A modern learning theory perspective on the etiology of panic disorder.

Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Poststress effects of danger and safety signals on gastric ulceration in rats.

Gastric ulceration of rats stressed by restraint in 19°C water for 75 min was markedly increased by allowing a 75-min postrestraint room-temperature rest period during which the rat was exposed to cues that had previously been associated with the delivery of 80 5-s uncontrollable electric shocks distributed over four sessions. This effect obtained equally without regard to whether "danger cues" were punctate signals or constant contextual cues or whether contextual ones were interrupted by punctate safety signals. The experimental treatments used were unusual in that they equated the groups on their total conditioning history and thus allowed a more pure look at the poststress effect than heretofore. Other groups provided controls for prior shocks, rest, and their interaction as well as handling. Analyses of corticosterone after the stress or stress-rest cycle revealed only a general decline in corticosterone levels with rest undifferentiated across groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of panic attack on mitral valve prolapse

It has been reported that panic attacks might cause mitral valve prolapse (MVP) via haemodynamic or indirect effects. Such prolapse can be classified as being physiological (benign course) or pathological (poor course). It is therefore important to consider whether panic attacks, as a risk factor for MVP, are associated with its physiological or pathological type. Our study sample consisted of two groups of patients with panic disorder (PD), one having onset within 1 year (n=24) and the other with a history of more than 10 years (n=21). Demographic data, symptom presentations, auscultatory and echocardiographic findings of both groups were compared, but no significant difference was found except with regard to anticipatory anxiety. It is concluded that panic attack exerts no significant effect on mitral valve prolapse.     

Intra-Administration Associations and Withdrawal Symptoms: Morphine-Elicited Morphine Withdrawal.

On the basis of a conditioning analysis, some drug "withdrawal symptoms" are conditional responses elicited by stimuli paired with the drug effect. Prior demonstrations of conditional elicitation of withdrawal symptoms evaluated the role of environmental cues; however, pharmacological cues also typically signal a drug effect. Within each administration, early drug onset cues (DOCs) may become associated with the later, larger drug effect (intra-administration associations). This experiment evaluated the contribution of intra-administration associations to withdrawal symptoms. The results indicated that (a) 5 mg/kg morphine elicited behavioral and thermic withdrawal symptoms in rats previously injected on a number of occasions with 50 mg/kg morphine and that (b) DOC-elicited withdrawal symptoms are not a sensitized response to the opiate but rather an associative phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug Onset Cues, Conditioned Withdrawal, and Drug Relapse: Comment on McDonald and Siegel (2004).

Previous research has shown that under certain conditions environmental cues associated with morphine administration induce drug-opposite conditioned effects that mimic symptoms of opiate withdrawal. R. V. McDonald and S. Siegel (see record 2004-10475-001) extend these observations by demonstrating that acute exposure to a low dose of morphine induces symptoms of opiate withdrawal in rats previously exposed to a high dose of morphine. They hypothesized that early drug onset cues, repeatedly paired with later, larger drug effects, mediate the paradoxical effect of the low drug dose on behavior. They also hypothesized that conditioned withdrawal symptoms induced by the early drug onset cues may mediate the "priming" effect of drugs on relapse and craving. The authors of this comment discuss the degree to which the literature supports this hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioning history and the reinforcing effects of drugs: Comment on Alessi, Roll, Reilly, and Johanson (2002).

Drug reinforcement plays a central role in drug abuse. Drugs of abuse are unconditioned reinforcers whose functional effects are mediated through neuropharmacological mechanisms. The role of conditioning has received attention, but the focus has been on associations between environmental cues and unconditioned drug stimuli. Recent studies by C.-E. Johanson, A. Mattox, and C. R. Schuster (see record 1996-10361-001) and S. M. Alessi, J. M. Roll, M. P. Reilly, and C.-E. Johanson (see record 2002-12827-002) have demonstrated that drugs can also acquire functional control over human behavior through conditioning processes. Given the potent effects that conditioned reinforcers (e.g., money) can have on human behavior, studies by Johanson et al. and Alessi et al. should engender further examination of conditioning processes and drug reinforcement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conditioning-specific reflex modification of the rabbit's nictitating membrane response and heart rate: Behavioral rules, neural substrates, and potential applications to posttraumatic stress disorder.

Interest in classical conditioning is usually focused on anticipatory responses to a stimulus associated with a significant event, and it is assumed that responses to the event itself are reflexive, involuntary, and relatively invariant. However, there is compelling evidence that both the rabbit nictitating membrane response (NMR) and heart rate response (HR), well-known reflexive reactions to aversive events, can change quite dramatically as a function of learning when measured in the absence of the conditioned stimulus. In the case of NMR conditioning, a simple blink is transformed into a larger and more complex response. For HR conditioning, reflexive heart rate acceleration can actually change to heart rate deceleration. In both cases, the reflex comes to resemble the conditioned response and follows some of the same behavioral laws. This change in response to the aversive event itself or weaker forms of that event is called conditioning-specific reflex modification (CRM). CRM may force us to reevaluate the behavioral and neural consequences of classical conditioning and may have important consequences for the treatment of conditions such as posttraumatic stress disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extensive apoptosis of bone marrow cells as evaluated by the in situ end-labelling (ISEL) technique may be the basis for ineffective haematopoiesis in patients with myelodysplastic syndromes

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14-15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorder covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed.     

The other learning process in substance abuse: Comment on Alessi, Roll, Reilly, and Johanson (2002).

The results presented in the article by S. M. Alessi, J. M. Roll, M. P. Reilly, and C.-E. Johanson (see record 2002-12827-002) suggest that the reinforcing impact of diazepam can change as a function of the participant's experience with the drug. The data fit nicely with a long tradition in learning theory that has shown the effects of reinforcers can depend crucially on what the organism has been able to learn about them. Often, that learning reflects an associative process like the one involved in Pavlovian conditioning. The hypothesis that preference for diazepam increased in the Alessi et al. study because the drug was associated with money would benefit from additional experiments that include control conditions isolating the role of the Pavlovian drug-money contingency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning in rats with caudate-putamen lesions: Unimpaired classical conditioning and beneficial effects of redundant stimulus cues on instrumental and spatial learning deficits.

The effects of caudate-putamen lesions in the rat on conditioning were investigated in 3 experiments. In Exp I, rats with lesions were impaired on a spatial task that required learning to make the correct position response, but no deficit was obtained when the alternatives were differentiated by salient visual cues. Performance remained good even when the visual cues were removed. A classical conditioned suppression paradigm was used in Exp II, and caudate-putamen lesions were found not to impair acquisition of suppression or overshadowing. In Exp III poor instrumental learning in subjects with lesions as retarded acquisition of lever-press responding and depressed variable interval response rates were found. When a light stimulus was present together with reinforced responses, response rates were depressed in the control group (which suggested an overshadowing phenomenon) but were potentiated in the group with lesions. Results show that caudate-putamen lesions did not produce a general deficit in association formation. There was disruption of learning about responses but not stimuli and, moreover, it was found that redundant stimulus cues aided response learning. It appears that for normal subjects, the salience or associability of the response cues may largely-determine the influence of stimuli presented during instrumental conditioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors

OBJECTIVES: To explore the circumstances and factors that explain variations in response to a cardiac event and to identify potentially modifiable factors. DESIGN: Qualitative analysis of semistructured, face to face interviews with patients admitted to two district hospitals for a cardiac event and with other people present at the time of the event. Patients were divided into three groups according to the length of delay between onset of symptoms and calling for medical help. SUBJECTS: 43 patients and 21 other people present at the time of the cardiac event. Patients were divided into three groups according to the length of time between onset of symptoms and seeking medical help: non-delayers (< 4 h; n = 21), delayers (4-12 h; n = 12), and extended delayers (> 12 h; n = 10). MAIN OUTCOME MEASURES: Decision making process, strategies for dealing with symptoms, and perception of risk and of heart attacks before the event according to delay in seeking help. RESULTS: The illness and help seeking behaviour of informants had several components, including warning, interpretation, preliminary action, re-evaluation, and final action stages. The length of each stage was variable and depended on the extent to which informants mobilised and integrated resources into a strategy to bring their symptoms under control. There were obvious differences in informants' knowledge of the symptoms that they associated with a heart attack before the event. Non-delayers described a wider range of symptoms before their heart attack and twice as many (13) considered themselves to be potentially at risk of a heart attack compared with the other two groups. For most informants the heart attack differed considerably from their concept of a heart attack. CONCLUSION: The most critical factor influencing the time between onset of symptoms and calling for professional medical help is that patients and others recognise their symptoms as cardiac in origin. This study suggests that various points of intervention in the decision making process could assist symptom recognition and therefore faster access to effective treatment.     

Form preferences in successive discrimination learning of young chicks.

In 4 experiments the effects of form and orientation pecking preferences of a total of 100 1- and 3-day old Vantress X Arbor Acre chicks on successive discrimination learning were determined using heat reinforcement. Results indicate that (a) the young chick has both circle and vertical orientation pecking preferences that are present during at least the 1st 3 days after hatching; (b) when either of these preferred cues is the nonreinforced cue, the young chick has difficulty in learning not to respond to it but learns quickly not to respond to an unpreferred cue; and (c) these pecking preferences can be modified by heat reinforcement, and the effects of this conditioning is evident in subsequent extinction and retention tests. It is concluded that form and orientation preferences, like brightness and color preferences, are important developmental constraints on conditioning of the young chick. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morton Prince on anxiety disorders: Intellectual antecedents of the cognitive approach to panic?

Comments on a reprint of a 1912 article by M. Prince (see record 1993-13839-001) describing the case of a 41-yr-old unmarried woman with a multitude of phobia-like symptoms and panic attacks. Prince argued for his early version of a cognitive theory of panic on the basis of observations of the sequence of events that led to the onset of the disorder. This analysis anticipated contemporary notions that the core fear in some phobias is about having a panic attack rather than being a fear of the subject of the phobia itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic onset and major events in the lives of agoraphobics: A test of contiguity.

