Behavioural and Cognitive Psychotherapy

Cambridge Journals Online - CUP Full-Text Page
Behavioural and Cognitive Psychotherapy (2010), 38:275-289 Cambridge University Press
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Research Article

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

David Berlea1 c1, Vladan Starcevica2, Denise Milicevica3, Anthony Hannana3 and Karen Mosesa3

a1 Sydney West Area Health Service, Australia
a2 University of Sydney, Australia
a3 Sydney West Area Health Service, Australia
Article author query
berle d [PubMed]  [Google Scholar]
starcevic v [PubMed]  [Google Scholar]
milicevic d [PubMed]  [Google Scholar]
hannan a [PubMed]  [Google Scholar]
moses k [PubMed]  [Google Scholar]


Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

(Online publication March 26 2010)

Keywords:Panic disorder; agoraphobia; cognitions; misinterpretation; panic symptoms


c1 Reprint requests to David Berle, Nepean Anxiety Disorders Clinic, Sydney West Area Health Service, PO Box 63, Penrith NSW 2751, Australia. E-mail: