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Adult Attachment Disturbances in Panic Disorder : a Comparison with Social Phobia and Specific Phobia Jesus A

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Adult Attachment Disturbances in Panic Disorder : a Comparison with Social Phobia and Specific Phobia Jesus A Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2002 Adult Attachment Disturbances in Panic Disorder : a Comparison with Social Phobia and Specific Phobia Jesus A. Salas Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Salas, Jesus A., "Adult Attachment Disturbances in Panic Disorder : a Comparison with Social Phobia and Specific hoP bia " (2002). PCOM Psychology Dissertations. Paper 121. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Phlladelphia College of Osteopathic Medicine Department ofPsychology ADULT ATTACHMENT DISTURBANCES IN PANIC DISORDER: A COMPARISON WITH SOCIAL PHOBIA AND SPECIFIC PHOBIA By Jesus A. Salas Copyright, 2002 Jesus A. Salas Submitted in Partial Fulfillment ofthe Requirements for the Degree of Doctor of Psychology November 2002 PHILADELPHIA COLLEGE OF OSTEOPATHIC lVlEDICINE DEPARTMENT OF PSYCHOLOGY Dissertation Approval This is to certify that the thesis presented to us by Jesus A. Salas on i' the 1Oth day of september , 2002 , in partial fulfillment ofthe requirements for the degree ofDoctor ofPsychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members' Signatures: Robert A. DiTomasso, Ph.D., ABPP, Chairperson Elizabeth A. Gosch, Ph.D. Stephanie H. Felgoise, Ph.D. Robert Cuzzolino Ed.D. Arthur Freeman, Ed.D., ABPP, Chair, Department of Psychology IV ACKNOWLEDGMENTS I am very grateful to Robert A. DiTomasso Ph.D., ,ABPP for his assistance as my advisor. I offer my sincere thanks for the hours he spent reviewing the project and the data, and for his helpful comments on draft copies ofthe manuscript. Many thanks to my dissertation committee: Dr. DiTomasso; Stephanie Felgoise Ph.D.; Elizabeth Gosch Ph.D.; and Robert Cuzzolino Ed.D. This work would not have been possible without the help ofcolleagues, who provided crucial support for this study at the outpatient clinics where the data was collected; Bruce Zahn Ed.D., ABPP; Barbara Golden, Psy.D.; and very specially, Frank M. Dattilio Ph.D., ABPP. To them, my gratitude for their invaluable cooperation. Special thanks to my clinical supervisors, Arthur Freeman Ed.D., ABPP.; Robert A. DiTomasso, Ph.D., ABPP; and Frank M. Dattilio Ph.D., ABPP, who acted as experts in the validation ofthe diagnoses made for the anxiety disordered participants. I also wish to acknowledge Mrs. Cathy VanLangen, who worked as a research assistant scoring the questionnaires. Many thanks to the researchers who kindly allowed me to use their assessment instruments in the present study, including Dianne L. Chambless, K. Elaine Williams, Thomas D'Zurilla, Lawrence Burns, Kelly L. Brennan, Catherine L. Clark, Philip R. Shaver, Peter Salovey, Chloe Martin, Brian 1. Cox, G. Ron Norton, Lucas van Gerwen, and Mark Sherer. I am deeply grateful to all participants in the study, who have afforded me the privilege of learning important issues about the relationship between panic disorder and attachment related variables by sharing their intimate thoughts and feelings. v Finally, I would particularly wish to express great thanks to my wife, Carolina, and my daughters, Ana Carolina and Monica Isabel for their unconditional support, encouragement and patience with the time taken away from them to bring this dissertation to fruition. Also, my gratitude to my father, Jesus, and mother, Leda, who have always been supporters ofmy work VI ABSTRACT The present study used attachment theory as a framework to explore the role of attachment related constructs as potential risk factors for panic disorder. A group ofpanic disordered participants were compared with a group of social phobics, a group of specific phobics (fearful flyers), and a group of nonclinical controls. The groups were compared on attachment dimensions, fear of emotions, fear of bodily changes, death attitudes, information processing style and self-efficacy. Results indicated that the panic disorder group and control group differed in a number ofways. Panic disordered participants evidenced higher levels of attachment anxiety and attachment avoidance than control participants. Also, the panic group reported lower social and generalized self-efficacy, and greater fear of losing emotional control than the c~:mtrol group. In addition, the panic group reported higher fear of death and of bodily changes than the control group. Finally, panic disordered participants indicated using less rational strategies when coping under stress. Social phobics presented no significantly different levels of attachment anxiety and avoidance than panic disordered participants. Also, no significant differences were found between the panic disorder and the social phobia groups regarding their perceived levels of social and generalized self-efficacy. The two groups significantly differed on fear of death and of bodily changes: the panic group evidenced higher levels than the social phobia group. The specific phobia group was most similar to the control group, except for their higher fear ofdeath and of bodily changes. In addition, the associations between the different constructs were also studied. Results are broadly consistent with attachment theory in that attachment disturbances are not exclusive to panic disorder. Findings suggest that distinct combined influenced of the variables are associated with the different disorders. The implications and limitations of the findings are discussed in relation to current conceptual, research and clinical issues in panic disorder theory and attachment theory. Vll TABLE OF CONTENTS LIST OF TABLES ix Introduction..................................................................................................................... 1 Risk Factors for Panic for Disorder ....................................................................... 3 Specific Risk Factors................................................................................ 4 Nonspecific Risk Factors........................................................................... , 7 Attachment Theory and Panic Disorder ................................................................ 11 Attachment Theory ................................................................................... 14 Attachment Patterns and Attachment Dimensions ..................................... 17 Conceptual Issues in Attachment Assessment. ............................................ 20, Attachment, Fear ofDeath and Fear ofBodily Changes ........................... 23 Attachment, Affect Regulation and Self-Efficacy..................................... \. 25 Attachment, Coping Styles and Generalized Self-Efficacy ......................... 27 Attachment Disturbances and Anxiety Disorders ....................................... 32 Purpose ofthe Study.......................................................................................... 34 Research questions ............................................................................................... 36 Hypotheses......................................................................................................... 37 Method........................................................................................................................... 40 Participants........................................................................................................ .. 40 Design................................................................................................................. 43 Instruments......................................................................................................... 43 Screening Related Instruments ................................................................. 43 Hypotheses Related Instruments .............................................................. 51 Procedure........................................................................................................... 59 Results........................................................................................................................... 60 Partlcl..pants 'Characterlstics.. ................................................................................ 60 Group Comparison on the Dependent Variables .................................................. 81 Prediction ofDiagnostic Status from Combined Attributes .................................. 99 Intercorrelations Between Dependent Variables .................................................. 103 Discussion....................................................................................................................... 112 Limitations ofthe Study..................................................................................... .. 122 Implications and Future Research ........................................................................ 124 Summary and Final Comments ............................................................................ 126 viii References.................................................................................................................... 128 Appendixes............ ......
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