Defensive mobilization during anticipation of symptom provocation: Association with panic pathology

  • Christoph Benke
    Correspondence
    Corresponding author: Christiane A. Pané-Farré, Phone: +49 6421 28-24013, Fax: + 49 3834 420 3790,
    Affiliations
    Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 29a, 35032 Marburg, Germany
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  • Manuela G. Alius
    Affiliations
    Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany
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  • Alfons O. Hamm
    Affiliations
    Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany
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  • Christiane A. Pané-Farré
    Affiliations
    Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 29a, 35032 Marburg, Germany

    Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487 Greifswald, Germany

    Center for Mind, Brain and Behavior (CMBB), University of Marburg and University of Giessen
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Published:November 22, 2021DOI:https://doi.org/10.1016/j.bpsc.2021.11.005

      Abstract

      Background

      Anxious apprehension about feared body symptoms is thought to play a crucial role in the development, chronicity, and treatment of panic disorder (PD). In the present study, we therefore aim to elucidate the role of defensive reactivity to anticipated unpleasant symptoms in PD which can contribute to a better understanding of pathomechanisms of PD as well as identification of potential targets in PD-focused interventions. By measuring amygdala dependent potentiation of the startle reflex, we aimed to investigate whether (

      American Psychiatric Association (2013): Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing.

      ) PD patients exhibit a specifically increased defensive reactivity to anticipated unpleasant body symptoms and (
      • Bouton M.E.
      • Mineka S.
      • Barlow D.H.
      A modern learning theory perspective on the etiology of panic disorder.
      ) whether clinical severity of panic symptomatology varies with magnitude of defensive activation.

      Methods

      Defensive mobilization to anticipated threat was investigated in 73 patients with a primary diagnosis of panic disorder with agoraphobia (PDA) and 52 healthy controls (HC). Threat of symptom provocation was established by a standardized hyperventilation task and contrasted to threat-of-shock to the forearm of the participant.

      Results

      Patients with PDA and HC did not differ in their defensive responses during anticipation of shock. In contrast, patients with severe PDA as compared to HC exhibited increased defensive response mobilization and reported more anxiety and panic symptoms during anticipation of feared body symptoms. Moreover, startle potentiation during anticipation of hyperventilation covaried with the severity of panic symptomatology.

      Conclusions

      The present findings suggest that increased defensive mobilization during anticipation of body symptoms is a neurobiological correlate of severe PDA which should be specifically targeted in PD interventions and might be used to monitor treatment success.

      Keywords

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