Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative

Alfons O Hamm; Jan Richter; Christiane Pané-Farré; Dorte Westphal; Hans-Ulrich Wittchen; Anna N Vossbeck-Elsebusch; Alexander L Gerlach; Andrew T Gloster; Andreas Ströhle; Thomas Lang; Tilo Kircher; Antje B M Gerdes; Georg W Alpers; Andreas Reif; Jürgen Deckert

doi:10.1111/psyp.12553

Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative

Psychophysiology. 2016 Mar;53(3):312-22. doi: 10.1111/psyp.12553.

Authors

Affiliations

¹ Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
² Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
³ Department of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany.
⁴ Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany.
⁵ Department of Psychology, University of Basel, Basel, Switzerland.
⁶ Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany.
⁷ Christoph-Dornier Foundation for Clinical Psychology, Bremen, Germany.
⁸ Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
⁹ Department Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
¹⁰ Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Frankfurt, Frankfurt, Germany.
¹¹ Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany.

PMID: 26877119
DOI: 10.1111/psyp.12553

Abstract

In the current review, we reconceptualize a categorical diagnosis-panic disorder and agoraphobia-in terms of two constructs within the domain "negative valence systems" suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N = 369 and N = 124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension-characterized by attentive freezing during postencounter defense-was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.

Trial registration: ClinicalTrials.gov NCT01323556.

Keywords: Anxiety; Autonomic; Genetics; Psychopathological; Psychopathology; Startle Blink.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Agoraphobia / diagnosis
Agoraphobia / physiopathology*
Agoraphobia / therapy
Animals
Avoidance Learning / physiology
Clinical Trials as Topic
Defense Mechanisms
Female
Humans
Male
Models, Neurological
Multicenter Studies as Topic
Neurosciences / methods
Panic Disorder / diagnosis
Panic Disorder / physiopathology*
Panic Disorder / therapy
Reflex, Startle
Risk Factors

Associated data

ClinicalTrials.gov/NCT01323556
ISRCTN/ISRCTN80046034