This article is more than 5 years old. Information may no longer be current.

Researchers find neural target area for CBT in panic disorder

Panic disorder is associated with a biased panic-related semantic network that can be normalized using cognitive behavioral therapy, according to results of a multicenter functional MRI study published in American Journal of Psychiatry.

“Panic-related associations were processed specifically with enhanced activation in the [anterior cingulate cortices (ACC)] in panic disorder, which were again normalized after CBT,” Yunbo Yang, PhD, of the department of psychiatry and psychotherapy at Philipps-University Marburg in Germany, and colleagues wrote. “A better understanding of this biased information processing can inform theoretical models on the etiology and maintenance of panic disorder and foster the development of innovative behavioral treatment strategies.”

According to the researchers, previous research has hypothesized that CBT can reduce the anxiety-related, pathologically enhanced semantic associations of patients with panic disorder. To investigate the CBT’s effects on the neural and behavioral correlates of the panic-related semantic network in this patient population, Yang and colleagues primed an automatic semantic priming paradigm tailored for panic disorder by using panic triggers, such as elevator, with neutral words, such as bottle, during functional MRI scanning. They scanned 118 patients with panic disorder before an exposure-based CBT and compared outcomes with those of 150 healthy controls, as well as 42 patients compared with 52 healthy controls after an exposure-based CBT. They investigated neural correlates by comparing 103 matched patient pairs and control subjects at the baseline (for patients) or T1 (for controls) assessment and 39 pairs at the post-treatment of T2 assessment, they wrote.

The researchers found that at baseline or T1, patients rated panic-trigger/panic-symptom word pairs with higher negative valence and higher relatedness compared with healthy controls. When panic-symptom words were preceded by panic-trigger words, patients made faster lexical decisions. Patients’ panic-priming effect compared with controls was highlighted in suppressed neural activation in the left and right temporal cortices and insulae, as well as enhanced activation in the anterior and posterior cingulate cortices. CBT resulted in significant clinical improvements in the patient group along with reduced relatedness and negative valence rating and attenuation of neural activation in the ACC for processing of panic-trigger/panic-symptom word pairs, the researchers noted.

“CBT weakened the emotional association and thus reduced the perception of relatedness, the emotional priming-related behavioral facilitation and the neural activation in the ACC,” they wrote. “These processes may have mediated therapeutic effects, as suggested by their correlations with clinical improvements. Combining our previous finding that CBT response in panic disorder was associated with modulation of baseline ACC activation during extinction learning, we propose that the ACC may also be a core target site of CBT for panic disorder and for other disorders from the internalizing spectrum (eg, depression).” – by Joe Gramigna

Disclosures: Yang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.