Panic disorder (PD) is associated with significant social and health consequences. The present study examined the impact of treatment on PD patients' quality of life. Patients (N = 156) meeting DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]; American Psychiatric Association, 1987) criteria for PD with agoraphobia were randomly assigned to group cognitive-behavioral treatment (CBT) or a delayed-treatment control. An assessment battery measuring the major clinical features of PD as well as quality of life was administered at baseline (Week 0), post-treatment (Week 9) and 6-month follow-up (Week 35). Consistent with previous studies, PD patients displayed significant impairment in quality of life at intake. Compared with delayed-treatment control participants, CBT-treated participants showed significant reductions in impairment that were maintained at follow-up. Consistent with prediction, anxiety and phobic avoidance were significantly associated with quality of life, whereas frequency of panic attacks was not.

D. F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO 2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO 2 levels (e.g., hyper ventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO 2 levels (e.g., inhalation of 35% CO 2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO 2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO 2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO 2 challenge. During the past decade, there has been a proliferation of research on the etiology of panic disorder (PD) from both biological and psychological perspectives (e.g., Ballenger, 1990; McNally, 1990). Klein's (1993) intriguing suffocation alarm theory of panic proposes that PD patients possess hypersensitive suffocation monitors that produce false suffocation alarms. The proposed suffocation detector monitors arterial partial pressure of carbon dioxide (PCO 2) levels and triggers a suffocation alarm when rising PCO 2 levels signal that asphyxiation is imminent. Klein (1993) integrated a variety of data to draw a linkage between suffocation and panic. Klein argued that dyspnea is common in patients with PD but rare in fear reactions among nonpatients. Nonpatients experiencing fear typically recall cardiovascular (e.g., heart palpitations) rather than respiratory (e.g., dyspnea) symptoms (McMillian & Rachman, 1988). On the other hand, respiratory distress is commonly reported by

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