Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany.
PLoS One. 2022 Sep 1;17(9):e0273413. doi: 10.1371/journal.pone.0273413. eCollection 2022.
Patients with Panic Disorder (PD) show an abnormal stress-induced functioning of the Hypothalamic-Pituitary-adrenal (HPA)-axis. Different protocols for stress induction are of rather low relevance for the psychotherapeutic treatment. In practice, interoceptive exposure is often realized as Low Intensity Exercise (LIE), as compared to an incremental cycle exercise test to exhaustion. Currently, it is not known, whether LIE displays an effective interoceptive stressor 1.) leading to a significant anxiety induction; 2.) a comparable HPA- and Sympathetic-Adreno-Medullar (SAM)-axis response in both patients and healthy controls; 3.) stress responses under LIE are associated with treatment outcomes.
N = 20 patients with PD and n = 20 healthy controls were exposed to ten minutes of LIE on an exercise bike. LIE was applied as part of the interoceptive exposure, during an intensive Cognitive-Behavioral Therapy (CBT) in a day clinic. Heart rate was monitored and salivary cortisol samples collected. Before and after the LIE, state anxiety/ arousal were assessed. In order to evaluate psychopathology, the Panic and Agoraphobia Scale, Mobility Inventory, Agoraphobic Cognitions Questionnaire and Body Sensations Questionnaire were applied, before (T1) and after five weeks (T2) of an intensive CBT.
LIE led to a significant and similar heart rate increase in both groups. Cortisol decreased over time in both groups, especially in male patients. A higher psychopathology before, and after CBT, was associated with a significantly lower cortisol response under LIE.
In the present study, LIE led to a divergent stress response: while there was a significant heart rate increase, cortisol decreased over time, particularly in male patients. A lower reactivity of the HPA-axis seems to be associated with a lower treatment outcome, which may affect extinction based learning. The findings suggest, that interoceptive stimuli should be designed carefully in order to be potent stressors.
惊恐障碍（PD）患者的下丘脑-垂体-肾上腺（HPA）轴在应激时出现异常功能。不同的应激诱导方案对于心理治疗的相关性较低。在实践中，内感受暴露通常作为低强度运动（LIE）来实现，而不是递增循环运动测试直至力竭。目前尚不清楚 LIE 是否能：1） 作为有效的内感受应激源，显著诱导焦虑；2） 在患者和健康对照组中产生类似的 HPA 和交感肾上腺髓质（SAM）轴反应；3） LIE 下的应激反应与治疗结果相关。
N = 20 例 PD 患者和 n = 20 例健康对照者在运动自行车上进行十分钟的 LIE。LIE 作为日间诊所强化认知行为治疗（CBT）的一部分，用于内感受暴露。监测心率并采集唾液皮质醇样本。在 LIE 前后评估状态焦虑/唤醒。为了评估精神病理学，在强化 CBT 前（T1）和五周后（T2）使用惊恐和广场恐惧症量表、活动量表、广场恐怖症认知问卷和身体感觉问卷进行评估。
LIE 导致两组的心率显著且相似增加。皮质醇在两组中均随时间减少，尤其是男性患者。CBT 前后的精神病理学较高与 LIE 下皮质醇反应显著降低相关。
在本研究中，LIE 导致了不同的应激反应：虽然心率显著增加，但皮质醇随时间减少，尤其是男性患者。HPA 轴的反应较低似乎与治疗效果较低相关，这可能会影响基于消退的学习。研究结果表明，内感受刺激应精心设计，以成为有效的应激源。
