Facing the fear: Clinical and neural effects of cognitive behavioural and 
pharmacotherapy in panic disorder with agoraphobia

Liebscher, Carolin; Wittmann, André; Gechter, Johanna; Schlagenhauf, Florian; Lueken, Ulrike; Plag, Jens; Straube, Benjamin; Pfleiderer, Bettina; Fehm, Lydia; Gerlach, Alexander L.; Kircher, Tilo; Fydrich, Thomas; Deckert, Jürgen; Wittchen, Hans-Ulrich; Heinz, Andreas; Arohlt, Volker; Ströhle, Andreas

doi:10.1016/j.euroneuro.2016.01.004

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Facing the fear: Clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia

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Schlagenhauf, Florian
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany;
Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society;

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Citation

Liebscher, C., Wittmann, A., Gechter, J., Schlagenhauf, F., Lueken, U., Plag, J., et al. (2016). Facing the fear: Clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. European Neuropsychopharmacology, 26(3), 431-444. doi:10.1016/j.euroneuro.2016.01.004.

Cite as: https://hdl.handle.net/11858/00-001M-0000-002B-1FD4-A

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.