Patterns and Mediators of Emotion Regulatory Disturbance in Panic Disorder

Emotion dysregulation is an oft-cited and potentially valuable explanation for panic disorder and other anxiety disorders. However, theoretical accounts conflict regarding whether panic disorder is associated with deficient or excessive emotion regulation, and these contradictory predictions have not been resolved by extant, primarily self-report-based studies. The present study (1) attempted to clarify the functioning of emotion regulation in panic disorder and (2) examined a putative mechanism for emotion regulatory dysfunction, effortful control. In a sample of 38 individuals with panic disorder and 37 controls, we gauged participants’ ability to voluntarily regulate emotional responding to unpredictable threat of shock using physiological indices of negative emotion (startle eye-blink reflex and corrugator activity). We also assessed performance on 3 behavioral measures of effortful control; the degree to which these measures were disrupted in a threatening context; and whether effortful control abilities were associated with emotion regulatory ability. Individuals with panic disorder with agoraphobia (PD/A) demonstrated an enhanced ability to voluntarily suppress both startle and corrugator responding to threat relative to controls and panic disorder without agoraphobia (PD/NA). Individuals with PD/NA showed poorer attentional control compared to controls and PD/A. All 3 measures of effortful control were positively correlated with startle suppression ability, and path analyses revealed indirect effects of PD/NA on emotion regulatory ability via attentional control. The results implicate excessive suppression of negative emotion in the maintenance of PD/A and add to a growing literature linking non-emotional effortful cognitive abilities to emotion regulation and psychopathology.