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Directed threat imagery in generalized anxiety disorder

Published online by Cambridge University Press:  24 July 2017

C. Buff ,
C. Schmidt ,
L. Brinkmann ,
B. Gathmann ,
S. Tupak  and
T. Straube
C. Buff*
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
C. Schmidt
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
L. Brinkmann
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
B. Gathmann
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
S. Tupak
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
T. Straube
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
*
*Address for correspondence: C. Buff, MSc, Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52; 48149 Muenster, Germany. (E-mail: [email protected])
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Abstract

Background

Worrying has been suggested to prevent emotional and elaborative processing of fears. In cognitive-behavioral therapy (CBT), generalized anxiety disorder (GAD) patients are exposed to their fears during the method of directed threat imagery by inducing emotional reactivity. However, studies investigating neural correlates of directed threat imagery and emotional reactivity in GAD patients are lacking. The present functional magnetic resonance imaging (fMRI) study aimed at delineating neural correlates of directed threat imagery in GAD patients.

Method

Nineteen GAD patients and 19 healthy controls (HC) were exposed to narrative scripts of either disorder-related or neutral content and were encouraged to imagine it as vividly as possible.

Results

Rating results showed that GAD patients experienced disorder-related scripts as more anxiety inducing and arousing than HC. These results were also reflected in fMRI data: Disorder-related v. neutral scripts elicited elevated activity in the amygdala, dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and the thalamus as well as reduced activity in the ventromedial prefrontal cortex/subgenual anterior cingulate cortex in GAD patients relative to HC.

Conclusion

The present study presents the first behavioral and neural evidence for emotional reactivity during directed threat imagery in GAD. The brain activity pattern suggests an involvement of a fear processing network as a neural correlate of initial exposure during directed imagery in CBT in GAD.

Keywords

AmygdalaCBTdirected imageryexposure therapyfear networkfMRI
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 4 , March 2018 , pp. 617 - 628
Copyright
Copyright © Cambridge University Press 2017 

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