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More PsychNotes: Anxiety

Perception of Family Criticism Impedes Recovery from Panic Disorder
by Monica A. Frank, PhD

Clinical treatment often varies from research protocols. When participants are selected for research the process usually involves meeting criteria such as no co-existing conditions. As a therapist I've frequently felt frustrated that my clients did not recover as quickly as the research showed with cognitive-behavioral therapy (CBT). However, I also recognized that most of the time the clients who sought me out as a CBT specialist with anxiety disorders didn't meet the criteria for a simple condition but presented with much more complex situations.

In particular, many of them experienced childhood trauma as well as current criticism or abuse by their families of origin. Frequently, such a history created a self-fulfilling prophecy focused on me or on those current family members who were trying to be supportive. In other words, their past history taught them to expect criticism which meant they were more likely to perceive criticism even when it was not present. This perception created another hurdle that therapy had to overcome.

Recent research by Dr. Dianne Chambless and colleagues (2017) confirms my experience. The research showed that when perception of criticism was high the CBT treatment outcome for Panic Disorder was worse. They concluded that family members should be included in the treatment process when perception of criticism is high.

Unfortunately, I've found that when perception of criticism is accurate family members are less likely to agree to involvement in treatment. Sometimes clients, even as adults, continue to experience mistreatment at the hands of parents or siblings. In such cases, treatment has to involve changing their self-concept so as to not accept the criticism and methods to protect themselves from the ongoing abuse.