The current project consists of two studies investigating the phenomenological characteristics, centrality levels, and traumatic symptoms of panic attack memories, while testing the effectiveness of the Imagery Rescripting (ImRs) intervention in the treatment of panic disorder. The first study investigates whether panic attack memories share similar phenomenological features, centrality levels, and physiological responses with classic traumatic memories and general negative life event memories in a sample of 152 participants. The second study is a randomized controlled trial (RCT) involving 32 participants diagnosed with panic disorder based on DSM-5 criteria. Participants are randomly assigned to either an Imagery Rescripting (ImRs) intervention group or a control group. The primary objective is to evaluate the clinical effectiveness of a 6-session ImRs protocol in reducing panic disorder symptoms and physiological arousal associated with panic attack memories.
This research project investigates the traumatic properties of panic attack memories and evaluates the therapeutic efficacy of an Imagery Rescripting (ImRs) intervention for individuals diagnosed with Panic Disorder through two interconnected studies. Study 1 utilizes a comparative cross-sectional design with 152 participants to examine the phenomenological characteristics, event centrality, traumatic stress symptom severity, and physiological reactivity of panic attack memories in comparison to classic traumatic memories and negative life event memories. During a structured memory recall and writing task, real-time physiological arousal is recorded via skin conductance and heart rate measurements, followed by the administration of self-report measures including the Autobiographical Memory Characteristics Questionnaire, the Centrality of Event Scale, and the Impact of Event Scale. Building upon these baseline phenomenological findings, Study 2 employs a randomized controlled trial (RCT) design to evaluate the clinical efficacy of Imagery Rescripting in a clinical sample of 32 participants meeting DSM-5 criteria for Panic Disorder. Participants are stratified by gender and randomly assigned to either an Intervention Group (n = 16), receiving a 6-session structured ImRs protocol incorporating psychoeducation, breathing exercises, and healthy adult mode rescripting, or a Control Group (n = 16) serving as a comparison condition. Treatment outcomes across both psychological and physiological domains-assessed via the Autobiographical Memory Characteristics Questionnaire, Centrality of Event Scale, Impact of Event Scale, DSM-5 Panic Disorder Scale, General Self-Efficacy Scale, Panic Self-Efficacy Single-Item Question, and skin conductance/heart rate tracking-are evaluated across three distinct time points: Baseline (Session 1), Post-Intervention (Session 6, following 6 weekly sessions), and a 1-Month Follow-Up (Session 7).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
The protocol consists of a 6-session Imagery Rescripting (ImRs) intervention followed by a 1-month follow-up assessment. Session 1 involves introduction, study orientation and baseline assessments (physiological recordings during memory writing and psychological scales). Session 2 covers psychoeducation on panic disorder, breathing exercises, and the Safe Place exercise. Session 3 introduces Healthy Adult Imagery to foster adaptive coping mechanisms. Sessions 4 and 5 consist of core ImRs applications targeting traumatic panic attack memories and related early memories, utilizing therapist- or client-led adult interventions to fulfill unmet emotional needs. Session 6 evaluates the intervention outcomes, future concerns and collects post-intervention measurements. Session 7 serves as a 1-month follow-up evaluation with no active intervention.
Bağcılar Eğitim ve Araştırma Hastanesi
Istanbul, Bağcılar, Turkey (Türkiye)
Change from Baseline in DSM-5 Panic Disorder Symptom Severity at Post-Intervention and 1-Month Follow-Up
The DSM-5 Panic Disorder Scale (American Psychiatric Association, 2013; Turkish validation by Balıkçı et al., 2017) was used to measure the severity of panic disorder symptoms over the past 7 days. The scale is a 10-item, single-factor measure. The internal consistency coefficient (Cronbach's alpha) for the Turkish version was reported as .96. Higher scores reflect greater severity of panic disorder symptoms.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Physiological Reactivity (Heart Rate) During Panic Attack Memory Recall at Post-Intervention and 1-Month Follow-Up
Assessed by recording Heart Rate (beats per minute, BpM) an indicator of autonomic nervous system arousal during the panic attack memory writing/recall task. Data are recorded using NeuLog Heart Rate \& Pulse Logger Sensor (NUL-208) attached to the ring finger of the non-dominant hand. Higher values of heart rate reflect greater autonomic arousal and physiological reactivity during traumatic memory recall.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Physiological Reactivity (Skin Conductance Level) During Panic Attack Memory Recall at Post-Intervention and 1-Month Follow-Up
Assessed by recording Skin Conductance (microSiemens) as indicators of autonomic nervous system arousal during the panic attack memory writing/recall task. Data are recorded using NeuLog NeuLog GSR Logger Sensor (NUL-217) attached to the index finger of the non-dominant hand. Higher values of the skin conductance reflect greater autonomic arousal and physiological reactivity during traumatic memory recall.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Phenomenological Characteristics of Autobiographical Memory at Post-Intervention and 1-Month Follow-Up
To assess the phenomenological properties of autobiographical memories, the 63-item Autobiographical Memory Characteristics Questionnaire (Boyacıoğlu \& Akfırat, 2015) was utilized. The questionnaire comprises 8 subscales: narrative coherence, reliving, vividness, perceptual detail, field perspective, observer perspective, emotional valence, and emotional intensity. Together, these subscales account for 72% of the total scale variance. In the original validation study, the internal consistency coefficients (Cronbach's alpha) for the subscales ranged from .66 to .97.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Event Centrality Score at Post-Intervention and 1-Month Follow-Up
Assessed using the 7-item short form of the Centrality of Event Scale (CES) (Berntsen \& Rubin, 2006; Turkish adaptation by Boyacıoğlu \& Aktaş, 2018) to measure the extent to which the traumatic panic memory is integrated into the participant's identity and life story (Cronbach alpha = .89 for negative memories). Items are rated on a 5-point Likert scale, with total scores ranging from 7 to 35. Higher scores reflect greater event centrality.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Traumatic Stress Symptom Severity at Post-Intervention and 1-Month Follow-Up
Assessed using the 22-item Turkish version of the Impact of Event Scale-Revised (IES-R) (Weiss \& Marmar, 1997; Turkish adaptation by Çorapçıoğlu et al., 2006) to evaluate traumatic stress symptoms associated with panic memories over the past week. The scale consists of 3 subscales: Intrusion, Avoidance, and Hyperarousal. Internal consistency values range from .88 to .94. Total scores range from 0 to 88, with higher scores indicating greater severity of post-traumatic stress symptoms.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in General Self-Efficacy Score at Post-Intervention and 1-Month Follow-Up
Assessed using the 17-item Turkish version of the General Self-Efficacy Scale (Sherer et al., 1982; Turkish adaptation by Yıldırım \& Özgür İlhan, 2010) to evaluate individuals' belief in their ability to cope with challenging life events. The scale demonstrates a three-factor structure accounting for 41.47% of the total variance, with an internal consistency coefficient of Cronbach alpha = .80. Higher scores indicate higher levels of perceived general self-efficacy.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
Change from Baseline in Perceived Panic Self-Efficacy Score at Post-Intervention and 1-Month Follow-Up
Assessed using a single-item question rated on a 6-point Likert scale (ranging from 0 = "Not confident at all" to 5 = "Completely confident"), adapted based on the work by Helbig-Lang (2012). The item asks: "How confident do you feel in your ability to cope with a potential panic attack in the future?" Higher scores reflect greater perceived self-efficacy in managing future panic attacks.
Time frame: Baseline, 6 weeks (post-treatment, following six weekly 50-minute sessions), and 1-month post-treatment follow-up
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