DEPRESSION AND ANXIETY 20:1722 (2004)

Research Article
CROSS-CULTURAL EVALUATION OF THE
PANIC DISORDER SEVERITY SCALE IN JAPAN
Ikuyo Yamamoto, M.D.,1 Yumi Nakano, M.D., Ph.D.,1 Norio Watanabe, M.D.,1 Yumiko Noda,1
Toshi A. Furukawa, M.D., Ph.D.,1* Takahiro Kanai, M.D., Ph.D.,2 Osamu Takashio, M.D., Ph.D.,3
Rumiko Koda, M.D.,3 Tempei Otsubo, M.D., Ph.D.,3 and Kunitoshi Kamijima, M.D., Ph.D.3

The Panic Disorder Severity Scale (PDSS) [Shear et al., 1997] is rapidly
gaining world-wide acceptance as a standard global severity measure of panic
disorder, however, its cross-cultural validity and reliability have not been
reported yet. We developed the Japanese version of the PDSS and examined its
factor structure, internal consistency and inter-rater reliability and concurrent
validity among Japanese patients with panic disorder with or without
agoraphobia. We also established rules of thumb for interpreting PDSS total
scores, taking the Clinical Global Impression severity scale as the anchoring
criterion. The identical one-factor structure of the PDSS was confirmed among
the Japanese patients as among the United States patients. Both internal and
inter-rater reliability was excellent (Cronbachs alpha was 0.86, and ANOVA
ICCs were all above 0.90). Concurrent validity of the PDSS items with self-
report questionnaires tapping similar or overlapping domains was satisfactory
(Pearson correlation coefficients were mostly above 0.5). Using the anchor-based
approach, the following interpretative guides are suggested: among those with
established panic disorder diagnosis, PDSS total scores up to 10 correspond with
mild, those between 11 and 15 with moderate, and those at or above 16
correspond with severe panic disorder. The present findings support the cross-
cultural generalizability of panic disorder symptomatology and of the PDSS, in
particular. Depression and Anxiety 20:1722, 2004. & 2004 Wiley-Liss, Inc.

Key words: panic disorder; psychiatric status rating scales; reproducibility of results;
cross-cultural comparison

INTRODUCTION
Since its introduction in DSM-III in 1980, panic
disorder has been the focus of much research interest
around the world. Ten years later, however, a consensus
development conference for the treatment of panic
disorder was convened at the U.S. National Institute of
Mental Health and came to the conclusion that there
was an urgent need for standardized diagnostic and
treatment outcome measures to enable direct compar-
isons between different research settings and different
treatment strategies [Wolfe and Maser, 1994]. At an
ensuing meeting to standardize the assessment meth-
ods, key researchers from 26 different sites failed to
endorse any extant instrument(s) as the best for rating
the overall illness severity [Shear and Maser, 1994;
Shear et al., 1998]. A systematic survey of selected
journals between 1980 and 1992 showed that only a
1
Department of Psychiatry and Cognitive-Behavioral Medi-
cine, Nagoya City University Graduate School of Medical
Sciences, Nagoya, Japan
2
Department of Psychiatry, Toyohashi Municipal Hospital,
Toyohashi, Japan
3
Department of Psychiatry, Showa University School of
Medicine, Tokyo, Japan
*Correspondence to: Professor Toshi A. Furukawa, Dept. of
Psychiatry and CognitiveBehavioral Medicine, Nagoya City
University Graduate School of Medical Sciences, Mizuho-cho,
Mizuho-ku, Nagoya 467-8601 Japan.
E-mail: furukawa@med.nagoya-cu.ac.jp
Received for publication 21 October 2003; Revised 12 June 2004;
Accepted 16 June 2004
DOI 10.1002/da.20029
Published online in Wiley InterScience (www.interscience.wiley.
com).

& 2004 WILEY-LISS, INC.

