Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder

Area of Science:

• Neuroscience
• Psychiatry
• Cognitive Science

Background:

• Panic disorder (PD) is characterized by heightened arousal and alerting.
• Anxiety sensitivity (ASI) is a key dimensional measure of panic-related anxiety.
• The neural underpinnings of the alerting network in PD require further investigation.

Purpose of the Study:

• To investigate the alerting network in patients with panic disorder compared to healthy controls.
• To examine the relationship between anxiety sensitivity and brain connectivity in the alerting network.
• To assess the impact of cognitive-behavioral therapy (CBT) on the alerting network and its correlation with treatment response.

Main Methods:

• Functional magnetic resonance imaging (fMRI) and Dynamic Causal Modeling (DCM) were used to analyze brain activation and effective connectivity during the Attention Network Task (ANT).
• 45 out-patients with PD and 51 healthy controls participated.
• Participants were rescanned after a 6-week intervention period (CBT for PD patients, waiting list for controls).

Main Results:

• Patients with PD showed decreased activation in fronto-parietal pathways (middle frontal gyrus [MFG], superior parietal lobule [SPL]) in the alerting condition.
• Anxiety sensitivity index (ASI) scores negatively correlated with connectivity from SPL, SFB, and LC to MFG in PD patients.
• CBT led to increased MFG and parietal activation and enhanced MFG-to-SPL connectivity, which correlated with reduced ASI scores.

Conclusions:

• Panic disorder involves a pathological disintegration of the MFG within the fronto-parietal alerting network.
• This neural alteration is linked to anxiety sensitivity and is reversible with successful CBT.
• Findings highlight the role of the alerting network in PD pathophysiology and treatment.