Interpretation Bias in Panic Disorder: Self-Referential or Global?

  • David H. Rosmarin
  • Lisa M. Bourque
  • Martin M. Antony
  • Randi E. McCabe
Original Article


Numerous studies have indicated that interpretation bias plays a key role in the development and maintenance of panic disorder; however, whether this bias is specific to the self or more generalized is unknown. This study offers a closer examination of the nature of interpretation bias among patients with panic disorder in an outpatient hospital-based anxiety clinic. Self-referential and global versions of the Body Sensation Interpretation Questionnaire (Clark et al. in J Consult Clin Psychol 65:203–213, 1997) were administered to 25 individuals with panic disorder, 25 individuals with social anxiety disorder and 24 non-anxious controls. Consistent with previous findings, individuals with panic disorder misinterpreted panic-related body sensations more so than anxious or non-anxious controls. Furthermore, the interpretation bias was limited to the self and did not extend to beliefs about how others would interpret panic sensations. Implications of these findings are discussed.


Panic disorder Interpretation bias Information processing Anxiety 


  1. Ahmad, T., Wardle, J., & Hayward, P. (1992). Physical symptoms and illness attributions in agoraphobia and panic. Behaviour Research and Therapy, 30, 493–500. doi:10.1016/0005-7967(92)90033-D.CrossRefPubMedGoogle Scholar
  2. Antony, M. M., Coons, M. J., McCabe, R. E., Ashbaugh, A. R., & Swinson, R. P. (2006). Psychometric properties of the Social Phobia Inventory: Further evaluation. Behaviour Research and Therapy, 44, 1177–1185. doi:10.1016/j.brat.2005.08.013.CrossRefPubMedGoogle Scholar
  3. Austin, D. W., & Richards, J. C. (2006). A test of core assumptions of the catastrophic misinterpretation model of panic disorder. Cognitive Therapy and Research, 30, 53–68. doi:10.1007/s10608-006-9010-4.CrossRefGoogle Scholar
  4. Barlow, D. H., Vermilyea, J., Blanchard, E. B., Vermilyea, B. B., Di Nardo, P. A., & Cerny, J. A. (1985). The phenomenon of panic. Journal of Abnormal Psychology, 94, 320–328. doi:10.1037/0021-843X.94.3.320.CrossRefPubMedGoogle Scholar
  5. Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.Google Scholar
  6. Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety. Advances in Behaviour Research and Therapy, 5, 51–62. doi:10.1016/0146-6402(83)90015-2.CrossRefGoogle Scholar
  7. Chambless, D. L., & Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13, 9–20. doi:10.1007/BF01178486.CrossRefGoogle Scholar
  8. Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. doi:10.1016/0005-7967(86)90011-2.CrossRefPubMedGoogle Scholar
  9. Clark, D. M. (1988). A cognitive model of panic attacks. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 71–89). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  10. Clark, D. M., Salkovskis, P. M., Breitholtz, E., Westling, B. E., Öst, L. G., Koehler, K. A., et al. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65, 203–213. doi:10.1037/0022-006X.65.2.203.CrossRefPubMedGoogle Scholar
  11. Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Foa, E., & Wesler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). The British Journal of Psychiatry, 176, 379–386. doi:10.1192/bjp.176.4.379.CrossRefPubMedGoogle Scholar
  12. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for the diagnostic and statistical manual of mental disorders, forth edition, axis I disorders-patient edition (SCID-I/P version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
  13. Gregor, K. L., & Zvolensky, M. J. (2008). Anxiety sensitivity and perceived control over anxiety-related events: Evaluating the singular and interactive effects in the prediction of anxious and fearful responding to bodily sensations. Behaviour Research and Therapy, 46, 1017–1025. doi:10.1016/j.brat.2008.06.003.CrossRefPubMedGoogle Scholar
