Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Rudolf-Bultmann-Straße 8, Marburg, Germany.
Biol Psychiatry. 2013 Jan 1;73(1):93-101. doi: 10.1016/j.biopsych.2012.07.026. Epub 2012 Aug 24.
Learning by conditioning is a key ability of animals and humans for acquiring novel behavior necessary for survival in a changing environment. Aberrant conditioning has been considered a crucial factor in the etiology and maintenance of panic disorder with agoraphobia (PD/A). Cognitive-behavioral therapy (CBT) is an effective treatment for PD/A. However, the neural mechanisms underlying the effects of CBT on conditioning processes in PD/A are unknown.
In a randomized, controlled, multicenter clinical trial in medication-free patients with PD/A who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before and after CBT. Quality-controlled fMRI data from 42 patients and 42 healthy subjects were obtained.
After CBT, patients compared to control subjects revealed reduced activation for the conditioned response (CS+ > CS-) in the left inferior frontal gyrus (IFG). This activation reduction was correlated with reduction in agoraphobic symptoms from t1 to t2. Patients compared to control subjects also demonstrated increased connectivity between the IFG and regions of the "fear network" (amygdalae, insulae, anterior cingulate cortex) across time.
This study demonstrates the link between cerebral correlates of cognitive (IFG) and emotional ("fear network") processing during symptom improvement across time in PD/A. Further research along this line has promising potential to support the development and further optimization of targeted treatments.
条件学习是动物和人类获得在不断变化的环境中生存所需的新行为的关键能力。异常的条件学习被认为是惊恐障碍伴广场恐怖症（PD/A）的病因和维持的一个关键因素。认知行为疗法（CBT）是 PD/A 的有效治疗方法。然而，CBT 对 PD/A 中条件作用过程的影响的神经机制尚不清楚。
在一项针对未经药物治疗的 PD/A 患者的随机、对照、多中心临床试验中，这些患者接受了 12 次手动 CBT 治疗，在 CBT 前后进行了恐惧条件反射的功能磁共振成像（fMRI）。从 42 名患者和 42 名健康受试者中获得了经过质量控制的 fMRI 数据。
与健康对照组相比，CBT 后患者的左额下回（IFG）对条件反应（CS+ > CS-）的激活减少。这种激活减少与从 t1 到 t2 的广场恐怖症状减少相关。与健康对照组相比，患者还表现出 IFG 与“恐惧网络”（杏仁核、岛叶、前扣带回皮质）区域之间的连通性随时间增加。
这项研究表明，在 PD/A 中，症状随时间改善时，认知（IFG）和情绪（“恐惧网络”）处理的大脑相关性之间存在联系。沿着这条线进行的进一步研究具有支持开发和进一步优化有针对性治疗的巨大潜力。
