Startle reflex modulation and autonomic responding during anxious apprehension in panic disorder patients

Melzig, Christiane A.; Weike, Almut I.; Zimmermann, Jörg; Hamm, Alfons O.

doi:10.1111/j.1469-8986.2007.00560.x

Cited by 58 publications

(65 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Contrary to recent suggestions (14), symptoms of depression did not appear to mask elevated fear-potentiated startle in panic disorder patients. Subclinical symptoms on the Beck Depression Inventory did not predict startle.…”

Section: Discussioncontrasting

confidence: 99%

“…Both the large fear-potentiated startle response to the threat cue (15,20,21) and the similar degree of potentiation across groups replicate previous findings (13,14). Contrary to recent suggestions (14), symptoms of depression did not appear to mask elevated fear-potentiated startle in panic disorder patients.…”

Section: Discussionsupporting

confidence: 81%

“…Nevertheless, these findings remain of unclear relevance to research on temporal predictability in animal models of anxiety, i.e., these studies relied on paradigms relatively far removed from models used with rodents. Somewhat surprisingly, in studies that used a more translational approach with humans, we (13) as well as other investigators (14) found that patients with panic disorder displayed normal fear, as indexed by fear-potentiated startle, when anticipating predictable threat. The present study tests the hypothesis that panic disorder involves abnormal response specific to unpredictable threat, despite normal response to predictable threat.…”

supporting

confidence: 60%

“…Five patients had a comorbid diagnosis of social anxiety disorder. Patients with a comorbid past or current major depressive disorder were excluded because depression may reduce fear-potentiated startle (14). Healthy comparison subjects had no current or past psychiatric diagnosis according to the SCID.…”

Section: Methods Participantsmentioning

confidence: 99%

“…Because some data suggest that depression may moderate fear-potentiated startle in panic disorder (14), we excluded subjects with major depression in the present study. Nevertheless, we also considered associations with subthreshold major depressive disorder by calculating the correlation between Beck Depression Inventory scores and fear-potentiated startle in the P condition.…”

Section: Cued Fear-potentiated Startlementioning

confidence: 99%

See 4 more Smart Citations

Increased Anxiety During Anticipation of Unpredictable But Not Predictable Aversive Stimuli as a Psychophysiologic Marker of Panic Disorder

Grillon

Lissek²,

Rabin³

et al. 2008

AJP

275

316

View full text Add to dashboard Cite

Objective-Predictability is a fundamental modulator of anxiety in that the ability to predict aversive events mitigates anxious responses. In panic disorder, persistent symptoms of anxiety are caused by anticipation of the next uncued (unpredictable) panic attack. The authors tested the hypothesis that elevated anxious reactivity, specifically toward unpredictable aversive events, is a psychophysiological correlate of panic disorder.Method-Participants were exposed to one condition in which predictable aversive stimuli were signaled by a cue, a second condition in which aversive stimuli were administered unpredictably, and a third condition in which no aversive stimuli were anticipated. Startle was used to assess anxious responses to cues and contexts.Results-Relative to healthy comparison subjects, patients with panic disorder displayed equivalent levels of fear-potentiated startle to the threat cue but elevated startle potentiation in the context of the unpredictable condition.Conclusions-Patients with panic disorder are overly sensitive to unpredictable aversive events. This vulnerability could be either a premorbid trait marker of the disorder or an acquired condition caused by the experience of uncued panic attacks. As a premorbid trait, vulnerability to unpredictability could be etiologically related to panic disorder by sensitizing an individual to danger, ultimately leading to intense fear/alarm responses to mild threats. As an acquired characteristic, such vulnerability could contribute to the maintenance and worsening of panic disorder symptoms by increasing anticipatory anxiety.Panic disorder involves two cardinal features: panic attacks, defined as acute surges of fear (1), and anticipatory anxiety (2), defined as persistent apprehension about future panic attacks (3). Only a subset of the many individuals who experience panic attacks develop panic disorder. The transition from panic attacks to panic disorder is thought to involve a process whereby anxiety in anticipation of subsequent panic attacks (4) increases the likelihood of additional attacks (5) and leads to full-blown panic disorder (3). According to this assessment, marked anticipatory anxiety about the uncertain recurrence of panic attacks leads to chronic anxiety (2).Interestingly, most research on the physiology of panic disorder focuses specifically on panic attacks as opposed to anticipatory anxiety in panic disorder. Understanding the correlates of Address correspondence and reprint requests to Dr. Grillon, NIMH/MAP, 15K North Dr., Bldg. 15K, Rm. 113, MSC 2670, Bethesda, MD 20892-2670 E-mail: Christian.grillon@nih.gov (e-mail anticipatory anxiety in the disorder may be very important. Because panic attacks typically are irregular and uncertain (2) and are perceived as arising 'out of the blue,' heightened sensitivity to unpredictable aversive events among individuals who experience spontaneous panic attacks may, over time, lead to persistent anticipatory anxiety, facilitating the transition from panic attacks to full-blown pa...

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 81%

supporting

confidence: 60%

Section: Methods Participantsmentioning

confidence: 99%

Section: Cued Fear-potentiated Startlementioning

confidence: 99%

See 3 more Smart Citations

Increased Anxiety During Anticipation of Unpredictable But Not Predictable Aversive Stimuli as a Psychophysiologic Marker of Panic Disorder

Grillon

Lissek²,

Rabin³

et al. 2008

AJP

275

316

View full text Add to dashboard Cite

show abstract

Conditioned Subjective Responses to Socially Relevant Stimuli in Social Anxiety Disorder and Subclinical Social Anxiety

Tinoco-González

Fullana

Torrents-Rodas

et al. 2014

Clin Psychology and Psychoth

View full text Add to dashboard Cite

show abstract

What is an anxiety disorder?

et al. 2009

View full text Add to dashboard Cite

Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of comorbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time. Depression and Anxiety

show abstract

Startle reflex modulation and autonomic responding during anxious apprehension in panic disorder patients

Cited by 58 publications

References 58 publications

Increased Anxiety During Anticipation of Unpredictable But Not Predictable Aversive Stimuli as a Psychophysiologic Marker of Panic Disorder

Increased Anxiety During Anticipation of Unpredictable But Not Predictable Aversive Stimuli as a Psychophysiologic Marker of Panic Disorder

Conditioned Subjective Responses to Socially Relevant Stimuli in Social Anxiety Disorder and Subclinical Social Anxiety

What is an anxiety disorder?

Contact Info

Product

Resources

About