Panic Away

Panic Away End Anxiety and Panic Attacks

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In modern life, anxiety disorders, together with depressive disorders, rank at the top of the most devastating forms of mental illness in Western society. These disorders affect as many as 46 million individuals in the United States alone (Kessler et al., 1994). In response, there is a rapidly proliferating literature on these emotional disorders, as well as on the group of closely related eating disorders.

Cognitive models of psychopathology have become prominent in contemporary attempts to understand the causes, mechanisms, and effective treatments for psychological problems. In these models, factors such as appraisals, attributions, and cognitive styles are important. Cognitive theories assume that mental processes—such as interpretation, attention, or memory—are intermediary events that intercede between environmental stimuli and emotional responses. Cognitive theories have received increasing attention not only in the clinical and psychiatric literatures, but also in the social and personality, experimental, cognitive, and developmental ones.

If emotional disorders such as anxiety and depression are, indeed, influenced by cognitive factors, it is important to understand the ways that these factors may contribute to cognitive vulnerability. Some individuals are clearly more susceptible than others to developing emotional disorders, and to experiencing chronic problems or recurrences. What, then, makes them susceptible? This is, in essence, a question about cognitive vulnerability, and one of the most vibrant research efforts in psycho-

pathology is now devoted to exploring it. The literature is rapidly burgeoning on cognitive vulnerability to not only depression but emotional disorders such as bipolar, panic, OCD, and eating disorders; new developments are constantly being reported.

Thus, we felt the lack of, and need for, a book that would present and synthesize the latest knowledge about cognitive factors in vulnerability to emotional disorders.

Most work on cognition addresses concurrent cognitions or biases (about which there is a huge literature). Work on vulnerability is different. It concerns the cognitive antecedents of these, and the disorders in which they are implicated. Understanding cognitive vulnerabilities is important for understanding how disorders develop, how they are maintained, and how they can be prevented and treated.

Cognitive vulnerabilities are faulty beliefs, long-previously developed cognitive patterns, or structures that are hypothesized to set the stage for later psychological problems. They are in place long before the earliest signs or symptoms of disorder first appear. These vulnerabilities are generally purported to create specific liabilities to particular psychological disorders after individuals encounter stressful events, and to maintain the problems after their onset. Only by addressing these vulnerabilities can long-term therapeutic improvements be maintained, and the risk of recurrences or relapse be reduced.

We have structured this book to make it easy for readers to focus on particular interests. They can read about specific disorders (e.g., depression or bipolar disorder, suicide, obsessive-compulsive or panic disorder), read about groups of disorders (e.g., mood disorders or anxiety disorders), or read about emotional disorders in general. The book is organized in what we hope is a highly accessible way within a common overarching conceptual framework. All the chapters build on a model of cognitive vulnerability that is described in the first chapter. This model explains the relationships between developmental factors, cognitive vulnerabilities as risk factors for later disorder, the nature of specific vulnerabilities for specific disorders, and the difference between distal antecedents of disorders (e.g., depressive inferential styles, dysfunctional attitudes) and proximal cognitive factors (e.g., schema activation, or inferences). It synthesizes the commonalities evidenced by a number of different cognitive clinical approaches to emotional disorders. The first chapter also provides an overview of the major issues bearing on design and methods, and how these must be guided by theory.

The remainder of the book is divided into three sections, on mood disorders, anxiety disorders, and eating disorders, respectively. Each section contains a series of chapters summarizing the latest formulation of the role of cognitive vulnerabilities in a particular disorder, by a leading ex pert who describes emerging theory and research, and also identifies areas where work remains to be done, since cognitive vulnerability is still less studied than other aspects of cognitive function in emotional disorder. Each section concludes with an integrative chapter, also by a leading expert, which offers incisive commentary, theoretical synthesis, and insightful suggestions for further systematic research.

Part I concentrates on mood disorders, both depressive and bipolar. Chapters by Alloy, Abramson, Safford, and Gibb, and Ingram, Miranda, and Segal, describe major recent findings and theoretical issues concerning cognitive vulnerability to depression; chapters by Alloy, Reilly-Har-rington, Fresco, and Flannery-Schroeder, and Pettit and Joiner, describe recent developments on research on cognitive vulnerability to bipolar disorder and suicide, respectively. A chapter by Traill and Gotlib sums up and synthesizes. Part II focuses on the major anxiety disorders. A chapter by Riskind and Williams describes work on a common cognitive vulnerability to anxiety disorders that differentiates them from depression. Other chapters by Schmidt and Woolaway-Bickel on panic disorder, Rachman, Shafran, and Riskind on OCD, Ledley, Fresco, and Heimberg on social anxiety, and Feeny and Foa on PTSD, describe recent findings and theoretical issues concerning specific anxiety disorders. Wells and Matthews sum up and synthesize. Part III is devoted to bulimia and anorexia nervosa, which are closely related to anxiety and depression and may share some of the same underlying causal processes. Chapters by Abram-son, Bardone-Cone, Vohs, Joiner, and Heatherton on bulimia, and by Garner and Magana on anorexia nervosa discuss current work; a chapter by Keel sums up and synthesizes.

We are excited about this book and hope that it will be helpful to all who seek to understand the cognitive-behavioral basis of mood, anxiety, and eating disorders in the service of more effective prevention and treatment. Our field of inquiry has expanded rapidly and witnessed much recent progress; we hope also that the book will stimulate further research.

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