What You Can Change _. And What You Can't - Martin E. Seligman [139]
3. This is a highly reliable finding, shown in dozens of studies. See, for example, M. Liebowitz, J. Gorman, A. Fryer, et al., “Lactate Provocation of Panic Attacks,” Archives of General Psychiatry 41 (1984): 764–70; and J. Gorman, M. Liebowitz, A. Fryer, et al., “Lactate Infusions in Obsessive-Compulsive Disorder,” American Journal of Psychiatry 142 (1985): 864–66.
4. See S. Torgersen, “Genetic Factors in Anxiety Disorders,” Archives of General Psychiatry 40 (1983): 1085–89; and R. Crowe, “Panic Disorder: Genetic Considerations,” Journal of Psychiatric Research 24 (1990): 129–34.
5. See D. Charney and G. Heninger, “Abnormal Regulation of Noradrenergic Function in Panic Disorders,” Archives of General Psychiatry 43 (1986): 1042–54; and E. Reiman, M. Raichle, E. Robins, et al., “The Application of Positron Emission Tomography to the Study of Panic Disorder,” American Journal of Psychiatry 143 (1986): 469–77.
6. See, for example, S. Svebak, A. Cameron, S. Levander, “Clonazepam and Imipramine in the Treatment of Panic Attacks,” Journal of Clinical Psychiatry 51 (1990): 14–17; and G. Tesar, “High-Potency Benzodiazepines for Short-term Management of Panic Disorder: The U.S. Experience,” Journal of Clinical Psychiatry 51 (1990): 4–10.
7. The proceedings of this conference are published in S. J. Rachman and J. Maser, eds., Panic-Psychological Perspectives (Hillsdale, N.J.: Erlbaum, 1988).
8. Parallel examples can be generated for fear of going crazy and fear of losing control, two other common contents of a panic attack. In each case, the first bodily sensations are misinterpreted as a sign of insanity or of losing control. The vicious cycle of misinterpreting mounting anxiety symptoms as further evidence of imminent cataclysm then starts.
9. This dialogue is adapted from D. Clark, “Anxiety States: Panic and Generalized Anxiety,” in K. Hawton, P. Salkovskis, J. Kirk, and D. Clark, eds., Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide (Oxford: Oxford University Press, 1989), 76–77.
10. For relapse with Xanax (alprazolam), see, for example, J. Pecknold, R. Swinson, K. Kuch, C. Lewis, “Alprazolam in Panic Disorder and Agoraphobia: Results from a Multicenter Trial: III. Discontinuation Effects,” Archives of General Psychiatry 45 (1988): 429–36. A very informative lay article about Xanax, “High Anxiety,” appeared in Consumer Reports January 1993, 19–24.
11. On 25–27 September 1991, NIMH brought the leading figures in panic together again for a “consensus” meeting, a trial by jury of the panic therapies. Their conclusion was equivocal and disappointing. The numbers presented agree very closely with my summary table. In spite of this, the jury did not explicitly compare the cognitive therapies to the drug therapies, and therefore no mention was made of the superiority of the cognitive treatment to drugs. I can only speculate as to what interests were served by this, but I think their conclusions were pusillanimous and a disservice to the general public. See “National Institutes of Health Consensus Development Statement. Treatment of Panic Disorder. September 25–27, 1991.” See especially J. Margraf, D. Barlow, D. Clark, and M. Telch, “Psychological Treatment of Panic: Work in Progress on Outcome, Active Ingredients, and Follow-up,” Behaviour Research and Therapy 31 (1993): 1–8.
Since my conclusions are not as yet universally accepted, I want to list the main outcome studies that document the unusually powerful effects of the cognitive treatment:
D. Clark, M. Gelder, P. Salkovskis, A. Hackman, H. Middleton, and P. Anastasiades, “Cognitive Therapy for Panic: Comparative Efficacy.” Paper presented at the annual meeting of the American Psychiatric Association, New York City, May 1990.
A. Beck, L. Sokol, D. Clark, B. Berchick, and F. Wright, “Focussed