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:
CreatorsEmailORCIDORCID Put Code
Liebscher, CarotinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wittmann, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gechter, JohannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schlagenhauf, FlorianUNSPECIFIEDorcid.org/0000-0001-8340-5027UNSPECIFIED
Lueken, UlrikeUNSPECIFIEDorcid.org/0000-0003-1564-4012UNSPECIFIED
Plag, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Straube, BenjaminUNSPECIFIEDorcid.org/0000-0002-9837-0944UNSPECIFIED
Pfleiderer, BettinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fehm, LydiaUNSPECIFIEDorcid.org/0000-0002-0825-8466UNSPECIFIED
Gerlach, Alexander L.UNSPECIFIEDorcid.org/0000-0001-6794-5349UNSPECIFIED
Kircher, TiloUNSPECIFIEDorcid.org/0000-0002-2514-2625UNSPECIFIED
Fydrich, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Deckert, JuergenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wittchen, Hans-UlrichUNSPECIFIEDorcid.org/0000-0002-6311-7711UNSPECIFIED
Heinz, AndreasUNSPECIFIEDorcid.org/0000-0001-5405-9065UNSPECIFIED
Arolt, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stroehle, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RANDOMIZED CONTROLLED-TRIAL; NEUROANATOMICAL HYPOTHESIS; TREATMENT RESPONSE; ANXIETY DISORDERS; THERAPY; BRAIN; PSYCHOTHERAPY; INVENTORY; AMYGDALA; FMRIMultiple languages
Clinical Neurology; Neurosciences; Pharmacology & Pharmacy; PsychiatryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/28369

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