CBT tied to clinical improvements in patients with panic disorder

Cognitive behavioural therapy (CBT) helps normalize a biased semantic network in patients with panic disorder, according to a study.

The investigators performed an automatic semantic priming paradigm specifically tailored for panic disorder, wherein panic symptoms (eg, dizziness) were primed by panic triggers (eg, elevator) compared with neutral words (eg, bottle), during functional magnetic resonance imaging scanning in 118 patients with panic disorder (vs 150 healthy controls) before and 42 patients (vs 52 healthy controls) after an exposure-based CBT.

Neural correlates were examined by comparing 103 pairs of matched patients and controls at baseline (for patients) or T1 (for controls) assessment and 39 pairs at post-treatment or T2 assessment.

Compared with controls, patients rated panic-trigger/panic-symptom word pairs with higher relatedness and higher negative valence at baseline or T1. They also made faster lexical decisions to the panic-symptom words when preceded by panic-trigger words.

“This panic-priming effect in patients [vs controls] was reflected in suppressed neural activation in the left and right temporal cortices and insulae and enhanced activation in the posterior and anterior cingulate cortices,” the investigators said.

Patients who received CBT showed significant clinical improvements, as well as a decrease in relatedness and negative valence rating and attenuation of neural activation in the anterior cingulate cortex for processing of panic-trigger/panic-symptom word pairs.

“Attenuation of anterior cingulate cortex activation for processing of panic-related associations provides a potential mechanism for future therapeutic interventions,” the investigators said.