Autonomic characteristics of nonclinical panic and blood phobia

doi:10.1016/0006-3223(93)90087-T

Biological Psychiatry

Volume 34, Issue 5, 1 September 1993, Pages 298-310

https://doi.org/10.1016/0006-3223(93)90087-T Get rights and content

Abstract

Autonomic characteristics of nonclinical panic and blood phobia were compared using spectral analysis of the electrocardiogram (EKG), as well as more conventional cardiovascular measures. The cardiovascular responses of 11 subjects who reported recent occureence of frequent severe panic attacks, and 10 subjects who reported intense somatic reactions to the sight of blood (including episodes of syncope) were recorded during a variety of laboratory tasks (quiet rest, reaction time/shock avoidance, face immersion, and combined reaction time/face immersion). Results suggest distinct autonomic patterns in the groups. Panickers showed (a) higher heart rate and reduced heart-rate variability (b) aberrant associations among cardiovascular measures, and (c) dominant sympathetic control of heart rate coupled with diminished vagal tone. Blood phobics generally displayed an opposite pattern. The relevance of these findings to the etiology of panic and blood phobia, as well as to biological models of anxiety disorders in general, is discussed.

References (143)

T.D. Borkovec et al.
The utility of analogue research
Behav Res Ther
(1979)
J. Connolly et al.
Selective association of fainting with blood-injury-illness fear
Behav Ther
(1976)
W. Coryell
Panic disorder and mortality
Psychiatr Clin North Am
(1988)
C.G. Costello
Anxiety and the persisting novelty of input from the autonomic nervous system
Behav Ther
(1971)
G. Glick et al.
Hemodynamic changes during spontaneous vasovagal reactions
Am J Med
(1963)
R.F. Gilmour et al.
Evidence for prejunctional and postjunctional antagonism of the sympathetic neuroeffector junction by acetylcholine in canine cardiac Purkinje fibers
J Am Coll Cardiol
(1984)
K.L. Granville-Grossman et al.
The effect of propranolol on anxiety
Lancet
(1966)
R. Hoehn-Saric et al.
The peripheral sympathetic nervous system: Its role in pathological anxiety
Psychiatr Clin North Am
(1988)
A.E. Holden et al.
Heart rate and heart rate variability recorded in vivo in agoraphobics and nonphobics
Behav Ther
(1986)
R.A. Kleinknecht
Vasovagal syncope and blood/injury fear
Behav Res Ther
(1987)

M. Kollai et al.

Cardiovascular reflexes and interrelationships between sympathetic and parasympathetic activity

J Autonom Nerv Sys

(1981)

J. Margraf et al.

Biological models of panic disorder and agoraphobia: A review

Behav Res Ther

(1986)

L. Michelson et al.

Panic disorder: Cognitive-behavioral treatment

Behav Res Ther

(1990)

L. Michelson et al.

Cognitive, behavioral, and psychophysiological treatments of agoraphobia: A comparative outcome investigation

Behav Ther

(1988)

G.R. Norton et al.

Factors associated with panic attacks in nonclinical subjects

Behav Ther

(1986)

L.-G. Ost et al.

Exposure in vivo vs. applied relaxation in the treatment of blood phobia

Behav Res Ther

(1984)

L.-G. Ost et al.

Physiological responses in blood phobics

Behav Res Ther

(1984)

W.S. Agras et al.

The epidemiology of common fears and phobias

Compr Psychiatry

(1969)

S. Akselrod et al.

Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control

Science

(1981)

M.T. Allen et al.

Patterns of autonomic response during laboratory stressors

Psychophysiology

(1989)

American Psychiatric Association

Diagnostic and Statistical Manual of Mental Disorders

P. Anastasiades et al.

Psychophysiological responses in panic and stress

J Psychophysiol

(1990)

J. Arabian et al.

Treatment of PAT: Bradycardic reflexes induced by dive vs. body tilt

Pavlovian J Biol Sci

(1983)

J.C. Ballenger

Biological aspects of panic disorder

Am J Psychiatry

(1986)

A. Bandura

On paradigms and recycled ideologies

Cog Res Ther

(1978)

D.H. Barlow

Anxiety and its Disorders

(1988)

G. Baseli et al.

Heart rate variability signal processing: A quantitative approach as an aid to diagnosis in cardiovascular pathologies

Int J Biomed Comput

(1987)

R.M. Berne et al.

Cardiovascular Physiology

(1992)

D.A. Bernstein

Some comments on therapy analogue research with small animal “phobias”

J Behav Ther Exp Psychiatry

(1973)

G.G. Berntson et al.

Autonomic determinism: The modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic contraint

Psychol Rev

(1991)

T.D. Borkovec et al.

Methodological and target behavior issues in analogue therapy outcome research

T.D. Borkovec et al.

Evaluation of clinically relevant target behavior for analogue outcome research

Behav Ther

(1974)

I. Brick

Circulatory responses to immersing the face in water

J Appl Physiol

(1966)

D.G. Byrne et al.

