Fear of Fear

Clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder but the mechanism responsible for the improvement are lacking. The reduction of fear of fear (FOF), or the tendency to respond fearfully to benign bodily sensations, is believed to underlie the improvement resulting from CBT. Research has provided evidence consistent with the FOF hypothesis. Descriptive studies consistently show that panic disorder patients score significantly higher on self-report measures tapping fear of bodily sensations. Those who score high on measures tapping FOF display heightened emotional responding to challenge compared with those who score low on these same FOF measures (M. Brown, Smits, Powers, & Telch, 2003; Eke & McNally, 1996; Holloway & McNally, 1987; McNally & Eke, 1996; Rapee & Medoro, 1994; Telch et al., 2003). Findings from several prospective studies suggest that people score big on the Anxiety Sensititivity Index (ASI) are at greater risk for developing occurring panic attacks (Schmidt, Lerew, & Jackson, 1997;p Shmidt, Lerew, & Joiner, 1998).

Specific procedural components contained in contemporary CBT manuals for panic disorder include education about the nature and physiology of panic and anxiety, breathing retraining designed to assist patients in learning to control hyperventilation, cognitive restructuring aimed at teaching patients to identify and correct faulty threat perceptions that contribute to their panic and anxiety, interoceptive exposure aimed at reducing patents’ fear of harmless bodily sensations associated with physiological activation, and fading of maladaptive defensive behaviors such as avoidance of external situations (Barlow, Craske, Cerny, & Klosko, 1989; Clark et al., 1994; Telch et al., 199).

On the basis of contemporary psychological theories of panic disorder, several findings implicate change in FOF as a mediator of treatment outcome. CBT results in significant reductions on measures broadly tapping FOF (Bouchard et al., 1996; Clark et al., 1997, Poulton & Andrews, 1996). Modifying patients; catastrophic misinterpretations of bodily sensations result in significant reductions in panic (Taylor, 2000). A clinical trial comparing cognitive therapy with guided master...

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... to 5 being extremely frightened Likert-type scale. The total score is computed by averaging the responses to the 17 items.

The hypothesis that the effects of CBT would be mediated by changes in FOF was tested in accordance with the analytic steps outlined by Baron and Kenny (1986). Step 1 is testing the effects of treatment on the proposed mediator by performing an ANOVA with treatment group (CBT vs. waitlist) as the grouping factor and FOF score as the dependent variable. Step 2 is testing for the presence of a treatment effect by performing the grouping factor and residualized change scores of the four major clinical status measures as the dependent variables. Step 3 is the relationship between the proposed mediator and the four major clinical status measures was examined. This step was tested by performing a series of analyses of covariance with treatment group (CBT vs. waitlist) as the grouping factor, residualized change scores of clinical status measures as the dependent variables, and the FOF score as the covariate. The final step is tested by comparing the effect of treatment in the third step with the effect of treatment in the second step.