18 Yamamoto et al.
small and variable percentage (between 633%) of
studies recorded some form of composite global rating
of severity for the disorder [Weise et al., 1996].
A promising research instrument to settle this
confusing state is the Panic Disorder Severity Scale
(PDSS), formerly called Cornell-Yale Panic Anxiety
Scale or Multicenter Panic Anxiety Scale, an interview-
based, seven-item scale for assessing the overall severity
of panic disorder. It was modeled after the Yale-Brown
Obsessive Compulsive Scale [Goodman et al., 1989a,
b], field-tested, and published in 1997 [Shear et al.,
1997]. The usual time frame for rating is the past
month, and the seven areas covered include: frequency
of panic attacks, distress during panic attacks, antici-
patory anxiety, agoraphobic fear/avoidance, interocep-
tive fear/avoidance, impairment of work functioning,
and impairment of social functioning. Each item is
rated on a 04 scale, with higher ratings indicating
greater degrees of symptom severity. Excellent inter-
rater reliability, moderate internal consistency relia-
bility and satisfactory concurrent validity, and good
sensitivity to change have been reported [Shear et al.,
1997, 2001].
The PDSS is gaining rapid acceptance internation-
ally, being translated into at least six languages by 2001
[Shear et al., 2001]. Psychometric properties of these
non-English versions have not yet been reported,
however, and the cross-cultural validity of the PDSS
is not yet known. The present authors developed the
Japanese version of the PDSS with the kind coopera-
tion of the original developers of the scale. The aims of
the present study are to analyze the factor structure of
the instrument, to report its reliability and validity, and
to provide some rules of thumb to facilitate the
interpretation of the scales scores.
PATIENTS AND METHODS
TRANSLATION OF THE PDSS
With the original authors permission, our team in
the Department of Psychiatry and Cognitive-Behavior-
al Medicine of the Nagoya City University Graduate
School of Medical Sciences translated the original
English PDSS into Japanese. We followed the standard
procedure of back translation for cross-cultural adapta-
tion of an original English psychometric instrument
[Brislin, 1970]. One of the authors (T.A.F.) translated
the English PDSS into Japanese first. This preliminary
Japanese PDSS was back translated into English by two
Japanese women who had 15 years living experiences
in English-speaking countries and one of whom had a
bachelors degree in psychology. The back translated
version was examined against the original by the
original developers of the scale who pointed out
possible discrepancies. T.A.F. then corrected the
Japanese translation accordingly. This process was
repeated three times until all agreed that the original
and back translated versions matched closely.
Throughout this procedure the two women who back
translated from Japanese into English remained blind
to the original English instrument.
PATIENTS
The study sample consisted of 77 psychiatric out-
patients who currently met DSM-IV criteria for panic
disorder in Nagoya City University Hospital (n 26)
and Showa University School of Medicine Hospital
(n 51) between January 2002 and January 2003.
Diagnosis was ascertained by the Structured Clinical
Interview for DSM-IV (SCID-IV). This study was
approved by the institutional Ethics Committee, and
patients provided signed informed consent to partici-
pate in this research.
PROCEDURE AND INSTRUMENTS
All the patients were administered the Japanese
PDSS by psychiatrists or a doctoral-level clinical
psychologist. For 66 patients, the interview was
conducted by two independent examiners, one of
whom conducted the interview while the other
observed and made independent, blind ratings. At the
same time with the PDSS, the patients were asked to
fill in the self-report questionnaire battery containing
Fear Questionnaire (FQ) [Marks, 1986], Mobility
Inventory for agoraphobia (MI) [Chambless et al.,
1985], Agoraphobic Cognitions Questionnaire (ACQ)
[Chambless et al., 1984], Body Sensations Question-
naire (BSQ) [Chambless et al., 1984], Symptom
Checklist-90-Revised (SCL-90-R) [Derogatis, 1992]
and Work, Home management, Social and Private
leisure activities Scale (WHL) [Marks, 1986].
Fear Questionnaire. A self-report instrument for
measuring severity of phobic avoidance [Marks, 1986].
The patients are asked to choose a number between 0
(would not avoid it) to 8 (always avoid it) to show how
much he/she would avoid each of the listed situations
because of fear or other unpleasant feelings. The
anchor points are therefore in nine grades. The
situations include agoraphobia, nosophobia, and social
phobia. Good testretest reliability and factor validity
have been demonstrated [Marks and Mathews, 1979].
Mobility Inventory for agoraphobia. A self-report
instrument for measuring the severity of agoraphobic
avoidance [Chambless et al., 1985]. The patients are
asked about 31 places and situations that they may
avoid because of anxiety or phobia. They answer with a
number between 1 (never avoid) to 5 (always avoid), in
five grades. The scales reliability and concurrent and
construct validity have been reported [Chambless et al.,
1985].
Agoraphobic Cognitions Questionnaire and
Body Sensations Questionnaire. Questionnaires de-
signed to measures aspects of fear of fear observed in
patients with panic disorder: the former assesses
maladaptive cognitions concerning potential harm of
a panic attack and the latter focuses on exaggerated fear
 Research Article: Japanese Version of PDSS
response touched off by sensations associated with
anxiety [Chambless et al., 1984]. There are 14 and 17
items, respectively, each rated in five grades. Both
instruments have been shown to have good reliability
and discriminant and construct validity [Chambless
et al., 1984].
Symptom Checklist-90 Revised. A widely-used
assessment tool for general psychopathology [Deroga-
tis, 1992]. It contains 90 items, subdivided into
nine subscales of somatization, obsessive-compulsive,
interpersonal sensitivity, depression, anxiety, hostility,
phobic anxiety, paranoid ideation, and psychoticism.
Work, Home Management, Social and Private
Leisure Activities Scale. A self-report instrument for
measuring the severity of functional impairments in the
work, home management, and social and private
activities [Marks, 1986]. The patients answers are
graded between 0 (not at all impaired) to 8 (very
severely impaired). Satisfactory reliability and construct
validity have been reported [Mundt et al., 2002].
For the subsample recruited at Nagoya City Uni-
versity Hospital, the global psychopathology of the
patient was evaluated with Clinical Global Impression
(CGI) severity by two independent assessors. This is a
measure of the severity of the disorder according to the
clinicians clinical global judgment [Guy, 1976], rated
from 1 (not ill) to 7 (most severe) in seven grades. The
inter-rater reliability of the CGI for the present sample
was an ANOVA intraclass correlation coefficient of
0.72 (95% CI 0.31 to 0.89). We used the average
score of two independent raters for further analyses.
ANALYSES
We used SPSS 11.0J for Windows [SPSS Inc., 2001]
for statistical analyses.
Factor analysis. The factor analysis is the best
method for examining the conceptual equivalence of a
psychological scale in dif ferent cultures [Irvine and
Carroll, 1980; Mumford et al., 1991]. We used the
scree plot to determine the number of factors to be
extracted, because this method has been demonstrated
to yield the most consistent results across various
situations [Zwick and Velicer, 1982]. We had expected
one factor to be extracted as in the original version. We
also examined the item-remainder correlations (i.e.,
correlation of each item with the sum of the remaining
items) to confirm the one-factor solution.
Reliability. The internal consistency reliability of
the scale was estimated with Cronbachs alpha coef fi-
cients. Cronbachs alpha should be above 0.70, but
probably not higher than 0.90 [Nunnally, 1978].
The inter-rater reliability was estimated with analysis
of variance intraclass correlation coef ficient (ANOVA
ICC). ANOVA ICC should generally be above 0.7 for
the scale to have good reliability.
Validity. Concurrent validity of the Japanese PDSS
was examined by calculating correlations between each
19
PDSS item and self-report measures thought to reflect
the item content.
Item 1 of the PDSS asks about the frequency of
panic attacks during the past month. This should
correlate with the self-reported MI subscale of panic
frequency for the past 3 weeks. Item 2 of the PDSS asks
about the distress associated with panic attacks during
the past month. This should correlate with the MI
subscale of the severity of panic attacks. PDSS Item 3
concerns the severity of anticipatory anxiety in-
between panic attacks. This should be reflected in the
anxiety subscale of SCL-90-R. PDSS Item 4 asks about
the severity of agoraphobia and avoidance, which the
corresponding subscales of SCL-90-R, FQ, and MI
should also be measuring. PDSS Item 5 is concerned
with the fear and avoidance of panic-related physical
sensations. This should correlate with self-reported
BSQ. Items 6 and 7 of the PDSS ask about the
impairments in work and social functioning, respec-
tively, and must correlate with the corresponding
subscales of the WHL.
Interpretative guides for the Japanese PDSS. For
a psychometric instrument to be clinically useful, it
needs be interpretable. We used the anchor-based
approach [Guyatt et al., 2002] to establish the rough
rules of thumb in interpreting the total scores of the
PDSS. After ascertaining that the CGI severity is at
least moderately correlated with the PDSS, we used
regression analyses to define PDSS scores that would
correspond with severe, moderate, or mild severity of
the panic disorder.
RESULTS
PATIENTS
The mean age of the 77 patients was 35.8 years
(sd 11.0, range 1964). There were 23 males (30%)
and 54 females (70%). Sixty-two of them (81%) were
suffering from panic disorder with agoraphobia.
FACTOR STRUCTURE
Figure 1 shows the scree plot from the principal
component factor analysis of the PDSS. It clearly
shows one factor to be extracted, just like the original
version. Table 1 shows the item-remainder correlations
for all seven items of the PDSS. The correlation
coef ficients were moderate to substantial.
We will proceed with the one-factor solution of the
Japanese PDSS.
RELIABILITY
Cronbachs alpha coefficient was 0.86, denoting
excellent internal consistency reliability.
Table 2 shows inter-rater reliability for each item as
well as the total score of the PDSS. All ANOVA ICCs
were 40.9, again demonstrating very good inter-rater
agreement.
20 Yamamoto et al.

4 VALIDITY
Table 3 shows correlation coefficients between each
PDSS items and the corresponding self-report scales as
3 hypothesized in the Methods section. All the coef fi-
cients were moderate to substantive, except for Item 5
with BSQ.
Eigenvalue

INTERPRETATIVE GUIDES
1
The correlation coefficient between total PDSS and
CGI severity was 0.61 (95% CI 0.26 to 0.82). Figure
2 shows the linear regression analysis of the PDSS on
CGI severity. Because Score 3 of CGI is anchored as
0
mild, Score 4 as moderate, Score 5 as marked,
1 2 3 4 5 6 7
Score 6 as severe, and Score 7 as most extremely ill,
Component Number
the regression equation would suggest that PDSS
Fig. 1. Scree plot for the Japanese PDSS (principal component scores around 8 correspond with mild panic disorder,
factor analysis). those around 11 with moderate panic disorder, those
around 14 with marked panic disorder, and 16 or
above with severe to very severe panic disorder
TABLE 1. Item-remainder correlations for the Japanese among those who are already diagnosed with panic
PDSS disorder.

PDSS item Pearson correlation coefficient (95% CI)

1 0.57 (0.46 to 0.68)

2 0.67 (0.56 to 0.78)
3 0.68 (0.58 to 0.78) 30
4 0.63 (0.52 to 0.74)
5 0.40 (0.29 to 0.51)
6 0.75 (0.65 to 0.85)
7 0.67 (0.56 to 0.78)
20
PDSS

TABLE 2. Inter-rater reliability of the Japanese PDSS

PDSS item ANOVA ICC (95% CI) 10

Total score 0.99 (0.98 to 0.99)

1 0.99 (0.99 to 1.00)
2 0.95 (0.92 to 0.97)
3 0.97 (0.96 to 0.98)
0
4 0.93 (0.90 to 0.96)
1 2 3 4 5 6 7
5 0.98 (0.98 to 0.99)
6 0.90 (0.84 to 0.94) CGI severity
7 0.94 (0.90 to 0.96) Fig. 2. Linear regression of CGI severity on PDSS total score.

TABLE 3. Concurrent validity with self-report questionnaires

PDSS Item Self-report questionnaires n Pearson correlation coefficients (95% CI)

1 MI frequency 69 0.45 (0.33 to 0.57)
2 MI severity 40 0.56 (0.41 to 0.71)
3 Symptom Check List-90-R Anxiety 31 0.47 (0.29 to 0.65)
4 Symptom Check List-90-R Phobic anxiety 31 0.64 (0.47 to 0.81)
4 FQ agoraphobia 73 0.49 (0.38 to 0.60)
4 MI total 70 0.58 (0.46 to 0.70)
5 BSQ 70 0.25 (0.15 to 0.35)
6 WHLS (average of work and home subscales) 39 0.51 (0.35 to 0.67)
7 WHLS (social leisure subscale) 38 0.66 (0.51 to 0.81)
 Research Article: Japanese Version of PDSS
DISCUSSION
We confirmed the single factor structure of the
Japanese PDSS and demonstrated its excellent internal
as well as external reliability and its satisfactory
concurrent validity. We further reported the rules of
thumb for interpreting the PDSS.
The first published study of the PDSS [Shear et al.,
1997] reported two-factor solution for the seven-item
PDSS, with Items 1 and 2 (panic frequency and panic
distress) loading on the first factor and the other five
on the second factor. This factor analysis was deemed
tentative, however, because the sample was limited to
panic disorder with no or limited agoraphobia and the
resultant range restriction for some of the scale items
may have affected the psychometric behavior of the
instrument. A second and a third study conducted with
full range of panic disorder patients confirmed the one-
factor structure of the scale [Shear et al., 2001]. Our
results confirmed that the symptomatology as assessed
with the PDSS was similarly unidimensional among the
Japanese patients. The item-remainder correlations
were again of very similar magnitude, in the range
between 0.600.80 for both the American and the
Japanese samples [Shear et al., 2001].
The internal consistency reliability of the scale was
reported to be moderate in the first study, probably due
to the circumstances noted above (Cronbachs
alpha 0.65). In the second study [Shear et al., 2001],
however, it was 0.88, a figure again very similar to ours.
The inter-rater reliability has always been excellent,
with ANOVA ICCs between 0.740.87 for individual
items and 0.87 for the total score [Shear et al., 1997].
The Japanese PDSS demonstrated similar, if only
better, inter-rater reliability.
Different sets of self-report questionnaires were used
to examine the concurrent validity of the PDSS. The
first validation study reported moderate correlations
between PDSS Item 3 (anticipatory anxiety) with the
Anxiety Sensitivity Index [Reiss et al., 1986], between
PDSS Item 4 (agoraphobic fear/avoidance) with
agoraphobia subscale of the Albany Panic and Phobia
Questionnaire [Rapee et al., 1994], between PDSS
Item 5 (interoceptive fear/avoidance) with interocep-
tive subscale of the same questionnaire, and between
PDSS Items 6 and 7 (work and social impairment) and
a questionnaire very similar to WHLS [Shear et al.,
1997]. The second study did not report correlations for
individual items of the PDSS but noted moderate to
substantive correlations of the total score with the
Anxiety Sensitivity Index and the Beck Anxiety
Inventory [Shear et al., 2001]. Our results confirm
and extend the concurrent validity between the PDSS
and self-report questionnaires reporting on similar or
overlapping domains.
To our knowledge, no study has yet reported on the
interpretative guides for the PDSS total scores. Using
the anchor-based approach, we established that, among
patients whose panic disorder diagnosis is already
21
established, PDSS total scores up to 10 would
correspond with mild panic disorder, those between
1115 with moderate to marked panic disorder, and
those with 16 or more with severe panic disorder.
Although we did not administer PDSS to those who do
not suffer currently from panic disorder and therefore
cannot know the cutof f for the instrument when used
as a screener, Shear et al. [2001] suggested the cutoff
score of 8 to pick up current panic disorder most
efficiently among the convenience sample of mood/
anxiety disorders. We think that this suggestion
coincides well with our findings.
There were some shortcomings in the present study.
First, we did not assess some important psychometric
characteristics including testretest reliability and
discriminant validity vis-a`-vis other anxiety disorders,
other mental disorders, and healthy patients. These
must be examined in separate, future studies. Second,
ours was only cross-sectional and could not report on
the instruments sensitivity to change, another very
important psychometric feature for any evaluative
instrument to be clinically useful [Guyatt et al.,
1987]. Several studies have ascertained this feature for
the original PDSS [Shear et al., 1997; Barlow et al.,
2000] and we are currently conducting a further study
with the PDSS after pharmacological and cognitive-
behavioral treatment. Third, the number of patients
was relatively small for some of the concurrent validity
checks, especially for the comparison between the
PDSS total score and the CGI severity. The substantive
correlations between these two measures (r .61) and
corroborative data from the American study on the
screening capability of the PDSS argue strongly for the
appropriateness of our interpretative guide for the
PDSS total score.
In summary, the Japanese PDSS showed excellent
reliability and satisfactory validity for it to be used
clinically in the Japanese settings. The identical factor
structure ascertained for both the English and the
Japanese versions of the instrument attests to the cross-
cultural generalizability of measurement of panic
disorder symptomatology. We also provided rules of
thumb for interpreting the PDSS total scores. This
interpretative guide needs be confirmed in a future
study with the original English PDSS.
Acknowledgments. We would like to thank Prof.
M.K. Shear and Ms. R. Palmieri for allowing us to
translate the PDSS into Japanese and for cooperating
in the back translation process.
REFERENCES
Barlow DH, Gorman JM, Shear MK, Woods SW. 2000. Cognitive-
behavioral therapy, imipramine, or their combination for panic
disorder: A randomized controlled trial. JAMA 283:25292536.
Brislin RW. 1986. Back-translation for cross-cultural research.
J Cross Cult Psychol 1:185216.
22 Yamamoto et al.
Chambless DL, Caputo GC, Bright P, Gallagher R. 1984. Assess-
ment of fear of fear in agoraphobics: The Body Sensations
Questionnaire and the Agoraphobic Cognitions Questionnaire. J
Consult Clin Psychol 52:10901097.
Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C. 1985.
The Mobility Inventory for Agoraphobia. Behav Res Ther 23:
3544.
Derogatis LR. 1992. SCL-90-R: Administration, scoring and
procedures manual-II for the R(evised) version and other instru-
ments of the psychopathology rating scale series. Towson, MD:
Clinical Psychometric Research, Inc. 71 p.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann
RL, Hill CL, Heninger GR, Charney DS. 1989a. The Yale-Brown
Obsessive Compulsive Scale. I. Development, use, and reliability.
Arch Gen Psychiatry 46:10061011.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P,
Heninger GR, Charney DS. 1989b. The Yale-Brown Obsessive
Compulsive Scale. II. Validity. Arch Gen Psychiatry 46:
10121016.
Guy W. 1976. ECDEU Assessment Manual for Psychopharmaco-
logy. Rockville, Maryland: U.S. Department of Health and Human
Services.
Guyatt G, Walter S, Norman G. 1987. Measuring change over time:
Assessing the usefulness of evaluative instruments. J Chronic Dis
40:171178.
Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. 2002.
Methods to explain the clinical significance of health status
measures. Mayo Clin Proc 77:371383.
Irvine SH, Carroll WK. 1980. Testing and assessment across cultures:
Issues in methodology and theory. In: Triandis HC, Berry JW,
editors. Handbook of cross-cultural psychology. Vol. 2. Methodo-
logy. Boston: Allyn and Bacon, Inc. p 181244.
Marks IM, Mathews AM. 1979. Brief standard self-rating for phobic
patients. Behav Res Ther 17:263267.
Marks IM. 1986. Behavioural psychotherapy: Maudsley pocket book
of clinical management. Bristol: IOP Publishing. 133 p.
Mumford DB, Whitehouse AM, Platts M. 1991. Sociocultural
correlates of eating disorders among Asian schoolgirls in Bradford.
Br J Psychiatry 158:222228.
Mundt JC, Marks, IM, Shear, MK, Greist, JM. 2002. The Work and
Social Adjustment Scale: A simple measure of impairment in
functioning. Br J Psychiatry 180:461464.
Nunnally JC. 1978. Psychometric Theory. New York: McGraw-Hill.
Rapee RM, Craske MG, Barlow DH. 1994/1995. Assessment
instrument for panic disorder that includes fear of sensation-
producing activities: The Albany Panic and Phobia Questionnaire.
Anxiety 1:114122.
Reiss S, Peterson RA, Gursky DM, McNally RJ. 1986. Anxiety
sensitivity, anxiety frequency and the prediction of fearfulness.
Behav Res Ther 24:18.
Shear MK, Maser JD. 1994. Standardized assessment for panic
disorder research. Arch Gen Psychiatry 51:346354.
Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE,
Woods SW, Gorman JM, Papp LA. 1997. Multicenter collabora-
tive panic disorder severity scale. Am J Psychiatry 154:15711575.
Shear MK, Clark D, Feske U. 1998. The road to recovery in panic
disorder: Response, remission, and relapse. J Clin Psychiatry
59(Suppl):48.
Shear MK, Rucci P, Williams J, Frank E, Grochocinski V, Vander Bilt
J, Houck P, Wang T. 2001. Reliability and validity of the Panic
Disorder Severity Scale replication and extension. J Psychiatr Res
35:293296.
SPSS Inc. 2001. SPSS for Windows Version 11.0. Chicago: SPSS Inc.
Weise RE, Shear MK, Maser JD. 1996. On the need for
standardization in panic disorder treatment research: Survey of
the literature, 1980-1992. Anxiety 2:257264.
Wolfe BE, Maser JD. 1994. Treatment of panic disorder: A consensus
development conference. Washington, DC: American Psychiatric
Press.
Zwick WR, Velicer WF. 1982. Factors influencing four rules for
determining the number of components to retain. Multivar Behav
Res 17:253269.