A Cognitive Model of Panic Attacks: David M. Clark
Ever since Freud's (l89411940a) classic essay on anxiety neurosis, it has been accepted that panic attacks are a frequent accompaniment of certain types of anxiety state. However, it is only relatively recently that panic attacks have become a focus of research interest in their own right. This shift in emphasis is largely a result of the work of Donald Klein. In a series of studies which started in the 1960s, Klein and his colleagues (Klein, 1964; Zitrin, Klein, & Woerner, 1980; Zitrin, Klein, Woerner & Ross, 1983; Zitrin, Woerner & Klein, 1981) obtained results which they interpreted as indicating that anxiety disorders which are characterized by panic attacks respond to imipramine while anxiety disorders which are not characterized by panic attacks fail to respond to imipramine. This apparent "pharmacological dissociation" led Klein (1981) to propose that panic anxiety is qualitatively different from nonpanic anxiety. This view was endorsed by the writers of the diagnostic and statistical manual, 3rd Revision (DSM-III, American Psychiatric Association, 1980) when they created the two diagnostic categories of panic disorder and agoraphobia with panic, and used the presence or absence of panic attacks as a major criterion for distinguishing between different types of anxiety disorder.