  14. Harvey, J. M., Richards, J. C., Dziadosz, T., & Swindell, A. (1993). Misinterpretation of ambiguous stimuli in panic disorder. Cognitive Therapy and Research, 17, 235–248. doi:10.1007/BF01172948.CrossRefGoogle Scholar
  15. Hibbert, G. A. (1984). Ideational components of anxiety: Their origin and content. The British Journal of Psychiatry, 144, 618–624. doi:10.1192/bjp.144.6.618.CrossRefPubMedGoogle Scholar
  16. McNally, R. J., & Foa, E. B. (1987). Cognitions and agoraphobia: Bias in the interpretation of threat. Cognitive Therapy and Research, 11, 567–581. doi:10.1007/BF01183859.CrossRefGoogle Scholar
  17. Ottaviani, R., & Beck, A. T. (1987). Cognitive aspects of panic disorders. Journal of Anxiety Disorders, 1, 15–28. doi:10.1016/0887-6185(87)90019-3.CrossRefGoogle Scholar
  18. Peterson, R. A., & Reiss, S. (1993). Anxiety sensitivity index revised test manual. Worthington, OH: IDS Publishing Corporation.Google Scholar
  19. Rachman, S., Levitt, K., & Lopatka, C. (1987). Panic: The links between cognitions and bodily sensations-1. Behaviour Research and Therapy, 25, 411–424. doi:10.1016/0005-7967(87)90018-0.CrossRefPubMedGoogle Scholar
  20. Rapee, R. M. (1985). Distinction between panic disorder and generalized anxiety disorder: Clinical presentation. The Australian and New Zealand Journal of Psychiatry, 19, 227–232. doi:10.3109/00048678509158827.CrossRefPubMedGoogle Scholar
  21. Rapee, R. M. (1993). Psychological factors in panic disorder. Advances in Behaviour Research and Therapy, 15, 85–102. doi:10.1016/0146-6402(93)90005-M.CrossRefGoogle Scholar
  22. Rapee, R. M., Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Response to hyperventilation and inhalation of 5.5% carbon dioxide-enriched air across the DSM-III-R anxiety disorders. Journal of Abnormal Psychology, 101, 538–552. doi:10.1037/0021-843X.101.3.538.CrossRefPubMedGoogle Scholar
  23. Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. doi:10.1016/0005-7967(86)90143-9.CrossRefPubMedGoogle Scholar
  24. Taylor, S., Koch, W. J., & McNally, R. J. (1992). How does anxiety sensitivity vary across the disorders? Journal of Anxiety Disorders, 6, 249–259. doi:10.1016/0887-6185(92)90037-8.CrossRefGoogle Scholar
  25. Teachman, B. A. (2005). Information processing and anxiety sensitivity: Cognitive vulnerability to panic reflected in interpretation and memory biases. Cognitive Therapy and Research, 29, 479–499. doi:10.1007/s10608-005-0627-5.CrossRefGoogle Scholar
  26. Teachman, B. A., Smith-Janik, S. B., & Saporito, J. (2007). Information processing biases and panic disorder: Relationships among cognitive and symptom measures. Behaviour Research and Therapy, 45, 1791–1811. doi:10.1016/j.brat.2007.01.009.CrossRefPubMedGoogle Scholar
  27. Vancleef, L. M. G., & Peters, M. L. (2008). Examining content specificity of negative interpretation biases with the Body Sensations Interpretation Questionnaire (BSIQ). Journal of Anxiety Disorders, 22, 401–415. doi:10.1016/j.janxdis.2007.05.006.CrossRefPubMedGoogle Scholar
  28. Westling, B. E., & Öst, L. G. (1993). Relationship between panic attack symptoms and cognitions in panic disorder patients. Journal of Anxiety Disorders, 7, 181–194. doi:10.1016/0887-6185(93)90001-2.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • David H. Rosmarin
    • 1
  • Lisa M. Bourque
    • 1
  • Martin M. Antony
    • 1
    • 2
  • Randi E. McCabe
    • 1
  1. 1.Anxiety Treatment and Research Centre, St. Joseph’s Healthcare, and Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of PsychologyRyerson UniversityTorontoCanada

Personalised recommendations