Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
Biol Psychiatry. 2012 Sep 15;72(6):512-20. doi: 10.1016/j.biopsych.2012.03.035. Epub 2012 May 22.
The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG).
Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test.
Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks.
We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
惊恐障碍的学习视角将急性惊恐和焦虑预感区分开来，认为这是两种不同的情绪状态。根据动物模型，这些临床实体反映了防御反应的不同阶段，这取决于内感受或外感受威胁线索的迫近程度。本研究通过调查一大群惊恐障碍伴广场恐怖症（PD/AG）患者的防御反应动力学来检验这一模型。
345 名 PD/AG 患者参加了一项标准化的行为回避测试（被困在一个小而黑暗的房间里 10 分钟）。通过测量回避和逃避行为、焦虑和惊恐症状的自我报告、自主唤醒（心率和皮肤电导）以及在行为回避测试暴露前后惊跳反射的增强，来评估防御反应。
惊恐障碍伴广场恐怖症患者在防御反应方面存在显著差异。虽然 31.6%的患者在这项任务中表现出强烈的焦虑预感（表现为焦虑增加、生理唤醒升高和惊跳反射增强），但 20.9%的患者从测试室中逃脱。如动物模型所预测的，主动逃避是在自主反应高峰时开始的，伴随着惊跳反应的抑制。这些生理反应与 34 例报告的惊恐发作期间观察到的模式相似。
我们发现证据表明，PD/AG 患者的防御反应是动态组织的，从焦虑预感到惊恐发作，随着内感受威胁的临近而增加。这些数据支持惊恐障碍的学习视角。
