© 2000 WILEY-LISS, INC. DEPRESSION AND ANXIETY 11:1–9 (2000) DA 00452 Research Articles RELATIONSHIP OF COGNITIONS TO FEAR OF SOMATIC SYMPTOMS: A TEST OF THE COGNITIVE THEORY OF PANIC Dianne L. Chambless, Ph.D., 1,2 * Aaron T. Beck, M.D., 3 Edward J. Gracely, Ph.D., 4 and Jessica R. Grisham, B.A. 5 The relationship between fear of physical anxiety symptoms and cognitive misin- terpretation of those symptoms, as measured by responses to the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire, respectively, was examined for two samples of outpatients with panic disorder. Factor analytic and correlational analyses demonstrated that the patients’ self-rated fear of specific physical and psychological symptoms was related to the frequency of specific logi- cally related catastrophic thoughts (e.g., fears of heart palpitations or chest pres- sure with thoughts of a heart attack). This specific relationship between the somatic sensations and the catastrophic thoughts experienced by agoraphobic in- dividuals provides further support for the cognitive theory of panic disorder. When the responses to the two questionnaires were factor-analyzed together, four factors were identified: symptoms and thoughts relevant to cardiovascular, neuro- logical, gastrointestinal, and behavioral control systems, respectively. These find- ings suggest that the nature of panic-related fears varies across patients, and that the use of specific treatment interventions designed to modify the specific varia- tions in their expression may be advisable. Depression and Anxiety 11:1–9, 2000. © 2000 Wiley-Liss, Inc. Key words: fear of fear; anxiety sensitivity; panic disorder; agoraphobia INTRODUCTION Two of the defining criteria for panic disorder with agoraphobia are persistent concern following a panic attack of having an additional attack and worry about the implications of the attack [DSM-IV; American Psy- chiatric Association, 1994]. Goldstein and Chambless [1978] labeled this fear of experiencing anxiety or panic attacks as “the fear of fear.” According to their model, the fear of fear consists of two elements: a) a fear of bodily sensations associated with panic and b) mal- adaptive thoughts about the consequences of becoming anxious [Chambless and Goldstein, 1981]. In later writings, Chambless and Goldstein [e.g., 1988] have noted that the fear of fear label is too limited a descrip- tor because panic patients may also misinterpret in- nocuous somatic cues, which do not arise from anxiety, as a sign of a pathological process. For example, an in- dividual with panic disorder may catastrophically mis- interpret the physical sensations associated with being in a hot, stuffy room as an indication that she is about to faint. This broadening makes Chambless and Gold- stein’s model more consistent with the cognitive mod- 1 Department of Psychology, University of North Carolina, Chapel Hill, North Carolina 2 Agoraphobia and Anxiety Treatment Center, Bala Cynwyd, Pennsylvania 3 Department of Psychiatry, University of Pennsylvania 4 MCP Hahnemann School of Medicine, Phildadelphia, Pennsylvania 5 Department of Psychiatry, University of Pennsylvania, Phildadelphia, Pennsylvania *Correspondence to: Dianne Chambless, Ph.D., Department of Psychology, UNC-CH, Chapel Hill, NC 27599-3270. E-mail: chambles@email.unc.edu Received for publication 16 July 1999; Accepted 23 November 1999 els of panic disorder proposed by Beck [e.g., Beck, 1988; Beck and Emery, 1985] and Clark [1986]. According to the cognitive model of panic disorder, physical and psychological experiences associated with panic should lead to the development of panic disor- der only in those individuals who misinterpret these symptoms in a catastrophic fashion. Thus, for ex-