Fear of fear and the anxiety disorders

The responses of 271 outpatients with diagnoses of agoraphobia with panic attacks, panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, or depression (major depressive disorder or dysthymic disorder) to the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ) were examined. Agoraphobics scored significantly higher than all other groups on fear of body sensations associated with anxiety. In addition, agoraphobics, together with clients with panic disorder, had significantly higher scores on thoughts that physical illness would be caused by their anxiety. All clinical groups scored significantly higher than normal controls on thoughts that their anxiety would lead to social embarrassment or loss of control; there were no significant differences among clinical subjects on this measure, although agoraphobics' scores were higher than those of all other groups. In addition, analyses of data from 364 agoraphobics showed that the ACQ and BSQ predicted an important feature of agoraphobia—namely, self-reported avoidance behavior, even once the common variance of fear of fear with trait anxiety was partialed out. In summary, it appears that fear of fear is an important distinguishing characteristic among clients with anxiety disorders, and one that cannot be reduced to global psychological distress or trait anxiety.The authors wish to thank Aaron T. Beck, Gary Brown, and Gail Steketee, whose cooperation in data collection made this study possible; Nazareth Pantaloni, for his assistance in data analysis; and Carol Glass, for her helpful comments on an earlier draft of this paper.