Panic and Agoraphobia Scale (PAS)

Abstract

The Panic and Agoraphobia Scale (PAS) is a specialized, 14-item psychological scale designed for both self-report and observer-rating. Its primary function is to quantitatively measure the severity and specific clinical characteristics associated with Panic Disorder (PD), often comorbid with Agoraphobia. Unlike diagnostic tools that merely count symptoms, the PAS employs a multidimensional approach, assessing five crucial domains of the disorder.

This instrument is highly valued in clinical research due to its sensitivity to change, making it an excellent outcome measure for evaluating the efficacy of pharmacological or psychotherapeutic interventions over time. The five dimensions assessed include the frequency and severity of panic attacks, agoraphobic avoidance behavior, anticipatory anxiety, functional disability, and illness-related health concerns.

Keywords

Panic Disorder, Agoraphobia, Panic and Agoraphobia Scale, PAS, Anxiety Assessment, Anticipatory Anxiety, Avoidance Behavior, Clinical Trial Outcome Measure, Bandelow Scale, Psychometrics.

Authors

Bandelow B.

Purpose

The fundamental purpose of the PAS is to serve as a reliable and validated instrument for the comprehensive quantification of the severity associated with Panic Disorder and Agoraphobia. It was specifically developed for use in clinical research settings to track patient improvement or deterioration following various therapeutic regimens.

By assessing both the acute symptoms (physiological and cognitive manifestations of panic) and the resulting functional impairment, the PAS provides a holistic view of the patient’s clinical status. Its multidimensional design allows clinicians and researchers to distinguish between various pathological components, such as generalized anticipatory distress versus specific phobic avoidance.

Construct

The PAS is structured to measure the overall severity of Panic Disorder and Agoraphobia, aligning with standard diagnostic criteria (e.g., DSM). The total score reflects the global severity of the condition, derived from the combination of responses across five distinct, empirically supported subscales, reflecting the complex nature of the syndrome.

• Panic Attacks: Measures the frequency, severity, duration, and type (expected vs. unexpected) of panic episodes.
• Agoraphobic Avoidance: Quantifies the extent to which the individual engages in avoidance behaviors related to situations where panic is feared.
• Anticipatory Anxiety: Assesses the level of persistent worry or fear concerning future panic episodes, often referred to clinically as “fear of fear.”
• Disability/Impairment: Evaluates the functional consequences and disruption caused by the disorder across crucial life domains, including family, social, and occupational settings.
• Functional Avoidance/Health Concerns: Measures the patient’s worry about somatic harm (e.g., having a heart attack) or the persistent misattribution of panic symptoms to an underlying physical illness.

Validity

The Panic and Agoraphobia Scale demonstrates strong content validity, as its 14 items are directly mapped onto the core diagnostic criteria and common clinical presentations of Agoraphobia and Panic Disorder. This close alignment ensures that the scale is measuring the intended constructs accurately.

Furthermore, the PAS exhibits robust criterion validity, evidenced by its high sensitivity to symptomatic change over time. This characteristic is essential for its application in longitudinal studies and clinical trials where tracking treatment response is the primary objective. A notable feature that enhances its clinical validity is item 4, which specifically distinguishes between expected and unexpected panic attacks, a key phenomenological distinction in PD diagnosis.

Reliability

The PAS exhibits excellent psychometric reliability, particularly in terms of internal consistency. For the total score, the reported internal reliability, measured using Cronbach’s alpha, is 0.86. This value is considered strong and confirms that the items collectively and consistently measure the global severity of panic and agoraphobia.

The reliability of the five individual subscales is also deemed acceptable for clinical usage, with Cronbach’s alpha coefficients ranging between 0.66 and 0.82. This consistency across subdimensions supports the versatile use of the PAS, allowing for reliable interpretation of both the overall severity score and scores on specific components of the disorder.

Factor Analysis

Extensive factor analytical studies confirm the intended multidimensional structure of the Panic and Agoraphobia Scale. The instrument is empirically shown to decompose the overall pathology into five distinct, yet related, underlying factors: Panic Attacks, Agoraphobic Avoidance, Anticipatory Anxiety, Disability/Impairment, and Functional Avoidance/Health Concerns.

This confirmed factor structure is critical for researchers, as it allows for nuanced analysis of treatment outcomes. Investigators can determine precisely which specific dimensions of the disorder are being successfully targeted and ameliorated by different types of therapeutic interventions.

Instrument

Test Type: Psychological scale; Self-report or clinician-rated questionnaire.

Format: The PAS comprises 14 items, primarily utilizing a 5-point severity or frequency scale (Likert-type responses) across most items. Responses reflect symptoms experienced over the preceding seven days.

Language Available: English, German, and multiple other translations.

Population Group: Clinical patients diagnosed with Panic Disorder (PD) and/or Agoraphobia (AG).

Age Group: Adults and adolescents.

Population Details: Based on an initial sample of 425 PD/AG patients, the mean total score observed was 23.5 (Standard Deviation = 10.3) (Bandelow, 1999).

Test Methodology: The respondent rates their level of panic symptoms, avoidance behaviors, general anxiety, and functional impairment based on their experience during the previous week. It can be administered by a clinician or completed independently by the patient.

Keywords

Psychometrics, Internal Consistency, Bandelow B., Severity Assessment, PD/AG, Multidimensional Scale, Outcome Measurement.

