Distressing Memories and Flashforwards in Panic Disorder

Background: Mental images of threat are common in panic disorder and may contribute to its onset and maintenance, making them potential relevant targets for treatment. They can be related to distressing memories or catastrophic future simulations (i.e., “ flashforwards ”). This study explored the similarities and differences between these two types of threat representations in terms of the credibility of encapsulated beliefs, emotional intensity, distress, controllability, aversiveness, sensory complexity, and episodic and semantic details. Methods: Forty-six patients diagnosed with panic disorder were asked about distressing memories and flashforwards related to their disorder using structured audio-recorded interviews and questionnaires before the treatment. The narratives were coded for episodic and semantic details. Results Results showed that both distressing memories and flashforwards were common and highly similar in image characteristics, but overall memories were self-rated as being more sensory-complex. Flashforwards were rated as more aversive, but threat representations did not differ in terms of credibility of encapsulated beliefs, emotional intensity, distress, and controllability. Compared to flashforwards, memories contained more episodic details, but threat representations did not differ in the number of semantic details or in relative scores. Conclusions Distressing memories and flashforwards in panic disorder are highly similar but differ in complexity and perceived aversiveness. The theoretical and clinical implications of distinguishing between these two types of threat representation are discussed.