Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487, Greifswald, Germany.
Transl Psychiatry. 2021 Mar 17;11(1):177. doi: 10.1038/s41398-021-01298-7.
Panic disorder (PD) is characterized by a dysfunctional defensive responding to panic-related body symptoms that is assumed to contribute to the persistence of panic symptomatology. The present study aimed at examining whether this dysfunctional defensive reactivity to panic-related body symptoms would no longer be present following successful cognitive behavior therapy (CBT) but would persist when patients show insufficient symptom improvement. Therefore, in the present study, effects of CBT on reported symptoms and defensive response mobilization during interoceptive challenge were investigated using hyperventilation as a respiratory symptom provocation procedure. Changes in defensive mobilization to body symptoms in the course of CBT were investigated in patients with a primary diagnosis of PD with or without agoraphobia by applying a highly standardized hyperventilation task prior to and after a manual-based CBT (n = 38) or a waiting period (wait-list controls: n = 20). Defensive activation was indexed by the potentiation of the amygdala-dependent startle eyeblink response. All patients showed a pronounced defensive response mobilization to body symptoms at baseline. After treatment, no startle reflex potentiation was found in those patients who showed a clinically significant improvement. However, wait-list controls and treatment non-responders continued to show increased defensive responses to actually innocuous body symptoms after the treatment/waiting period. The present results indicate that the elimination of defensive reactivity to actually innocuous body symptoms might be a neurobiological correlate and indicator of successful CBT in patients with PD, which may help to monitor and optimize CBT outcomes.
惊恐障碍（PD）的特征是对与惊恐相关的身体症状的防御反应失调，这种失调被认为是导致惊恐症状持续存在的原因。本研究旨在检验成功的认知行为疗法（CBT）后，这种对与惊恐相关的身体症状的功能失调的防御反应是否不再存在，而当患者的症状改善不足时，这种反应是否会持续存在。因此，在本研究中，我们使用过度通气作为呼吸症状诱发程序，研究了 CBT 对报告的症状和对内脏挑战期间防御反应动员的影响。通过在基于手册的 CBT（n=38）或等待期（等待名单对照组：n=20）之前和之后应用高度标准化的过度通气任务，研究了具有或不具有广场恐怖症的 PD 原发性诊断患者在 CBT 过程中对身体症状的防御动员变化。防御激活的指标是杏仁核依赖的惊吓眨眼反应的增强。所有患者在基线时均表现出明显的对身体症状的防御反应动员。治疗后，那些临床症状显著改善的患者没有发现惊吓反射增强。然而，等待名单对照组和治疗无反应者在治疗/等待期后仍表现出对实际上无害的身体症状的防御反应增加。本研究结果表明，对实际上无害的身体症状的防御反应的消除可能是 PD 患者 CBT 成功的神经生物学相关指标和标志物，这有助于监测和优化 CBT 结果。
