Current findings of fMRI in panic disorder: contributions for the fear neurocircuitry and CBT effects

Abstract

Thanks to brain imaging great advances have been made concerning the comprehension of neural substrates related to panic disorder (PD). This article aims to: review the recent functional MRI (fMRI) studies concerning PD; correlate the PD fMRI neurobiological findings with the fear neurocircuitry hypothesis; discuss the fear neurocircuitry hypothesis and link it to cognitive-behavior therapy findings; and comment on fMRI study limitations and suggest methodological changes for future research. As a whole, there is increasing evidence that brain structures such as the prefrontal cortex, the anterior cingulate cortex and limbic areas (hippocampus and amygdala) might play a major role in the panic response.

Cognitive Dysfunction in FMR1 Premutation Carriers

“…Diffusion tensor imaging studies in men with FXTAS showed white matter abnormalities in the cerebellar-brainstem and limbic systems, in particular the middle and superior cerebellar peduncles, cerebral peduncle, as well as the fornix and stria terminalis [51]. The limbic system (particularly amygdala) plays a major role in the panic response [52]. Structural and functional imaging studies in premutation carriers support this thesis.…”

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

“…8,9 The ROIs (amygdala, insula, thalamus, mPFC, ACC and MCC) were created based on the Automated Anatomic Labelling (AAL) atlas included in the Wake Forest University (WFU) pick atlas 28,29 with a 1 mm dilation factor for the amygdala and insula. For the mPFC, we used the 2 AAL templates "Frontal_Med_Orb" and "Frontal_Sup_ Medial."…”

“…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. [8][9][10] However, the neural basis of the processing of panic-related stimuli when these are irrelevant for the task at hand has not commonly been investigated in patients with panic disorder. Using an emotional Stroop task, greater activation in patients with panic disorder than in healthy controls was found in the prefrontal cortex, 11 ACC, thalamus, amygdala, hippocampus and inferior parietal cortex.…”

Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study

“…Thus, the advantage of going with the patient out into the field during exposure might be mediated by different encoding or learning strategies, possibly also leading to a better cognitive awareness of contingencies for external and internal events. The investigation of the neural correlates of learning mechanisms such as exteroceptive fear conditioning in PD/AG can help to understand CBT-related changes on the brain level [1,28,29,30]. …”

“…Brain imaging studies have related fear conditioning in healthy subjects to a neural network including the amygdalae, hippocampi, insulae, anterior cingulate and medial frontal cortices [1,29,31,32,33,34,35,36,37]. This network has substantial overlap with fear circuitry structures that have been reported to show dysactivation across different anxiety disorders [38,39].…”