Arrange the following events in the order of their occurrence in panic circle? I. Apprehension or worry II. Body sensations III. Perceived threat IV. Interpretation of sensations as catastrophic V. Trigger stimulus

Appeared in: GMCH Chandigarh - 2019

Explanation

The correct sequence follows Clark's cognitive model of panic, which is a cornerstone of Cognitive Behavioral Therapy (CBT) for panic disorder.
The cycle begins with a trigger stimulus (V), which is then interpreted as a threat (III).
This perception of threat leads to apprehension (I), which activates the body's physiological fight-or-flight response, causing various bodily sensations (II).
The crucial step that fuels the panic attack is the catastrophic misinterpretation (IV) of these harmless bodily sensations, which creates a vicious feedback loop.

Why Other Options Were Wrong

Option A: This sequence is illogical as it starts with apprehension (I) and perceived threat (III) before the trigger stimulus (V) is introduced. The trigger is the initiating event.
Option B: This sequence incorrectly places the experience of bodily sensations (II) immediately after the trigger, before the psychological steps of perceiving a threat (III) and feeling apprehension (I). The cognitive appraisal of the trigger is what leads to the escalation of bodily sensations.
Option D: This sequence incorrectly starts with a perceived threat (III) before a trigger stimulus (V). A trigger must occur first to be perceived as a threat.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clark's Cognitive Model of Panic (Panic Circle) as background academic context rather than a clinical decision trigger.
Understanding the panic cycle is crucial for nurses to provide effective psychoeducation to patients, helping them recognize the pattern and learn coping strategies.
During a panic attack, a nurse's priority is to provide a safe and calm environment, use a reassuring tone, and guide the patient in slow, deep breathing to counteract the physiological symptoms of hyperventilation.
What if the patient has a known cardiac condition? The nurse must still provide reassurance but also perform a more thorough immediate assessment (e.g., vital signs, asking about specific chest pain characteristics, and potentially a 12-lead ECG as per protocol) to rule out an acute cardiac event, as symptoms can overlap significantly.

How to Approach the Question

First, identify the question type. This is a sequencing question that requires knowledge of a specific psychological model (the panic circle).
Identify the logical starting point of the cycle. In any stimulus-response model, a 'trigger' or 'stimulus' is almost always the first step. This points to 'V. Trigger stimulus' as the beginning.
Identify the logical endpoint or climax of the cycle. The 'catastrophic interpretation' (IV) is the cognitive event that defines the peak of the panic loop and fuels its continuation, making it the last step in this sequence.
With the start (V) and end (IV) points established, examine the options. Only option C starts with V and ends with IV.
Logically place the intermediate steps: The trigger (V) is perceived as a threat (III), which causes worry (I), leading to physical sensations (II), which are then misinterpreted catastrophically (IV). This confirms the sequence V → III → I → II → IV.

Concept Tested & Keywords

Concept Tested: Clark's Cognitive Model of Panic (Panic Circle)
Stem keywords: panic circle, order of occurrence, events
Lead-in keywords: Arrange

Question ID

QuqruvYBhADk8XnbGlteWe

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 15574-15577, 5721-5723

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1286-1288

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