2.2- Panic Disorder & Agoraphobia

Case 2 - Case Formulation Using the Integrative Model: (pp. 20-22)

Answer: B. Predisposing factor

Explanation: Genetic and familial vulnerabilities increase susceptibility to panic disorder, making them predisposing factors.

According to the integrative model of panic disorder, John’s strong family history of panic disorder and alcoholism represents which of the following?

A. Precipitating factor
B. Predisposing factor
C. Perpetuating factor
D. Protective factor

Answer: A. Precipitating factor

Explanation: The stressful life event triggered the onset of his first panic attack, which fits the definition of a precipitating factor.

John experienced his first panic attack during a stressful period (birth of his first child, hectic work schedule). According to the 4Ps model, this is best described as:

A. Precipitating factor
B. Perpetuating factor
C. Predisposing factor
D. Protective factor

Answer: B. Perpetuating factor

Explanation: Safety behaviors and avoidance prevent exposure and reinforce anxiety, maintaining the disorder.

John avoids driving, exercise, and caffeine because he fears they may trigger panic symptoms. In the 4Ps framework, this avoidance is an example of:

A. Protective factor
B. Perpetuating factor
C. Predisposing factor
D. Precipitating factor

Answer: A. A supportive partner encouraging gradual exposure to feared situations

Explanation: Protective factors buffer against the disorder or aid in recovery. Supportive relationships enhance treatment response and resilience.

Which of the following would be considered a protective factor for John?

A. A supportive partner encouraging gradual exposure to feared situations
B. His genetic vulnerability to panic disorder
C. Avoidance of driving due to fear of panic attacks
D. His tendency to misinterpret bodily sensations as catastrophic

Answer: B. Interoceptive conditioning

Explanation: Interoceptive conditioning occurs when internal bodily sensations are paired with fear, eventually triggering anxiety themselves.

The process by which bodily sensations (e.g., rapid heartbeat during exercise) become associated with fear responses is known as:

A. Cognitive distortion
B. Interoceptive conditioning
C. Catastrophic misinterpretation
D. Learned helplessness

Answer: C. Catastrophic misinterpretations

Explanation: Misinterpreting benign bodily sensations as catastrophic is a core cognitive mechanism that perpetuates panic disorder.

In John’s case, catastrophic beliefs that panic attacks signal serious illness (e.g., heart disease) reflect which maintaining factor in panic disorder?

A. Learned alarms
B. Genetic predisposition
C. Catastrophic misinterpretations
D. Protective coping strategies

Answer: C. Genetic vulnerability interacts with stressful life events to trigger panic disorder

Explanation: John’s family history (diathesis) plus major life stress (stress) is consistent with the diathesis–stress model.

Which statement best reflects the diathesis-stress model in John’s case?

A. Panic disorder arises only in those with stressful life events
B. Vulnerability is irrelevant unless there is substance abuse
C. Genetic vulnerability interacts with stressful life events to trigger panic disorder
D. Panic disorder occurs when protective factors are absent

Answer: C. Develops after panic attacks as a response to avoidance of feared situations

Explanation: Agoraphobia almost always arises after unexpected panic attacks. Avoiding feared situations (e.g., driving) becomes a way to manage anxiety, reinforcing the disorder.

In John’s case, agoraphobia developed after experiencing repeated panic attacks while driving. According to research and the integrative model, agoraphobia typically:

A. Develops before the first panic attack
B. Always develops without panic attacks
C. Develops after panic attacks as a response to avoidance of feared situations
D. Is unrelated to panic disorder

Answer: B. False alarms are unexpected panic attacks, whereas learned alarms are conditioned responses to internal or external cues

Explanation: A false alarm is the fight-or-flight response triggered at inappropriate times (panic attack). Through conditioning, these attacks become associated with cues, turning into learned alarms that maintain the disorder.

In the integrative model, the difference between “false alarms” and “learned alarms” is best explained as:

A. False alarms occur in safe contexts, whereas learned alarms are inherited genetically
B. False alarms are unexpected panic attacks, whereas learned alarms are conditioned responses to internal or external cues
C. False alarms involve catastrophic misinterpretations, whereas learned alarms involve protective factors
D. False alarms occur in agoraphobia, whereas learned alarms occur in generalized anxiety disorder