Examining the relationship between cognitive factors and insight in panic disorder before and during treatment

Asala Halaj*, Asher Y. Strauss, Dina Zalaznik, Isaac Fradkin, Elad Zlotnick, Gerhard Andersson, David Daniel Ebert, Jonathan D. Huppert

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Individuals with Panic Disorder (PD) often have impaired insight, which can impede their willingness to seek treatment. Cognitive processes, including metacognitive beliefs, cognitive flexibility, and jumping to conclusions (JTC) may influence the degree of insight. By understanding the relationship between insight and these cognitive factors in PD, we can better identify individuals with such vulnerabilities to improve their insight. The aim of this study is to examine the relationships between metacognition, cognitive flexibility, and JTC with clinical and cognitive insight at pretreatment. We investigate the association among those factors’ changes and changes in insight over treatment. Eighty-three patients diagnosed with PD received internet-based cognitive behavior therapy. Analyses revealed that metacognition was related to both clinical and cognitive insight, and cognitive flexibility was related to clinical insight at pre-treatment. Greater changes in metacognition were correlated with greater changes in clinical insight. Also, greater changes in cognitive flexibility were related to greater changes in cognitive insight. The current study extends previous studies suggesting potential relationships among insight, metacognition, and cognitive flexibility in PD. Determining the role of cognitive concepts in relation to insight may lead to new avenues for improving insight and can have implications for engagement and treatment-seeking behaviors.

Original languageAmerican English
Pages (from-to)331-346
Number of pages16
JournalCognitive Behaviour Therapy
Issue number4
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • Clinical insight
  • cognitive factors
  • cognitive flexibility
  • cognitive insight
  • panic disorder


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