title: Changes in automatic threat processing precede and predict clinical changes with exposure-based cognitive-behavior therapy for panic disorder.
abstract: BACKGROUND
  Cognitive behavioral therapy (CBT) is an effective treatment for emotional disorders such as anxiety or depression, but the mechanisms underlying successful intervention are far from understood. Although it has been a long-held view that psychopharmacological approaches work by directly targeting automatic emotional information processing in the brain, it is usually postulated that psychological treatments affect these processes only over time, through changes in more conscious thought cycles. This study explored the role of early changes in emotional information processing in CBT action.
  
  
  METHODS
  Twenty-eight untreated patients with panic disorder were randomized to a single session of exposure-based CBT or waiting group. Emotional information processing was measured on the day after intervention with an attentional visual probe task, and clinical symptoms were assessed on the day after intervention and at 4-week follow-up.
  
  
  RESULTS
  Vigilance for threat information was decreased in the treated group, compared with the waiting group, the day after intervention, before reductions in clinical symptoms. The magnitude of this early effect on threat vigilance predicted therapeutic response after 4 weeks.
  
  
  CONCLUSIONS
  Cognitive behavioral therapy rapidly affects automatic processing, and these early effects are predictive of later therapeutic change. Such results suggest very fast action on automatic processes mediating threat sensitivity, and they provide an early marker of treatment response. Furthermore, these findings challenge the notion that psychological treatments work directly on conscious thought processes before automatic information processing and imply a greater similarity between early effects of pharmacological and psychological treatments for anxiety than previously thought.
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, United Kingdom. andrea.reinecke@psych.ox.ac.uk
authors.forename: Andrea
authors.initials: A
authors.lastname: Reinecke
authors.forename: Lara
authors.initials: L
authors.lastname: Waldenmaier
authors.forename: Myra J
authors.initials: MJ
authors.lastname: Cooper
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Harmer
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D001288:Attention / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004644:Emotions / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016584:Panic Disorder / Q000523:psychology* / Q000534:rehabilitation*; D010775:Photic Stimulation; D011930:Reaction Time / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult