title: Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative.
abstract: In the current review, we reconceptualize a categorical diagnosis-panic disorder and agoraphobia-in terms of two constructs within the domain "negative valence systems" suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N = 369 and N = 124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension-characterized by attentive freezing during postencounter defense-was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.
authors.affiliation: Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
authors.forename: Alfons O
authors.initials: AO
authors.lastname: Hamm
authors.affiliation: Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Richter
authors.affiliation: Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Pané-Farré
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Dorte
authors.initials: D
authors.lastname: Westphal
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Vossbeck-Elsebusch
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerlach
authors.affiliation: Department of Psychology, University of Basel, Basel, Switzerland.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gloster
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ströhle
authors.affiliation: Christoph-Dornier Foundation for Clinical Psychology, Bremen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lang
authors.affiliation: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kircher
authors.affiliation: Department Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
authors.forename: Antje B M
authors.initials: AB
authors.lastname: Gerdes
authors.affiliation: Department Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
authors.forename: Georg W
authors.initials: GW
authors.lastname: Alpers
authors.affiliation: Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Frankfurt, Frankfurt, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reif
authors.affiliation: Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Würzburg, Würzburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Deckert
mesh_terms: D000379:Agoraphobia / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D000818:Animals; D001362:Avoidance Learning / Q000502:physiology; D002986:Clinical Trials as Topic; D003674:Defense Mechanisms; D005260:Female; D006801:Humans; D008297:Male; D008959:Models, Neurological; D015337:Multicenter Studies as Topic; D009488:Neurosciences / Q000379:methods; D016584:Panic Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013216:Reflex, Startle; D012307:Risk Factors
keywords: Anxiety; Autonomic; Genetics; Psychopathological; Psychopathology; Startle Blink