The Impact of Treatment on Anxiety Sensitivity
Michael W Otto Noreen A. Reilly-Harrington Massachusetts General Hospital and Harvard Medical School
Previous chapters in this volume have made it clear that anxiety sensitivity (AS) can develop independently from panic attacks and that high AS may place an individual at risk for panic disorder (see chaps. 6 and 10, this volume). Furthermore, high AS predicts the maintenance of panic disorder among untreated patients, the prospective emergence of panic attacks among infrequent panickers, the emergence of panic among individuals free of a history of panic ( Ehlers, 1995), as well as the average longer term outcome achieved by patients in a clinic setting ( Pollack et al., 1996). All of these studies support the hypothesis that AS is central to panic disorder. Consequently, the degree to which successful treatment impacts AS is an important issue for examining the nature of treatment response and the likelihood of maintaining improvement.
This chapter examines the impact of treatment on AS, and addresses the question of whether treatments for panic disorder must directly target fears of anxiety sensations to achieve robust changes in AS. Anxiety sensitivity is considered as both a cause and consequence of panic disorder, with the assumption that a mutually causal cycle may exist between fears of anxiety symptoms and recurrent panic episodes (see Taylor, 1995). Cognitive-behavioral approaches to panic disorder focus on fears of anxiety symptoms as the core maintaining influence on panic disorder. Treatment packages that directly target the modification of these fears have demonstrated clear efficacy for