Cardiac awareness before and after cognitive-behavioral treatment for panic disorder

Recent cognitive-behavioral theories of panic disorder (PD) suggest that PD patients experience heightened anxiety over, and hypervigilance for, specific physical sensations. Researchers have recently begun to examine whether PD patients evidence heightened interoceptive awareness, relative to normals, with inconclusive results. The present study examined changes in cardiac awareness in 15 PD patients following cognitive-behavioral treatment. Before and after treatment, cardiac awareness was evaluated by having patients count heart beats during specified intervals while actual heart rate was monitored. Despite significant reductions in panic attacks and related symptomatology, cardiac awareness did not change on average, although some individual subjects showed dramatic changes in either direction. As was the case with the entire sample, a subgroup of patients who showed the greatest reduction in anxiety over panic sensations did not evidence significant changes in heart beat awareness. The implications of these results are discussed.