Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-01-09T00:23:58.739Z Has data issue: false hasContentIssue false
  • English
  • Français

Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders

Published online by Cambridge University Press:  21 November 2016

K. Feldker ,
C. Y. Heitmann ,
P. Neumeister ,
S. V. Tupak ,
E. Schrammen ,
R. Moeck ,
P. Zwitserlood ,
M. Bruchmann  and
T. Straube
K. Feldker*
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
C. Y. Heitmann
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
P. Neumeister
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
S. V. Tupak
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
E. Schrammen
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
R. Moeck
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
P. Zwitserlood
Affiliation:
University of Muenster, Muenster, Germany
M. Bruchmann
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
T. Straube
Affiliation:
University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
*
*Address for correspondence: K. Feldker, Institute of Medical Psychology and Systems Neuroscience, Von-Esmarch-Straße 52, D-48149 Muenster, Germany. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed.

Method

The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes.

Results

Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses.

Conclusions

The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.

Keywords

Amygdalafunctional magnetic resonance imagingpanic disordersocial anxiety disorderspecific phobia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 730 - 743
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

† Both authors contributed equally to this work.

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn: DSM-IV-TR®. American Psychiatric Association: Arlington, VA.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association: Arlington, VA.Google Scholar
Ball, T, Rahm, B, Eickhoff, SB, Schulze-Bonhage, A, Speck, O, Mutschler, I (2007). Response properties of human amygdala subregions: evidence based on functional MRI combined with probabilistic anatomical maps. PLoS ONE 2, e307.Google Scholar
Ball, T, Ramsawh, HJ, Campbell-Sills, L, Paulus, MP, Stein, MB (2013). Prefrontal dysfunction during emotion regulation in generalized anxiety and panic disorders. Psychological Medicine 43, 1475–1486.Google Scholar
Bandelow, B (1997). Panic and Agoraphobia Scale (PAS) , vol. III. Hogrefe & Huber Publishers: Ashland, OH.Google Scholar
Baxter, AJ, Scott, KM, Vos, T, Whiteford, HA (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine 43, 897–910.Google Scholar
Blair, K, Geraci, M, Smith, BW, Hollon, N, DeVido, J, Otero, M, Blair, JR, Pine, DS (2012). Reduced dorsal anterior cingulate cortical activity during emotional regulation and top-down attentional control in generalized social phobia, generalized anxiety disorder, and comorbid generalized social phobia/generalized anxiety disorder. Biological Psychiatry 72, 476–482.Google Scholar
Blair, K, Shaywitz, J, Smith, BW, Rhodes, R, Geraci, M, Jones, M, McCaffrey, D, Vythilingam, M, Finger, E, Mondillo, K, Jacobs, M, Charney, DS, Blair, RJR, Drevets, WC, Pine, DS (2008). Response to emotional expressions in generalized social phobia and generalized anxiety disorder: evidence for separate disorders. American Journal of Psychiatry 165, 1193–1202.Google Scholar
Brühl, AB, Delsignore, A, Komossa, K, Weidt, S (2014). Neuroimaging in social anxiety disorder – a meta-analytic review resulting in a new neurofunctional model. Neuroscience and Biobehavioral Reviews 47, 260–280.Google Scholar
Bullmore, ET, Suckling, J, Overmeyer, S, Rabe-Hesketh, S, Taylor, E, Brammer, MJ (1999). Global, voxel, and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain. IEEE Transactions on Medical Imaging 18, 32–42.Google Scholar
Button, KS, Ioannidis, JPA, Mokrysz, C, Nosek, BA, Flint, J, Robinson, ESJ, Munafò, MR (2013). Power failure: why small sample size undermines the reliability of neuroscience. Nature Reviews. Neuroscience 14, 365–376.Google Scholar
Carlson, JM, Greenberg, T, Rubin, D, Mujica-Parodi, LR (2011). Feeling anxious: anticipatory amygdalo-insular response predicts the feeling of anxious anticipation. Social Cognitive and Affective Neuroscience 6, 74–81.Google Scholar