Authors

Author ORCID Identifier: Information not provided in source content.

Affiliation Email addresses: Information not provided in source content.

Correspondence Address: Information not provided in source content.

Permissions & Fee and Test Year

The Panic and Agoraphobia Scale (PAS) was developed in 1995 and formally published in 1999. The scale is commercially distributed by Hogrefe & Huber Publishing. Individuals seeking to use the instrument for clinical practice or research purposes should contact the publisher or the original author, Bandelow B., to ascertain current usage permissions and associated fee structures.

Reference’s

Bandelow B. 1995. Assessing the Efficacy of Treatments for Panic Disorder and Agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology, 10(2)2;73-81.

Bandelow B. (1999) The Panic and Agoraphobia Scale (PAS) Hogrefe & Huber Publishing.

Bandelow B, Broocks A, Pekrun G, et al. 2000. The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial. Pharmacopsychiatry, 33(5):174-81

R Lam, EE Michalak, RP Swinson. 2004. Assessment Scales in Depression, Mania And Anxiety, 136-140.

The instrument may be available for review at: https://db.arabpsychology.com/

Items of the Panic and Agoraphobia Scale (PAS)

Panic attacks are sudden outbursts of anxiety, accompanied by one or more of the following symptoms:

• palpitations, pounding heart, or increased heart rate
• sweating
• trembling or shaking
• dry mouth
• difficulty breathing
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress (churning in stomach)
• feeling dizzy, unsteady, faint, or light-headed
• feelings that objects are unreal (like in a dream)
• fear of losing control, “going crazy,” or passing out
• fear of dying
• hot flushes or cold chills
• numbness, or tingling sensations

Panic attacks develop suddenly and increase in intensity within about 10 minutes.

1 How frequently did you have panic attacks?

• no panic attacks in the past week
• 1 panic attack in the past week
• 2-3 panic attacks in the past week
• 4-6 panic attacks in the past week
• more than 6 panic attacks in the past week

2 How severe were the panic attacks in the last week?

• no panic attacks
• attacks were usually mild
• attacks were usually moderate
• attacks were usually severe
• attacks were usually extremely severe

3 How long did the panic attacks last?

• no panic attacks
• 1 to 10 minutes
• 10 to 60 minutes
• 1 to 2 hours
• over 2 hours

4- Were most of the attacks expected (occurring in feared situations) or unexpected (spontaneous)?

• mostly unexpected (or no panic attacks)
• more unexpected than expected
• some unexpected, some expected
• more expected than unexpected
• mostly expected

5- In the past week, did you avoid certain situations because you feared ha‎ving a panic attack or a feeling of discomfort?

• no avoidance (or my attacks don’t occur in specific situations
• infrequent avoidance of feared situations
• occasional avoidance of feared situations
• frequent avoidance of feared situations
• very frequent avoidance of feared situations

6- Please check the situation(s) you avoided or in which you developed panic attacks or a feeling of discomfort when you are not accompanied:

• Airplanes
• Subways (underground)
• Buses, trains
• Ships
• Theaters, cinemas
• Supermarkets
• Standing in lines (queues)
• Auditoriums, stadiums
• Parties, social gatherings
• Crowds
• Restaurants
• Museums
• Elevators (lifts)
• Enclosed spaces (tunnels)
• Classrooms, lecture halls
• Driving or riding in a car
• Large rooms (lobbies)
• Walking on the street
• Fluids, wide streets, courtyards
• High places
• Crossing bridges
• Travelling away from home
• Staying home alone
• Other

7 How important were the avoided situations?

• unimportant (or no agoraphobia)
• not very important
• moderately important
• very important
• extremely important

8- In the past week, did you suffer from the fear of ha‎ving a panic attack (anticipatory anxiety or “fear of being afraid?)

• no anticipatory anxiety
• infrequent fear of ha‎ving a panic attack
• sometimes fear ha‎ving a panic attack
• frequent fear of ha‎ving a panic attack
• fear ha‎ving a panic attack all the time

9 How strong was this “fear of fear?

• none
• mild
• moderate
• marked
• extreme

10- In the past week, did panic attacks or agoraphobia lead to an impairment in your family relationships (partner, children, etc.)?

• no impairment
• mild impairment
• moderate impairment
• marked impairment
• extreme impairment

11- In the past week, did panic attacks or agoraphobia lead to an impairment of your social life and leisure activities (for example, you weren’t able to go a film or party)?

• no impairment
• mild impairment
• moderate impairment
• marked impairment
• extreme impairment

12- In the past week, did panic attacks or agoraphobia lead to an impairment of your work or household responsibilities?

• no impairment
• mild impairment
• moderate impairment
• marked impairment
• extreme impairment

13- In the past week, did you worry about suffering harm from your panic attacks (for example, ha‎ving a heart attack or fainting)?

• not true
• hardly true
• partly true
• mostly true
• definitely true

14- Do you sometimes believe that your doctor was wrong when he told you your symptoms (like rapid heart rate, tingling sensations, or shortness of breath) have a psychological cause? Do you believe the actually cause of these symptoms is an undiscovered physical problem?

• not true (rather psychic disease)
• hardly true
• partly true
• mostly true
• definitely true (rather organic disease)