Brain activation during disorder-related script-driven imagery in panic disorder: a pilot study

Area of Science:

• Neuroscience
• Psychiatry
• Cognitive Psychology

Background:

• Altered threat processing is a hallmark of panic disorder (PD), but its neural basis remains unclear.
• Mental imagery effectively probes threat perception in anxiety disorders.
• Previous research has not conclusively identified the brain networks involved in PD's threat processing.

Purpose of the Study:

• To investigate brain activation patterns in PD patients using functional magnetic resonance imaging (fMRI) during disorder-specific mental imagery.
• To compare neural responses to threat-related versus neutral scripts in PD patients and healthy controls (HC).

Main Methods:

• Seventeen PD patients and seventeen HC underwent fMRI scans while exposed to newly developed disorder-related and neutral narrative scripts.
• Participants vividly imagined the scenarios and rated their emotional responses post-scan.
• Brain activation differences between PD patients and HC were analyzed for script-specific effects.

Main Results:

• PD patients reported higher arousal, unpleasantness, and anxiety when imagining disorder-related scripts compared to HC.
• Relative to HC, PD patients showed increased activation in the right amygdala and brainstem.
• PD patients exhibited decreased activation in the rostral anterior cingulate cortex and medial/lateral prefrontal cortex during disorder-related imagery.

Conclusions:

• Script-driven imagery reveals distinct neural activation patterns in PD patients.
• Findings suggest altered engagement of amygdala/brainstem and prefrontal cortex networks in PD.
• Opposed activation patterns in key brain networks may underlie dysfunctional threat processing in panic disorder.