Universität zu Köln

Richter, Jan ORCID: 0000-0002-7127-6990, Pietzner, Anne, Koenig, Julian, Thayer, Julian F., Pane-Farre, Christiane A., Gerlach, Alexander L., Gloster, Andrew T., Wittchen, Hans-Ulrich ORCID: 0000-0002-6311-7711, Lang, Thomas, Alpers, Georg W. ORCID: 0000-0001-9896-5158, Helbig-Lang, Sylvia, Deckert, Juergen, Fydrich, Thomas, Fehm, Lydia, Stroehle, Andreas, Kircher, Tilo ORCID: 0000-0002-2514-2625, Arolt, Volker and Hamm, Alfons O. (2021). Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia. Sci Rep, 11 (1). BERLIN: NATURE RESEARCH. ISSN 2045-2322

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Abstract

Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a marker of prefrontal inhibition of subcortical defensive activation. We investigated ultra-short-term changes of vagally controlled high frequency heart rate variability (HRV) during a standardized threat challenge (entrapment) in n=232 patients with panic disorder and agoraphobia, and its interaction with various indices of defensive activation. We found a strong inverse relationship between HRV and heart rate during threat, which was stronger at the beginning of exposure. Patients with a strong increase in heart rate showed a deactivation of prefrontal vagal control while patients showing less heart rate acceleration showed an increase in vagal control. Moreover, vagal control collapsed in case of imminent threat, i.e., when body symptoms increase and seem to get out of control. In these cases of defensive action patients either fled from the situation or experienced a panic attack. Active avoidance, panic attacks, and increased sympathetic arousal are associated with an inability to maintain vagal control over the heart suggesting that teaching such regulation strategies during exposure treatment might be helpful to keep prefrontal control, particularly during the transition zone from post-encounter to circa strike defense.Trial Registration Number: ISRCTN80046034.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Richter, Jan UNSPECIFIED orcid.org/0000-0002-7127-6990 UNSPECIFIED Pietzner, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Koenig, Julian UNSPECIFIED UNSPECIFIED UNSPECIFIED Thayer, Julian F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pane-Farre, Christiane A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerlach, Alexander L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gloster, Andrew T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittchen, Hans-Ulrich UNSPECIFIED orcid.org/0000-0002-6311-7711 UNSPECIFIED Lang, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Alpers, Georg W. UNSPECIFIED orcid.org/0000-0001-9896-5158 UNSPECIFIED Helbig-Lang, Sylvia UNSPECIFIED UNSPECIFIED UNSPECIFIED Deckert, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Fydrich, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Fehm, Lydia UNSPECIFIED UNSPECIFIED UNSPECIFIED Stroehle, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kircher, Tilo UNSPECIFIED orcid.org/0000-0002-2514-2625 UNSPECIFIED Arolt, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamm, Alfons O. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-604328
DOI:	10.1038/s41598-021-86867-y
Journal or Publication Title:	Sci Rep
Volume:	11
Number:	1
Date:	2021
Publisher:	NATURE RESEARCH
Place of Publication:	BERLIN
ISSN:	2045-2322
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NEURAL ORGANIZATION; DEFENSIVE BEHAVIOR; MOBILITY INVENTORY; RATE-VARIABILITY; FEAR; DYNAMICS; ANXIETY; MOBILIZATION; INHIBITION; CIRCUITS Multiple languages Multidisciplinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60432