends and develops what is already known.

There have been only two studies exphcitly investigating level and content of self­ focus in panic disorder to date ( Brown & Cash, 1990; Borden et al. 1993). Brown & Cash (1990) showed elevated somatic self-fbcus in a group of non-clinical panickers using a questionnaire measure of dispositional self-focus (Body Consciousness

Questionnaire, Miller, Murphy & Buss, 1981). No difference was found in cognitive self­ focus as measured by the Self-Consciousness Scale. The results of this study are

encouraging, but only limited the conclusions can be drawn for a number o f reasons. These include the failure to control for depression (which is known to affect self-focus), the use of a non-patient population and the brevity of the questionnaire measures o f self­ focus which were used.

The most thorough study of panic and self-focus is that by Borden et al. (1993) which used a thought-sampling paradigm to measure direction and content o f attention in both a group o f panickers and a group without panic. Measures were taken under three

conditions - baseline, during a relaxation exercise (listening to peaceful music) and during a midly stressful task (a bogus intelhgence test). Responses were coded for self'task focus

and self-focused responses were further divided into cognitive and somatic categories. As would be predicted on the basis of previous research the patient group, showed higher levels of cognitive focus in all three conditions. However, in addition, during the baseline and relaxation phases, the panickers exhibited much, higher levels of physiological self­ focus than non-panickers. The stressful task appeared to induce a shift towards cognitive self-focus in both groups and the content of responses was predominantly related to performance concerns. This effect was sufficiently potent to override the baseline tendency to physiological self-focus in the panickers. Thus, this study provides

preliminary evidence of selective attention to physiological cues in individuals with panic. However, there were a number of methodological problems which make a definitive interpretation of the findings impossible. Probably the most serious flaw in the Borden et aL (1993) study was the failure to control for depression. Although subjects were

excluded if they met criteria for another DSM III-R Axis I disorder other than

Generalised Anxiety Disorder, no screening measure was used to assess levels of sub- clinical depression.. There have been a number of studies demonstrating effects of sub- clinical depression on self-focus (Ingram.& Smith, 1984; Larsen & Cowan, 1988; Smith & Greenberg, 1981; Smith, Ingram & Roth, 1985), thus, level of depression needs to be taken into account if a clear picture of the selective effect of other disorders such as panic is to be clarified. The DSM III-R diagnostic criteria are fairly stringent and it is possible to experience a signficant amount of depressive symptomatology without reaching the level required for diagnosis. Panic patients frequently describe symptoms typical of depression sucfras low mood, fatigue, poor concentration and so o n even when they do not show a

full-blown depressive illness and the failure of the Borden et al. study to recognise this casts doubt on their interpretation of the results. That is, although differences were found between panic patients and normal controls, it is impossible to be certain whether these differences should be attributed to depression (which is known to affect self-focus) or to a selective effect of panic.

In addition to these threa studies which have used the self-focus construct, there have also been other studies on somatic attention in panic. For example, Pauli, Marquardt, Hartl^ Detlev, Nutzinger, Holzl & Strian (1991) investigated cardiac perception in panickers. In this study, a 24 hour ambulatory ECG was recorded in panickers and controls. Participants were asked to report any cardiac perceptions during this period. The incidence of such perceptions was found to be greater in the panickers but the difference was not statistically significant. Thus, these findings do not fully support the positive results reported by the two studies of self-focus described above. However, again no attempt was made to control for depression.

Fisher & Wilson (1985) used two more unusual experimental paradigms to assess whether agoraphobics are characterised by enhanced utilisation of internal cues. First, a procedure was used which induced subjects to form a facial expression without being aware that they were doing so. They then completed a self-report measure of mood. Since previous research had shown that subject who use internal rather than external cues are more strongly influenced m their mood by facial expression, it was predicted that agoraphobics would report stronger moods. However, no differences between the experimental groups were found. Similarly, negative findings were reported on a rod and

frame task which determines to what extent internal cues are being utilised. It does not seem surprising that agoraphobics did not show differing performance on these tasks, since the type of internal cues used were not of the type thought to be particularly associated with panic (e.g.^ cardiac sensations, breathlessness etc.).

Thus, the literature on attention to somatic cues in panic is by no means extensive and the results of the few existent studies present a somewhat contradictory picture.