Department of Psychiatry and Psychotherapy, Philipps University Marburg, Marburg, Germany.
Psychother Psychosom. 2014;83(4):222-33. doi: 10.1159/000359955. Epub 2014 Jun 19.
Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus self-guided (T-) exposure on the neural correlates of fear conditioning in PD/AG.
In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T-, n = 20).
The interaction of diagnosis (PD/AG, HS), treatment group (T+, T-), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2).
After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.
认知行为疗法（CBT）是治疗广场恐惧症伴惊恐障碍（PD/AG）的有效方法。目前尚不清楚 CBT 的不同变体如何调节与 PD/AG 相关的大脑网络。本研究旨在评估治疗师指导（T+）与自我指导（T-）暴露对 PD/AG 恐惧条件反射神经相关的影响。
在一项针对药物治疗的 PD/AG 患者的随机、对照、多中心临床试验中，患者接受 12 次 CBT 手册化治疗，在 CBT 前后（t1 和 t2）使用功能磁共振成像（fMRI）进行恐惧条件反射。从 42 名患者和 42 名健康对照者（HS）中获得了经过质量控制的 fMRI 数据。患者被随机分配到两种 CBT 变体（T+，n=22；T-，n=20）。
诊断（PD/AG、HS）、治疗组（T+、T-）、时间点（t1、t2）和刺激类型（条件刺激：是、否）的交互作用显示左海马体和枕颞皮质有激活。T+组在 t2 时显示海马体的激活增加（t2 > t1），这与治疗效果呈正相关，并且左额下回和左海马体之间的连通性随着时间的推移而降低（t1 > t2）。
在 T+暴露后，与后海马体相关的条件编码过程增强，与左额下回的过程的相关性降低，左额下回先前被证明在 PD/AG 中过度活跃。将单一程序变体与神经基质联系起来，为优化靶向心理治疗干预提供了潜力。
