Anxiety induced by false heart rate feedback in patients with panic disorder

The psychophysiological model of panic attacks postulates a positive feedback loop between anxiety symptoms and the patient's anxious reaction to these symptoms. We tested the underlying assumption that the appraisal of bodily change can induce anxiety in this patient group. Twenty-five patients with panic disorder or agoraphobia with panic attacks (DSM-III) and 25 matched normal controls were given false feedback of an abrupt heart rate increase. Self-ratings of anxiety and excitement, heart rate, skin conductance level, and systolic and diastolic blood pressure were taken. On all measures, patients who believed that the feedback was accurate (N = 19) responded differently to the false feedback than controls (N = 16). Patients showed increases in anxiety and physiological arousal. The preceding true heart rate feedback did not induce changes in anxiety. Patients and controls did not differ in their accuracy of heart rate perception. The results underline the role of appraisal processes and the fear of anxiety symptoms in panic disorder.