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  Anticipating agoraphobic situations: The neural correlates of panic disorder with agoraphobia

Wittmann, A., Schlagenhauf, F., Guhn, A., Lueken, U., Gaehlsdorf, C., Stoy, M., et al. (2014). Anticipating agoraphobic situations: The neural correlates of panic disorder with agoraphobia. Psychological Medicine, 44(11), 2385-2396. doi:10.1017/S0033291713003085.

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Wittmann, Anke1, Author           
Schlagenhauf, Florian1, 2, Author           
Guhn, A.3, Author
Lueken, U.4, Author
Gaehlsdorf, C.1, Author
Stoy, M.1, Author
Bermpohl, F.1, 5, Author
Fydrich, T.6, Author
Pfleiderer, B.7, Author
Bruhn, H.8, Author           
Gerlach, A. L.9, Author
Kircher, T.10, Author
Straube, B.10, Author
Wittchen, Hans-Ulrich4, Author           
Arolt, V.11, Author
Heinz, A.1, Author
Ströhle, Andreas1, Author           
1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany, ou_persistent22              
2Max Planck Fellow Group Cognitive and Affective Control of Behavioural Adaptation, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_1753350              
3Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Germany, ou_persistent22              
4 Institute of Clinical Psychology and Psychotherapy, TU Dresden, Germany, ou_persistent22              
5Berlin School of Mind and Brain, Humboldt University Berlin, Germany, ou_persistent22              
6Department of Psychology, Humboldt University Berlin, Germany, ou_persistent22              
7Department of Clinical Radiology, Münster University, Germany, ou_persistent22              
8Department of Radiology, Friedrich Schiller University Jena, Germany, ou_persistent22              
9 Department of Psychology, University of Cologne, Germany, ou_persistent22              
10Department of Psychiatry and Psychotherapy, Philipps University Marburg, Germany, ou_persistent22              
11Department of Psychiatry, Münster University, Germany, ou_persistent22              


Free keywords: Agoraphobia; Anticipation; Functional magnetic resonance imaging; Insula; Panic; Ventral striatum; Westphal paradigm
 Abstract: Background: Panic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia. Method: We compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm). Results: During the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures. Conclusions: This study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobia-specific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.


Language(s): eng - English
 Dates: 2013-06-062013-11-282014-01-072014-08
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1017/S0033291713003085
PMID: 24398049
Other: Epub 2014
 Degree: -



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Title: Psychological Medicine
Source Genre: Journal
Publ. Info: Cambridge, England : Cambridge University Press
Pages: - Volume / Issue: 44 (11) Sequence Number: - Start / End Page: 2385 - 2396 Identifier: ISSN: 0033-2917
CoNE: https://pure.mpg.de/cone/journals/resource/954927634419