Anxiety and coronary heart disease

G.J. Carasnos

Neurocirculatory asthenia

M. Carruthers et al.

Vagotonicity of violence: Biochemical and cardiac responses to violent films and television programmes

Br Med J

(1973)

D.S. Charney et al.

Abnormal regulation of noradrenergic function in panic disorders

Arch Gen Psychiatry

(1986)

D.S. Charney et al.

Noradrenergic dysregulation in panic disorder

C. Cohn et al.

A case of blood-injury-illness fear

J Nerv Ment Dis

(1976)

R. Colombo et al.

A comprehensive PC solution to heart rate variability analysis in mental stress

1989 IEEE Comp Cardiol

(1990)

W. Coryell et al.

Excess mortality in panic disorder: A comparison with primary unipolar depression

Arch Gen Psychiatry

(1982)

M.G. Craske et al.

Mobility, cognitions, and panic

J Psychopathol Behav Assess

(1986)

R.R. Crowe

Molecular genetics and panic disorder: New approaches to an old problem

R.R. Crowe et al.

A family study of anxiety neurosis: Morbidity risk in families of patients with and without mitral valve prolapse

Arch Gen Psychiatry

(1983)

G. Curtis et al.

Fainting on exposure to phobic stimuli

Am J Psychiatry

(1983)

M.E. Dawson et al.

The role of autonomic dysfunctions within a vulnerability-stress model of schizophrenic disorders

T.E. Dielman

Pooled cross-sectional and time series data: A survey of current statistical methodology

Am Statistician

(1983)

A. Ehlers et al.

Experimental induction of panic attacks

G.L. Engel

Psychologic stress, vasodepressor syncope, and sudden death

Ann Intern Med

(1978)

H.J. Eysenck

The Structure of Human Personality

(1970)

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^a: Research was supported in part by National Heart Lung and Blood Institute Training Grant HL-07560

^b: National Institute on Alcohol Abuse and Alcoholism Grant AA-07352

^c: National Institute of Mental Health Research Grant MH-39172

^d: Fulbright Fel lowship to the second author. The authors would like to thank Dr. Larry Michelson for his insightful comments on the manuscript, and assistance in subject selection procedures.

View full text

Autonomic characteristics of nonclinical panic and blood phobia

Abstract

Behav Res Ther

Behav Ther

Psychiatr Clin North Am

Behav Ther

Am J Med

J Am Coll Cardiol

Lancet

Psychiatr Clin North Am

Behav Ther

Behav Res Ther

J Autonom Nerv Sys

Behav Res Ther

Behav Res Ther

Behav Ther

Behav Ther

Behav Res Ther

Behav Res Ther

The epidemiology of common fears and phobias

Compr Psychiatry

Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control

Science

Patterns of autonomic response during laboratory stressors

Psychophysiology

Diagnostic and Statistical Manual of Mental Disorders

Psychophysiological responses in panic and stress

J Psychophysiol

Treatment of PAT: Bradycardic reflexes induced by dive vs. body tilt

Pavlovian J Biol Sci

Biological aspects of panic disorder

Am J Psychiatry

On paradigms and recycled ideologies

Cog Res Ther

Anxiety and its Disorders

Heart rate variability signal processing: A quantitative approach as an aid to diagnosis in cardiovascular pathologies

Int J Biomed Comput

Cardiovascular Physiology

Some comments on therapy analogue research with small animal “phobias”

J Behav Ther Exp Psychiatry

Autonomic determinism: The modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic contraint

Psychol Rev

Methodological and target behavior issues in analogue therapy outcome research

Evaluation of clinically relevant target behavior for analogue outcome research

Behav Ther

Circulatory responses to immersing the face in water

J Appl Physiol

Anxiety and coronary heart disease

Neurocirculatory asthenia

Vagotonicity of violence: Biochemical and cardiac responses to violent films and television programmes

Br Med J

Abnormal regulation of noradrenergic function in panic disorders

Arch Gen Psychiatry

Noradrenergic dysregulation in panic disorder

A case of blood-injury-illness fear

J Nerv Ment Dis

A comprehensive PC solution to heart rate variability analysis in mental stress

1989 IEEE Comp Cardiol

Excess mortality in panic disorder: A comparison with primary unipolar depression

Arch Gen Psychiatry

Mobility, cognitions, and panic

J Psychopathol Behav Assess

Molecular genetics and panic disorder: New approaches to an old problem

A family study of anxiety neurosis: Morbidity risk in families of patients with and without mitral valve prolapse

Arch Gen Psychiatry

Fainting on exposure to phobic stimuli

Am J Psychiatry

The role of autonomic dysfunctions within a vulnerability-stress model of schizophrenic disorders

Pooled cross-sectional and time series data: A survey of current statistical methodology

Am Statistician

Experimental induction of panic attacks

Psychologic stress, vasodepressor syncope, and sudden death

Ann Intern Med

The Structure of Human Personality