Department of Psychiatry, Georgetown University Medical Center, Washington, DC.
Department of Psychiatry, Georgetown University Medical Center, Washington, DC.
Biol Psychiatry. 2024 Jan 1;95(1):85-92. doi: 10.1016/j.biopsych.2023.06.003. Epub 2023 Jun 16.
Biological markers for anxiety disorders may further understanding of disorder pathophysiology and suggest potential targeted treatments. The fear-potentiated startle (FPS) (a measure of startle to predictable threat) and anxiety-potentiated startle (APS) (startle to unpredictable threat) laboratory paradigm has been used to detect physiological differences in individuals with anxiety disorders compared with nonanxious control individuals, and in pharmacological challenge studies in healthy adults. However, little is known about how startle may change with treatment for anxiety disorders, and no data are available regarding alterations due to mindfulness meditation training.
Ninety-three individuals with anxiety disorders and 66 healthy individuals completed 2 sessions of the neutral, predictable, and unpredictable threat task, which employs a startle probe and the threat of shock to assess moment-by-moment fear and anxiety. Between the two testing sessions, patients received randomized 8-week treatment with either escitalopram or mindfulness-based stress reduction.
APS, but not FPS, was higher in participants with anxiety disorders compared with healthy control individuals at baseline. Further, there was a significantly greater decrease in APS for both treatment groups compared with the control group, with the patient groups showing reductions bringing them into the range of control individuals at the end of the treatment.
Both anxiety treatments (escitalopram and mindfulness-based stress reduction) reduced startle potentiation during unpredictable (APS) but not predictable (FPS) threat. These findings further validate APS as a biological correlate of pathological anxiety and provide physiological evidence for the impact of mindfulness-based stress reduction on anxiety disorders, suggesting that there may be comparable effects of the two treatments on anxiety neurocircuitry.
焦虑障碍的生物学标志物可以进一步了解疾病的病理生理学，并提示潜在的靶向治疗方法。恐惧增强的惊跳反应（FPS）（对可预测威胁的惊跳反应的测量）和焦虑增强的惊跳反应（APS）（对不可预测威胁的惊跳反应）实验室范式已被用于检测焦虑障碍患者与非焦虑对照个体之间的生理差异，以及在健康成年人的药物挑战研究中。然而，对于惊跳反应如何随着焦虑障碍的治疗而变化知之甚少，并且对于正念冥想训练引起的变化没有数据。
93 名焦虑障碍患者和 66 名健康个体完成了中性、可预测和不可预测威胁任务的 2 个会话，该任务采用惊跳探针和电击威胁来评估恐惧和焦虑的瞬间变化。在两次测试会话之间，患者接受了随机 8 周的 escitalopram 或基于正念的压力减轻治疗。
与健康对照组相比，基线时焦虑障碍患者的 APS 较高，而 FPS 则没有。此外，与对照组相比，两个治疗组的 APS 均显著降低，而患者组的降低幅度使他们在治疗结束时达到了对照组的范围。
两种焦虑治疗方法（escitalopram 和基于正念的压力减轻）均降低了不可预测（APS）但不降低可预测（FPS）威胁时的惊跳反应增强。这些发现进一步验证了 APS 作为病理性焦虑的生物学相关性，并为基于正念的压力减轻对焦虑障碍的影响提供了生理证据，表明这两种治疗方法可能对焦虑神经回路具有类似的影响。
