Priming associations between bodily sensations and catastrophic misinterpretations: Specific for panic disorder? q Dirk Hermans a, * , Klara De Cort b , Daphne Noortman b , Debora Vansteenwegen a , Tom Beckers a, c , Adriaan Spruyt d , Koen Schruers b a Department of Psychology, University of Leuven, Tiensestraat 102, B-3000 Leuven, Belgium b Department of Psychiatry and Neurospyschology, Academic Anxiety Center, Maastricht University, The Netherlands c Amsterdam University, The Netherlands d Flemish Research Foundation (FWO e Vlaanderen), Ghent University, Belgium article info Article history: Received 17 November 2009 Received in revised form 15 May 2010 Accepted 19 May 2010 Keywords: Panic disorder Associative priming Misinterpretation Cognitive models abstract Cognitive models assume that panic disorder is characterised by a tendency to misinterpret benign bodily symptoms (e.g. breathlessness) in a catastrophic fashion (e.g. suffocation). This is a central part of the cognitive model which presents a core focus for treatment. Several studies have supported this hypothesis. These studies have, however, almost always relied on self-report. In addition to susceptibility to biases (e.g. distortions of memory), a limitation of research based on verbal report is its inability to capture the spontaneous/automatic nature that is attributed to these catastrophic interpretations. The present paper reports on two experiments in which a priming procedure was used to test the hypothesis that panic disorder is characterised by spontaneous catastrophic interpretations and whether this effect is ‘specific’ to panic disorder. In line with predictions from the cognitive model, it was observed in the first experiment that the panic group demonstrated facilitated responses to trials consisting of a ‘symptom’ prime and a ‘catastrophic outcome’ target (e.g. breathlessness e suffocate). Similar effects were not observed for an anxious control group and a nonclinical control group, supporting the speci- ficity of this effect. Interestingly, however, significant priming effects were observed for a group of mental health professionals (part of the healthy control group) who had no history of panic disorder. Subse- quently, this unexpected observation was explicitly addressed in a second experiment, which confirmed the findings of Experiment 1. Together, these results suggest that associations between mental repre- sentations of benign bodily symptoms and catastrophic outcomes might develop as part of professional knowledge and experience, and should not necessarily be viewed as pathogenic. Theoretical and clinical implications are discussed. Ó 2010 Elsevier Ltd. All rights reserved. One of the central tenets of cognitive models of panic disorder (e.g. Clark, 1986, 1988) is that persons suffering from panic disorder (PD) are characterised by a relatively enduring tendency to misin- terpret benign bodily sensations as indications of an immediately impending physical or mental catastrophe. Typically, autonomic responses like palpitations, breathlessness or headache are spon- taneously interpreted as signals of an impending heart attack, choking or the presence of a brain tumor. This is assumed to be the basis for a vicious circle in which misinterpretations of bodily sensations increase anxiety, which subsequently amplifies the level of these (anxiety related) sensations, which in turn feeds the catastrophic misinterpretations and the level of anxiety that follows from them. This loop can then terminate in a panic attack. Because maladaptive interpretations are viewed as the central element in the cognitive model of panic disorder, they are one of the main targets for treatment according to the cognitive account of PD (e.g. Craske & Barlow, 2008). Research has supported the view that patients suffering from panic disorder are characterised by an enhanced tendency to misinterpret benign symptoms. For example, in two studies Clark et al. (1997) administered the Body Sensations Interpretation Questionnaire (BSIQ) to patients suffering from panic disorder and controls. The BSIQ measures negative interpretations in four domains, including bodily sensations for which the cognitive theory predicts that these will be more likely misinterpreted by panic disorder patients (e.g. ‘You notice that your heart is beating quickly and pounding’). Each item was followed by the question q Preparation of this paper was in part supported by Grant BOF/GOA2006/001 of Ghent University. * Corresponding author. Tel.: þ32 (0)16 32 59 63; fax: þ32 (0)16 32 60 99. E-mail address: dirk.hermans@psy.kuleuven.be (D. Hermans). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2010.05.015 Behaviour Research and Therapy 48 (2010) 900e908