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Dynamics of defensive reactivity in patients with panic disorder and agoraphobia: Implications for the etiology of panic disorder

Richter, J. and Hamm, A. O. and Pané-Farré, C. A. and Gerlach, A. L. and Gloster, A. T. and Wittchen, H. -U. and Lang, T. and Alpers, G. W. and Helbig-Lang, S. and Deckert, J. and Fydrich, T. and Fehm, L. and Ströhle, A. and Kircher, T. and Arolt, V.. (2012) Dynamics of defensive reactivity in patients with panic disorder and agoraphobia: Implications for the etiology of panic disorder. Biological Psychiatry, 72. pp. 512-520.

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Official URL: http://edoc.unibas.ch/48934/

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Abstract

BACKGROUND:
The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG).
METHODS:
Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test.
RESULTS:
Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks.
CONCLUSIONS:
We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
Faculties and Departments:07 Faculty of Psychology > Departement Psychologie > Forschungsbereich Klinische Psychologie und Neurowissenschaften > Klinische Psychologie und Epidemiologie (Lieb)
UniBasel Contributors:Gloster, Andrew
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Elsevier
ISSN:0006-3223
e-ISSN:1873-2402
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:22 Jan 2018 09:40
Deposited On:22 Jan 2018 09:40

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