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

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• 作者：Carolin Liebscher^a ; ^{carolin.liebscher@charite.de" class="auth_mail" title="E-mail the corresponding author} ; André ; Wittmann^a ; Johanna Gechter^a ; Florian Schlagenhauf^a ; ^b ; Ulrike Lueken^c ; Jens Plag^a ; Benjamin Straube^d ; Bettina Pfleiderer^e ; Lydia Fehm^f ; Alexander L. Gerlach^g ; Tilo Kircher^d ; Thomas Fydrich^f ; Jü ; rgen Deckert^c ; Hans-Ulrich Wittchen^h ; Andreas Heinz^a ; Volker Aroltⁱ ; Andreas Strö ; hle^a
• 关键词：Panic ; Agoraphobia ; CBT ; SSRI ; fMRI ; Westphal-Paradigm
• 刊名：European Neuropsychopharmacology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：26
• 期：3
• 页码：431-444
• 全文大小：1543 K

文摘

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.