Changes in Automatic Threat Processing Precede and Predict Clinical Changes with Exposure-Based Cognitive-Behavior Therapy for Panic Disorder

Frontal Cortex Stimulation Reduces Vigilance to Threat: Implications for the Treatment of Depression and Anxiety

“…In particular, the administration of the SSRI citalopram (47) and the benzodiazepine diazepam (50) were found to reduce fear vigilance in healthy volunteers using a similar dot-probe task. A parallel study using an exposure-based cognitive behavioural intervention for panic disorder also revealed an early effect of treatment on vigilance to fearful faces and this effect predicted subsequent reduction in anxiety following treatment (21). Together, these results suggest that tDCS has an anxiolytic-like profile in this task, and that these effects can be seen most clearly with bipolar-balanced DLPFC stimulation.…”

“…The results from this study support the use of bipolar-balanced DLPFC stimulation paradigms and measurements of attentional bias. These measurements have been identified as a marker of efficacy in other treatments and so this protocol could have a similar effect in a clinical population, where reductions in negative biases have been shown to predict later clinical improvement (19,21). The focus of this study was to investigate acute effects of tDCS, by testing for an induced change in emotional processing similar to what was previously observed acutely with antidepressant or anxiolytic treatment.…”

“…These early changes in emotional processing are predictive of later therapeutic response (20,21). Acute behavioural measurements can be designed to selectively probe distinct domains of altered cognition characteristic of different disorders, such as vigilance to threat observed at short stimulus durations in anxiety disorders (21) versus more effortful interpretive cognition at longer stimulus durations known to be affected by depressive symptoms (22).…”

The Neurobiology of Dispositional Negativity and Attentional Biases to Threat: Implications for Understanding Anxiety Disorders in Adults and Youth

“…For example, Pérez-Edgar, Fox, and colleagues have demonstrated that among youth with an early childhood history of extreme dispositional negativity, it is the subset who also show an attentional bias to threat-related cues on the dot-probe task that is most likely to exhibit social withdrawal and elevated anxiety symptoms later in development, at ages 5 and 15 (Perez-Edgar, Bar-Haim, et al, 2010; Perez-Edgar et al, 2011; White et al, in press). Likewise, there is emerging evidence that clinically effective cognitive-behavioral and pharmacological treatments for anxiety also tend to reduce attentional biases to threat-related cues (Murphy, Yiend, Lester, Cowen, & Harmer, 2009; Reinecke, Waldenmaier, Cooper, & Harmer, 2013; Van Bockstaele et al, 2014). Direct support for this hypothesis comes from studies using computer-based interventions targeting attentional biases to threat.…”

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

“…2 In patients with panic disorder and other anxiety disorders, threat-related stimuli, which are by definition salient, activate neural mechanisms that facilitate fast and preferred processing. [3][4][5][6] This automatic attention to threat-related stimuli is associated with detection and evaluation mechanisms, reorientation of resources and amplification of processing mechanisms. 7 Reviews of functional imaging studies propose a network including the amygdala, brainstem, thalamus, insula, anterior cingulate cortex (ACC), midcingulate cortex (MCC) and medial prefrontal cortex (mPFC) as neural underpinnings of altered threat processing in patients with panic disorder.…”