Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study

Pfleiderer, Bettina; Berse, Timo; Stroux, D.; Ewert, Adrianna; Konrad, Carsten; Gerlach, Alexander L.

doi:10.1007/s00702-014-1248-5

Cited by 12 publications

(10 citation statements)

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“…The hypothesis of an increased attentional focus in PD towards bodily symptoms and their neural correlates was tested in a study by Pfleiderer et al[43] in a group at risk for PD, i.e ., 24 healthy female students with high levels of anxiety sensitivity. In contrast to 24 females with normal levels of anxiety sensitivity, the highly anxiety-sensitive group reported higher arousal scores and higher activation during interoception (attention on the heartbeats) in a network of cortical, i.e ., frontal, motor regions and subcortical brain regions, i.e ., claustrum, thalamus, amygdala, parahippocampus that overlaps with known fear circuitry structures.…”

Section: Resultsmentioning

confidence: 99%

Functional neuroanatomy in panic disorder: Status quo of the research

Sobanski¹,

Wagner²

2017

WJP

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AIMTo provide an overview of the current research in the functional neuroanatomy of panic disorder.METHODSPanic disorder (PD) is a frequent psychiatric disease. Gorman et al (1989; 2000) proposed a comprehensive neuroanatomical model of PD, which suggested that fear- and anxiety-related responses are mediated by a so-called “fear network” which is centered in the amygdala and includes the hippocampus, thalamus, hypothalamus, periaqueductal gray region, locus coeruleus and other brainstem sites. We performed a systematic search by the electronic database PubMed. Thereby, the main focus was laid on recent neurofunctional, neurostructural, and neurochemical studies (from the period between January 2012 and April 2016). Within this frame, special attention was given to the emerging field of imaging genetics.RESULTSWe noted that many neuroimaging studies have reinforced the role of the “fear network” regions in the pathophysiology of panic disorder. However, recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem, anterior and midcingulate cortex (ACC and MCC), insula, and lateral as well as medial parts of the prefrontal cortex. Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al (2000). Indeed, amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms, sample heterogeneity and size, as well as on limitations of neuroimaging techniques. Advanced neurochemical studies have substantiated the major role of serotonergic, noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD. However, alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable. A promising new research approach is “imaging genetics”. Imaging genetic studies are designed to evaluate the impact of genetic variations (polymorphisms) on cerebral function in regions critical for PD. Most recently, imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor, CRH receptor, human TransMEMbrane protein (TMEM123D), and amiloride-sensitive cation channel 2 (ACCN2) genes.CONCLUSIONIn light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.

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Section: Resultsmentioning

confidence: 99%

Functional neuroanatomy in panic disorder: Status quo of the research

Sobanski¹,

Wagner²

2017

WJP

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“…A subgroup of patients ( n = 89) were invited to participate in the fMRI substudy (33). This analysis is based on a subsample ( n = 59) representing all PD/AG patients who completed CBT (including the assessment of clinical outcomes) as well as an interoception fMRI task (41) at baseline and fMRI data quality assessment (see Figure S1 in Supplementary Material for a flowchart of patient selection). Analogous to Hahn et al (11) a reduction in HAM-A scores ≥50% (primary outcome) from baseline to posttreatment assessment was used as a standard criterion for treatment response (43).…”

Section: Methodsmentioning

confidence: 99%

“…During the fMRI scan, participants performed a mental tracking paradigm (41) adapted from the so-called “Schandry task” (55). The paradigm examines the effects of focusing one’s attention internally (interoception) vs. externally (exteroception) using a block design with four blocks.…”

Section: Methodsmentioning

confidence: 99%

“…In total, two blocks of interoception (I1, I2) and two blocks of exteroception (E1, E2) were presented. This paradigm had been validated previously in anxiety sensitive females (41). …”

Section: Methodsmentioning

confidence: 99%

“…Data were filtered with a high-pass filter (cutoff period of 128 s). The two blocks of interoception and the two blocks of exteroception, respectively, were added to build one condition (I = I1 + I2; E = E1 + E2) (41). …”

Section: Methodsmentioning

confidence: 99%

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Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia

et al. 2017

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BackgroundThe approach to apply multivariate pattern analyses based on neuro imaging data for outcome prediction holds out the prospect to improve therapeutic decisions in mental disorders. Patients suffering from panic disorder with agoraphobia (PD/AG) often exhibit an increased perception of bodily sensations. The purpose of this investigation was to assess whether multivariate classification applied to a functional magnetic resonance imaging (fMRI) interoception paradigm can predict individual responses to cognitive behavioral therapy (CBT) in PD/AG.MethodsThis analysis is based on pretreatment fMRI data during an interoceptive challenge from a multicenter trial of the German PANIC-NET. Patients with DSM-IV PD/AG were dichotomized as responders (n = 30) or non-responders (n = 29) based on the primary outcome (Hamilton Anxiety Scale Reduction ≥50%) after 6 weeks of CBT (2 h/week). fMRI parametric maps were used as features for response classification with linear support vector machines (SVM) with or without automated feature selection. Predictive accuracies were assessed using cross validation and permutation testing. The influence of methodological parameters and the predictive ability for specific interoception-related symptom reduction were further evaluated.ResultsSVM did not reach sufficient overall predictive accuracies (38.0–54.2%) for anxiety reduction in the primary outcome. In the exploratory analyses, better accuracies (66.7%) were achieved for predicting interoception-specific symptom relief as an alternative outcome domain. Subtle information regarding this alternative response criterion but not the primary outcome was revealed by post hoc univariate comparisons.ConclusionIn contrast to reports on other neurofunctional probes, SVM based on an interoception paradigm was not able to reliably predict individual response to CBT. Results speak against the clinical applicability of this technique.

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Examining links between anxiety, reinvestment and walking when talking by older adults during adaptive gait

et al. 2015

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Falls by older adults often result in reduced quality of life and debilitating fear of further falls. Stopping walking when talking (SWWT) is a significant predictor of future falls by older adults and is thought to reflect age-related increases in attentional demands of walking. We examine whether SWWT is associated with use of explicit movement cues during locomotion, and evaluate if conscious control (i.e. movement specific reinvestment) is causally linked to fall-related anxiety during a complex walking task. We observed whether twenty-four older adults stopped walking when talking when asked a question during an adaptive gait task. After certain trials, participants completed a visuospatial recall task regarding walkway features, or answered questions about their movements during the walk. In a subsequent experimental condition, participants completed the walking task under conditions of raised postural threat. Compared to a control group, participants who SWWT reported higher scores for aspects of reinvestment relating to conscious motor processing but not movement self-consciousness. The higher scores for conscious motor processing were preserved when scores representing cognitive function were included as a covariate. There were no group differences in measures of general cognitive function, visuospatial working memory or balance confidence. However, the SWWT group reported higher scores on a test of external awareness when walking, indicating allocation of attention away from task-relevant environmental features. Under conditions of increased threat, participants self-reported significantly greater state anxiety and reinvestment and displayed more accurate responses about their movements during the task. SWWT is not associated solely with age-related cognitive decline or generic increases in age-related attentional demands of walking. SWWT may be caused by competition for phonological resources of working memory associated with consciously processing motor actions and appears to be causally linked with fall-related anxiety and increased vigilance.

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Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study

Cited by 12 publications

References 45 publications

Functional neuroanatomy in panic disorder: Status quo of the research

Functional neuroanatomy in panic disorder: Status quo of the research

Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia

Examining links between anxiety, reinvestment and walking when talking by older adults during adaptive gait

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