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Panic disorder
Panic disorder is a remarkably common psychological condition, characterized by sudden attacks of intense fear and panic. This new edition includes information on the nature, symptoms, causes, theories and treatment of panic disorder, all in non-technical language.
Book
MAOA and mechanisms of panic disorder revisited: from bench to molecular psychotherapy
Panic disorder with agoraphobia (PD/AG) is a prevalent mental disorder featuring a substantial complex genetic component. At present, only a few established risk genes exist. Among these, the gene encoding
monoamine oxidase A
(
MAOA
) is noteworthy given that genetic variation has been demonstrated to influence gene expression and monoamine levels. Long alleles of the
MAOA
-uVNTR promoter polymorphism are associated with PD/AG and correspond with increased enzyme activity. Here, we have thus investigated the impact of
MAOA
-uVNTR on therapy response, behavioral avoidance and brain activity in fear conditioning in a large controlled and randomized multicenter study on cognitive behavioral therapy (CBT) in PD/AG. The study consisted of 369 PD/AG patients, and genetic information was available for 283 patients. Carriers of the risk allele had significantly worse outcome as measured by the Hamilton Anxiety scale (46% responders vs 67%,
P
=0.017). This was accompanied by elevated heart rate and increased fear during an anxiety-provoking situation, that is, the behavioral avoidance task. All but one panic attack that happened during this task occurred in risk allele carriers and, furthermore, risk allele carriers did not habituate to the situation during repetitive exposure. Finally, functional neuroimaging during a classical fear conditioning paradigm evidenced that the protective allele is associated with increased activation of the anterior cingulate cortex upon presentation of the CS+ during acquisition of fear. Further differentiation between high- and low-risk subjects after treatment was observed in the inferior parietal lobes, suggesting differential brain activation patterns upon CBT. Taken together, we established that a genetic risk factor for PD/AG is associated with worse response to CBT and identify potential underlying neural mechanisms. These findings might govern how psychotherapy can include genetic information to tailor individualized treatment approaches.
Journal Article
Evaluation of an Online-Based Self-Help Program for Patients With Panic Disorder: Randomized Controlled Trial
Panic disorder is an anxiety disorder marked by severe fear of panic attacks in the absence of causes. Agoraphobia is a related anxiety disorder, which involves fear and avoidance of specific situations in which escape or help may be difficult. Both can be debilitating and impair well-being. One treatment option may be internet-based cognitive behavioral therapy (iCBT), which allows large-scale application and may overcome treatment barriers for some individuals.
This study aimed to evaluated the effectiveness of a novel online self-help intervention for panic disorder with or without agoraphobia. As our primary hypotheses, we expected the intervention to improve panic and agoraphobia symptoms and well-being. Our secondary hypotheses entailed improvements in daily functioning, mental health literacy, working ability, and health care use in the intervention group.
German-speaking patients (N=156) aged 18-65 years with internet access and a diagnosis of panic disorder with or without agoraphobia were recruited for this randomized controlled trial. The intervention group (n=82) received access to a 12-week online self-help program entailing psychoeducation, cognitive restructuring, exposure, and mindfulness elements. The control group (n=72) received care as usual during the study period and was offered the prospect of using the program after 12 weeks. The primary outcomes were assessed via the Panic and Agoraphobia Scale (PAS) and the WHO (World Health Organization)-5 Well-Being Index (WHO-5). Mixed effect models were computed using multivariate imputation by chained equation for the analysis of intervention effects.
In the intervention group, participants completed on average 7.3 out of 12 (60.8%) modules, and 27 out of 82 (32.1%) participants finished the whole course. Changes in PAS revealed a significant effect in favor of the intervention group (t
=-2.22, P
=.03) with a small to moderate effect size (d=-0.37, 95% CI -0.70 to -0.04). No significant effect was found for the second primary outcome WHO-5 (t
=1.35, P
=.09) or the secondary outcomes. Improvements were observed in anxiety (t
=-4.12; P<.001; Cohen d=-0.60, 95% CI -0.089 to -0.32) and depression (t
=-3.20; P<.001; Cohen d=-0.41 95% CI -0.66 to -0.16). No negative effects were associated with the intervention (t
=-1.14, P=.26).
The presented online intervention can help reduce the core symptomatology of panic disorder and agoraphobia, as well as anxiety symptoms and associated depression. No effects were found for well-being and secondary outcomes. This may be due to higher illness burden in the intervention group and possibly the COVID pandemic, which caused unique challenges to patients suffering from panic disorder. Therefore, further research and intervention adaptations may be warranted to improve these outcomes.
