The nature and assessment of catastrophic thoughts in panic disorder

This essay describes the current status of our conceptualization and assessment of catastrophic thoughts in panic disorder, an area that is more heterogeneous than may first appear. It is suggested that a heuristic approach would involve assessing both ‘state’ catastrophic cognitions (automatic thoughts) and the underlying ‘trait’ cognitive factors (beliefs). The cognitive symptoms listed in the DSM-IV and the self-report Anxiety Sensitivity Index serve as useful preliminary measures for assessing these respective domains. The trait cognitive domain is seen as multidimensional and congruence is required with internal or external stimuli in producing state catastrophic thoughts and accompanying panic attacks. Pressing challenges and controversies in this field are also highlighted and strategies for potentially resolving these issues are offered. Accordingly, several directions for future investigation are presented throughout the paper. Examples of innovative assessment techniques are briefly described.