Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia.

Abstract

INTRODUCTION:

Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates.

EXPERIMENTAL PROCEDURES:

We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29).

RESULTS:

Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups.

DISCUSSION:

This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala's involvement in the fear system's sensitivity to treatment.

• Authors: Carolin Liebscher, André Wittmann, Johanna Gechter, Florian Schlagenhauf, Ulrike Lueken, Jens Plag, Benjamin Straube, Bettina Pfleiderer, Lydia Fehm, Alexander L Gerlach, Tilo Kircher, Thomas Fydrich, Jürgen Deckert, Hans-Ulrich Wittchen, Andreas Heinz, Volker Arolt, Andreas Ströhle
• Journal: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology (Eur Neuropsychopharmacol) Vol. 26 Issue 3 Pg. 431-44 (Mar 2016) ISSN: 1873-7862 [Electronic] Netherlands
• PMID: 26837851 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Chemical References

• Serotonin Uptake Inhibitors
• Oxygen

Topics

• Agoraphobia (complications, diagnostic imaging, drug therapy, rehabilitation)
• Brain (diagnostic imaging, drug effects, physiology)
• Cognitive Behavioral Therapy
• Fear (psychology)
• Female
• Humans
• Image Processing, Computer-Assisted
• Magnetic Resonance Imaging
• Male
• Oxygen (blood)
• Panic Disorder (complications, diagnostic imaging, drug therapy, rehabilitation)
• Personality Inventory
• Psychiatric Status Rating Scales
• Self Report
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Statistics as Topic
• Treatment Outcome