Indicated prevention of mental disorders in subjects with initial panic symptomatology: effectiveness and underlying mechanisms of action
Final Report Abstract
Mental disorders are common and pose a significant burden, highlighting the need for preventionfocused research. Panic attacks (PA) and milder forms, fearful spells (FS), are linked to higher risk for mental disorders (e.g., anxiety, depression, substance use). FS/PA may indicate dysfunctions in fearrelated brain circuits (especially excessive threat responsivity), making them promising prevention targets. Although early intervention in PA or subthreshold/mild panic disorder can effectively reduce panic severity, it is unclear whether intervening at initial signs of panic (FS/PA) can prevent a further progression towards mental disorders. This randomized controlled trial (RCT) in high-risk subjects with FS/PA but no full-threshold mental disorder tested whether a brief CBT-based panic-related preventive intervention can effectively reduce psychopathological symptoms (intervention efficacy) and prevent threshold mental disorders onset (prevention efficacy). To identify central mechanisms of action, experimental paradigms (conditioning, NPU threat test and threat-looming test) were used toof 7 whether intervention and prevention efficacy are accompanied by favorable changes in defensive responsivity to acute threat and potential harm. In three German study centers, 247 participants with PA/FS but no threshold mental disorder within the last 12 months were randomly allocated to an intervention (IG) or control group (CG). The IG received a brief two-session cognitive-behavioral intervention with psychoeducation about panic and exposure exercises. CG participants completed assessments only. Assessments took place before (baseline) and after the intervention (post; or a similar time period for CG) and 12 months later (followup). Analyses regarding intervention efficacy showed that the IG experienced greater improvements in panic symptomatology and closely related outcomes than the CG from baseline to post and baseline to follow-up. Transdiagnostic improvement was visible for somatic and - marginally - depressive symptoms but short term (i.e., from baseline to post, but not from baseline to follow-up). Regarding prevention efficacy, analysis revealed a lower incidence rate of panic and related anxiety disorders in the IG compared to the CG. For other individual groups of mental disorders and “any mental disorder”, the incidence difference was not statistically significant. Analyses from our experimental data revealed significant reductions in indicators of defensive reactivity to acute and potential threat across different paradigms from baseline to post-assessment in the IG, with effects partly sustained at follow-up. No such changes were observed in the CG. Findings suggest that brief indicated cognitive-behavioral interventions can effectively reduce panic and related symptoms and prevent incident panic and related disorders in individuals with PA/FS. Moreover, our results from experimental paradigms indicate that such interventions may also alleviate excessive defensive reactivity and thus can modify not only symptomatology but also underlying neurobiological vulnerability markers. Longer-term follow-up studies are needed to investigate potential transdiagnostic benefits. Screening for fearful spells might be useful to identify target populations for allocation to indicated cognitive-behavioral preventive intervention.
Publications
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Decreased defensive reactivity to interoceptive threat after successful exposure-based psychotherapy in patients with panic disorder. Translational Psychiatry, 11(1).
Benke, Christoph; Alius, Manuela G.; Hamm, Alfons O. & Pané-Farré, Christiane A.
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Defensive Mobilization During Anticipation of Symptom Provocation: Association With Panic Pathology. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 8(4), 397-405.
Benke, Christoph; Alius, Manuela G.; Hamm, Alfons O. & Pané-Farré, Christiane A.
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Effects of an indicated prevention on the reduction of defensive reactivity: A randomized controlled trial in individuals with fearful spells or panic attacks [Conference presentation]. Deutscher Psychotherapie Kongress, Berlin, Germany
Benke, C., Franke, J., Wideburg, S., Asselmann, E., Beesdo-Baum, K. & Melzig, C. A.
