title: The panic attack-posttraumatic stress disorder model: applicability to orthostatic panic among Cambodian refugees.
abstract: This article examines the ability of the panic attack-posttraumatic stress disorder (PTSD) model to predict how panic attacks are generated and how panic attacks worsen PTSD. The article does so by determining the validity of the panic attack-PTSD model in respect to one type of panic attack among traumatized Cambodian refugees: orthostatic panic (OP) attacks (i.e. panic attacks generated by moving from lying or sitting to standing). Among Cambodian refugees attending a psychiatric clinic, the authors conducted two studies to explore the validity of the panic attack-PTSD model as applied to OP patients (i.e. patients with at least one episode of OP in the previous month). In Study 1, the panic attack-PTSD model accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis-associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious-depressive distress (Symptom Checklist-90-R subscales), and OP severity significantly mediated the effect of anxious-depressive distress on Clinician-Administered PTSD Scale severity. In Study 2, as predicted by the panic attack-PTSD model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a cognitive behavioural therapy study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.
authors.affiliation: Southeast Asian Clinic, Arbour Counseling Services, Lowell, MA 02114, USA. devon_hinton@hms.harvard.edu
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Hofmann
authors.forename: Roger K
authors.initials: RK
authors.lastname: Pitman
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
mesh_terms: D000328:Adult; D001213:Asian / Q000523:psychology*; D002160:Cambodia / Q000208:ethnology; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D004244:Dizziness / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D016584:Panic Disorder / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D015995:Prevalence; D012036:Refugees / Q000523:psychology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D014481:United States