title: Applying the Quadruple Process model to evaluate change in implicit attitudinal responses during therapy for panic disorder.
abstract: OBJECTIVE
  This study explored the automatic and controlled processes that may influence performance on an implicit measure across cognitive-behavioral group therapy for panic disorder.
  
  
  METHODS
  The Quadruple Process model was applied to error scores from an Implicit Association Test evaluating associations between the concepts Me (vs. Not Me) + Calm (vs. Panicked) to evaluate four distinct processes: Association Activation, Detection, Guessing, and Overcoming Bias. Parameter estimates were calculated in the panic group (n = 28) across each treatment session where the IAT was administered, and at matched times when the IAT was completed in the healthy control group (n = 31).
  
  
  RESULTS
  Association Activation for Me + Calm became stronger over treatment for participants in the panic group, demonstrating that it is possible to change automatically activated associations in memory (vs. simply overriding those associations) in a clinical sample via therapy. As well, the Guessing bias toward the calm category increased over treatment for participants in the panic group.
  
  
  CONCLUSIONS
  This research evaluates key tenets about the role of automatic processing in cognitive models of anxiety, and emphasizes the viability of changing the actual activation of automatic associations in the context of treatment, versus only changing a person's ability to use reflective processing to overcome biased automatic processing.
authors.affiliation: Department of Psychology, Miami University, Oxford, OH, USA. Electronic address: clerkiem@miamioh.edu.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Clerkin
authors.affiliation: Department of Psychology, Miami University, Oxford, OH, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Fisher
authors.affiliation: Department of Psychology, University of California, Davis, CA, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Sherman
authors.affiliation: Department of Psychology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Teachman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001244:Association; D001290:Attitude; D016022:Case-Control Studies; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D008960:Models, Psychological; D016584:Panic Disorder / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
keywords: Associations; Cognitive-behavioral group therapy; Implicit; Panic disorder; Quadruple Process model