Universität zu Köln

Liebscher, Carotin, Wittmann, Andre, Gechter, Johanna, Schlagenhauf, Florian ORCID: 0000-0001-8340-5027, Lueken, Ulrike ORCID: 0000-0003-1564-4012, Plag, Jens, Straube, Benjamin ORCID: 0000-0002-9837-0944, Pfleiderer, Bettina, Fehm, Lydia ORCID: 0000-0002-0825-8466, Gerlach, Alexander L. ORCID: 0000-0001-6794-5349, Kircher, Tilo ORCID: 0000-0002-2514-2625, Fydrich, Thomas, Deckert, Juergen, Wittchen, Hans-Ulrich ORCID: 0000-0002-6311-7711, Heinz, Andreas ORCID: 0000-0001-5405-9065, Arolt, Volker and Stroehle, Andreas (2016). Facing the fear - clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. Eur. Neuropsychopharmacol., 26 (3). S. 431 - 445. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 1873-7862

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Abstract

Introduction: Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates. Experimental procedures: We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29). Results: Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups. Discussion: This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala's involvement in the fear system's sensitivity to treatment. (C) 2016 Elsevier B.V. and ECNP. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liebscher, Carotin UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittmann, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Gechter, Johanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlagenhauf, Florian UNSPECIFIED orcid.org/0000-0001-8340-5027 UNSPECIFIED Lueken, Ulrike UNSPECIFIED orcid.org/0000-0003-1564-4012 UNSPECIFIED Plag, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Straube, Benjamin UNSPECIFIED orcid.org/0000-0002-9837-0944 UNSPECIFIED Pfleiderer, Bettina UNSPECIFIED UNSPECIFIED UNSPECIFIED Fehm, Lydia UNSPECIFIED orcid.org/0000-0002-0825-8466 UNSPECIFIED Gerlach, Alexander L. UNSPECIFIED orcid.org/0000-0001-6794-5349 UNSPECIFIED Kircher, Tilo UNSPECIFIED orcid.org/0000-0002-2514-2625 UNSPECIFIED Fydrich, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Deckert, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittchen, Hans-Ulrich UNSPECIFIED orcid.org/0000-0002-6311-7711 UNSPECIFIED Heinz, Andreas UNSPECIFIED orcid.org/0000-0001-5405-9065 UNSPECIFIED Arolt, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Stroehle, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-283698
DOI:	10.1016/j.euroneuro.2016.01.004
Journal or Publication Title:	Eur. Neuropsychopharmacol.
Volume:	26
Number:	3
Page Range:	S. 431 - 445
Date:	2016
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	1873-7862
Language:	English
Faculty:	Faculty of Human Sciences
Divisions:	Faculty of Human Sciences > Department Psychologie
Subjects:	Psychology
Uncontrolled Keywords:	Keywords Language RANDOMIZED CONTROLLED-TRIAL; NEUROANATOMICAL HYPOTHESIS; TREATMENT RESPONSE; ANXIETY DISORDERS; THERAPY; BRAIN; PSYCHOTHERAPY; INVENTORY; AMYGDALA; FMRI Multiple languages Clinical Neurology; Neurosciences; Pharmacology & Pharmacy; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28369