Major life events were reported in greater numbers and by a higher percentage of 50 index agoraphobics during a time period around panic onset than during either a within-subjects or a between-subjects control period. These differences were found for analyses of life events in general, events that preceded panic, and foreseeable events that occurred shortly after panic onset. Though many events involved separation or interpersonal conflict, other types of events were frequently reported. Results provide more convincing evidence than prior studies of a contiguous relationship between life events and onset of panic attacks associated with agoraphobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ingestion of a novel flavor before exposure to pups injected with lithium chloride produces a taste aversion in mother rats (Rattus norvegicus).

A series of experiments investigated the ability of Sprague-Dawley mother rats to learn aversions to novel flavors ingested prior to the illness of their pups. In Exp I, 24 mothers learned to avoid a novel flavored solution ingested prior to the illness of their nursing litters. Exp II was designed to investigate the extent to which any adult rat is capable of such learning: 16 nonlactating multiparous females learned aversions to novel flavors ingested prior to exposure to pups injected with LiCl, whereas 16 nonlactating nulliparous females and 16 males did not learn these aversions. Several possible reasons for differences in this learning ability are discussed. In Exps III and IV, the nature of the UCS for these aversions was investigated. Visual, auditory, and taste cues associated with the lithium-injected pups did not mediate the aversions. Evidence suggests that olfactory characteristics of the lithium-injected pups mediated the flavor aversions in the present experiments. These olfactory cues did not appear to be general stress signals but instead were likely specific cues for gastrointestinal discomfort. Results are discussed in terms of classical conditioning and also of their adaptive significance for both mother and offspring. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of Listeria in raw and pasteurized milk

We report the case of a 16-year-old adolescent with the onset of a panic disorder with agoraphobia after a first panic attack during marijuana intoxication. There was a good response to standard cognitive behavioural therapy for panic disorder.     

Reactivity of alcoholics and nonalcoholics to drinking cues.

An interest in reducing relapse among alcoholics has led to a consideration of stimulus control factors in drinking. Research suggests that through classical conditioning alcoholics may develop reactions to cues previously associated with drinking and that these reactions might be an important determinant of relapse. Although this model indicates the potential for cue exposure treatment methods to alter conditioned reactions, data on reactivity to alcohol cues by alcoholics and nonalcoholics are scarce. Two studies are presented that address this issue and provide evidence for the validity of salivation as a measure of cue reactivity. Alcoholics and nonalcoholics were presented with the sight and smell of their preferred brand of alcohol and a control beverage. Self-report, behavioral, and psychophysiological data were collected. Alcoholics salivated more than nonalcoholics to alcohol cues and more to alcohol than to the control beverage. Alcoholics salivated differentially to cues, whereas nonalcoholics did not. Patterns of reactivity were consistent with a conditioning model. Both groups reported greater urges to drink alcohol in the presence of alcohol, but neither group reported more thoughts about alcohol in the presence of alcohol as compared with the control beverage. Implications of salivary reactivity for theory and treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic disorder: effective treatment options

Panic disorder is a distressing and debilitating condition with a familial tendency; it may be associated with situational (agoraphobic) avoidance. The diagnosis of panic disorder requires recurrent, unexpected panic attacks and at least one of the following characteristics: persistent concern about having an additional attack (anticipatory anxiety); worry about the implications of an attack or its consequences (e.g., a catastrophic medical or mental consequence) and making a significant change in behavior as a consequence of the attacks. A variety of pharmacologic interventions is available, as are non-pharmacologic cognitive or cognitive-behavioral therapies that have demonstrated safety and efficacy in the treatment of panic disorder. Early detection and thoughtful selection of appropriate first-line interventions can help these patients, who often have been impaired for years, regain their confidence and ability to function in society.     

Automatic affective responses to smoking cues.

The authors examined automatic emotional reactions to smoking cues among 35 smokers and 25 nonsmokers (32 women and 28 men), using a novel implicit measure, the Affect Misattribution Procedure. Associative-learning theories of addiction suggest that smokers develop positive responses to cues linked to the rewarding effects of nicotine. Prior research, however, has yielded mixed evidence for whether smokers have favorable or unfavorable automatic responses to smoking cues. These findings may depend on the methods used to measure implicit responses. Using the Affect Misattribution Procedure, the authors found that nonsmokers responded to smoking cues with clear negative affect, whereas smokers' responses depended on individual differences in current smoking withdrawal. Smokers having withdrawal symptoms and those most motivated to smoke showed favorable emotional responses to smoking cues, but those with no withdrawal or low motivation to smoke showed negative responses. These results help integrate previous studies finding that smokers have negative automatic responses to cigarettes with those studies finding that smokers' responses were relatively positive. The results are important for theories that emphasize the role of cue conditioning in maintaining addiction because these theories assume, consistent with the current findings, that smoking cues can take on positive reward value. (PsycINFO Database Record (c) 2010 APA, all rights reserved)