Attentional focus and fearful responding in patients with panic disorder during a 35% CO2 challenge

Patients with panic disorder show attentional hypervigilance to internal bodily sensations (i.e., body vigilance), but the role of body vigilance in the genesis of anxiety has not been evaluated. The present study utilized an experimental paradigm to examine the relationship between attentional focus and fearful responding to biological challenge. Patients with panic disorder (n = 45) and matched nonclinical controls (n = 45) were randomly assigned to one of three experimental conditions in which their attentional focus was directed toward internal bodily sensations (Internal Focus) or external cues (External Focus), or was allowed to alter freely (No Focus Control) in the context of a 35% CO2 challenge. Subjective and physiological measures were taken at baseline and during the biological challenge procedure. Consistent with prediction, patients showed greater attention to internal arousal cues prior to the challenge, but patient status did not interact with condition to predict response to the challenge. On the other hand, level of anxiety sensitivity was found to interact with attentional focus in the expected direction. These findings add support for cognitive models of panic disorder.