Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks

Nocturnal panic involves waking suddenly from sleep in a state of panic, with no apparent cause, and affects more than half of patients with panic disorder. The Fear of Loss of Vigilance theory is the only proposed model for nocturnal panic, suggesting nocturnal panickers fear states in which they are unable to react to danger or protect themselves from threats. Prior work using a self-report questionnaire designed to test the theory (i.e., Fear of Loss of Vigilance Questionnaire; FLOVQ) was unsuccessful at differentiating nocturnal from daytime panickers. This study tested the theory using alternative measures to the FLOVQ. We predicted nocturnal panickers would show elevated responses to measures assessing fears of being unable to respond to or protect themselves from threats. A diverse community sample (N = 218) completed self-report measures related to panic attacks, intolerance of uncertainty, responsibility for harm, and anxiety sensitivity dimensions. Nocturnal panickers endorsed greater inhibitory intolerance of uncertainty and responsibility for harm, but not prospective intolerance of uncertainty, or anxiety sensitivity physical or cognitive concerns. This study provides support for the fear of loss of vigilance theory and suggests intolerance of uncertainty and responsibility for harm reduction be targeted in treatment for nocturnal panic attacks.