German Clinical Trials Register DRKS00023800; https://drks.de/search/en/trial/DRKS00023800.
Journal Article
Sad girls
Schoolgirl Audrey starts suffering from panic attacks after a lie she told left one of her classmates dead, but she finds hope in the form of Rad, a boy who could turn her life around, but their romance may be ill-timed and push her closer to the edge.
Book
Efficacy of an Internet-based intervention with self-applied exposure therapy in virtual reality for people with panic disorder: study protocol for a randomized controlled trial
Background
Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is Internet-based psychotherapy, which has been shown particularly effective in guided formats. Still, there remains room for improvement to make these digital therapies more accessible, cost-efficient, and aligned with best practices for in-person interventions (e.g., exposure). The smartphone app “Invirto – Treatment for Anxiety” offers digitally guided, evidence-based treatment of panic disorders including virtual reality (VR) for exposure therapy. The aim present study is to investigate the efficacy, safety, and acceptance of Invirto in comparison to a care-as-usual (CAU) control group.
Methods
We plan to conduct a randomized controlled trial with two conditions (intervention vs. CAU), three assessment times via online surveys (t0: baseline; t1: 3 months after baseline; t2: follow-up assessment 6 months after baseline), and a total of 128 participants with a clinical diagnosis of panic disorder (symptoms must be experienced ≥ 1 year). Recruitment will take place via email, phone, and the study website. The primary outcome will be the change in anxiety symptoms as measured by Beck’s Anxiety Inventory from t0 to t1. Secondary outcomes will be the change in anxiety symptoms (measured by the Panic and Agoraphobia Scale, PAS; Questionnaire on panic-related Anxieties, Cognitions and Avoidance, ACA), depressive symptoms (measured by the Beck-Depression-Inventory, BDI-II), treatment satisfaction (measured by the Client Satisfaction Questionnaire, CSQ-8; Treatment Adherence Perception Questionnaire, TAPQ-adapt; Positive and Negative Effects of Psychotherapy Scale, PANEPS-I), psychological flexibility (measured by the Acceptance and Action Questionnaire-II, AAQ-II), and dissociation during VR exposure (measured by an adapted version of the Peritraumatic Dissociative Experiences Questionnaire, PDEQ-adapt). Participants in the intervention group will receive access to the intervention (Invirto) right after t0, while the CAU group will receive access to Invirto after t1. We expect a larger change in both the primary and secondary outcomes from t0 to t1 in the intervention group in comparison to the CAU group.
Discussion
This study is one of the first to evaluate an Internet-based intervention for people with panic disorder that includes self-application of VR exposure therapy. The findings are expected to extend the body of knowledge about effective Internet-based treatment options for people with panic disorder. The empirical and clinical implications and the limitations of the study are discussed.
Trial registration
DRKS00027585 (
www.drks.de/drks_web/
), date of registration: 13 January 2022.
Journal Article
The fear fix : solutions for every child's moments of worry, panic and fear
\"While serious anxiety affects 1 in 5 children and teens, virtually every child has anxious moments and feelings of worry or dread. Fear of bees, robbers, lightning storms, worries about failing and being rejected, panic about sleeping alone--kids and teens experience all this and more. Friendly and authoritative, Sarah Chana Radcliffe helps parents understand the difference between \"normal\" and more serious anxiety, so that parents know when professional help is required and when home treatment is appropriate\"--Back cover.
Book
Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety
Background
Approximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1–2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms.
Methods
This multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore’s largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone.
Discussion
This trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety.
Trial registration
ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.
Journal Article
Her every fear
\"Growing up, Kate Priddy was always a bit neurotic, experiencing momentary bouts of anxiety that exploded into full-blown panic attacks after an ex-boyfriend kidnapped her and nearly ended her life. When Corbin Dell, a distant cousin in Boston, suggests the two temporarily swap apartments, Kate, an art student in London, agrees, hoping that time away in a new place will help her overcome the recent wreckage of her life. But soon after her arrival at Corbin's grand apartment on Beacon Hill, Kate makes a shocking discovery: his next-door neighbor, a young woman named Audrey Marshall, has been murdered\"--Amazon.com.
BOOK
Anterior hippocampal volume predicts affect-focused psychotherapy outcome
The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].
Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.
Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.
This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the 'limbic' AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.
Journal Article