Caseras, X, Giampietro, V, Lamas, A, Brammer, M, Vilarroya, O, Carmona, S, Rovira, M, Torrubia, R, Mataix-Cols, D (2010). The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls. Psychological Medicine 40, 125–134.Google Scholar
Corah, NL (1969). Development of a dental anxiety scale. Journal of Dental Research 48, 596.Google Scholar
Craig, AD (2009). How do you feel – now? The anterior insula and human awareness. Nature Reviews. Neuroscience 10, 59–70.Google Scholar
Craske, MG, Rauch, SL, Ursano, R, Prenoveau, J, Pine, DS, Zinbarg, RE (2009). What is an anxiety disorder? FOCUS: The Journal of Lifelong Learning in Psychiatry 9, 369–388.Google Scholar
Critchley, HD, Wiens, S, Rotshtein, P, Öhman, A, Dolan, RJ (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience 7, 189–195.Google Scholar
Cuthbert, BN (2014). Translating intermediate phenotypes to psychopathology: The NIMH Research Domain Criteria. Psychophysiology 51, 1205–1206.Google Scholar
Cuthbert, BN (2015). Research Domain Criteria: toward future psychiatric nosologies. Dialogues in Clinical Neuroscience 17, 89–97.CrossRefGoogle ScholarPubMed
Dale, AM, Greve, DN, Burock, MA (1999). Optimal stimulus sequences for event-related fMRI. Paper presented at 5th International Conference on Functional Mapping of the Human Brain, Duesseldorf, Germany, 11–16 June 1999.Google Scholar
Davidson, RJ (2002). Anxiety and affective style: role of prefrontal cortex and amygdala. Biological Psychiatry 51, 68–80.Google Scholar
Davis, M, Whalen, PJ (2001). The amygdala: vigilance and emotion. Molecular Psychiatry 6, 13–34.Google Scholar
de Carvalho, MR, Rozenthal, M, Nardi, AE (2010). The fear circuitry in panic disorder and its modulation by cognitive–behaviour therapy interventions. World Journal of Biological Psychiatry 11, 188–198.Google Scholar
Del Casale, A, Ferracuti, S, Rapinesi, C, Serata, D, Piccirilli, M, Savoja, V, Kotzalidis, GD, Manfredi, G, Angeletti, G, Tatarelli, R, Girardi, P (2012). Functional neuroimaging in specific phobia. Psychiatry Research: Neuroimaging 202, 181–197.Google Scholar
Duval, ER, Javanbakht, A, Liberzon, I (2015). Neural circuits in anxiety and stress disorders: a focused review. Therapeutics and Clinical Risk Management 11, 115–126.Google Scholar
Eklund, A, Nichols, T, Knutsson, H (2016). Can parametric statistical methods be trusted for fMRI based group studies? PNAS 113, 7900–7905.Google Scholar
Etkin, A (2010). Functional neuroanatomy of anxiety: a neural circuit perspective. Current Topics in Behavioral Neurosciences 2, 251–277.Google Scholar
Etkin, A, Egner, T, Kalisch, R (2011). Emotional processing in anterior cingulate and medial prefrontal cortex. Trends in Cognitive Sciences 15, 85–93.Google Scholar
Etkin, A, Wager, TD (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry 164, 1476–1488.Google Scholar
Feldker, K, Heitmann, CY, Neumeister, P, Bruchmann, M, Vibrans, L, Zwitserlood, P, Straube, T (2016). Brain responses to disorder-related visual threat in panic disorder. Human Brain Mapping 37. Published online 20 July 2016. doi:10.1002/hbm.23320.Google Scholar
Fischer, H, Wright, CI, Whalen, PJ, McInerney, SC, Shin, LM, Rauch, SL (2003). Brain habituation during repeated exposure to fearful and neutral faces: a functional MRI study. Brain Research Bulletin 59, 387–392.Google Scholar
Foa, EB, Cashman, L, Jaycox, L, Perry, K (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment 9, 445–451.Google Scholar
Fonzo, GA, Ramsawh, HJ, Flagan, TM, Sullivan, SG, Letamendi, A, Simmons, AN, Paulus, MP, Stein, MB (2015). Common and disorder-specific neural responses to emotional faces in generalised anxiety, social anxiety and panic disorders. British Journal of Psychiatry 206, 206–215.Google Scholar
Forster, GL, Novick, AM, Scholl, JL, Watt, MJ (2012). The role of the amygdala in anxiety disorders. In The Amygdala – A Discrete Multitasking Manager (ed. Ferry, B). InTech. (http://www.intechopen.com/books/the-amygdala-a-discrete-multitasking-manager/the-role-of-the-amygdala-in-anxiety-disorders).Google Scholar
Fredrikson, M, Faria, V (2013). Neuroimaging in anxiety disorders. Modern Trends in Pharmacopsychiatry 29, 47–66.Google Scholar
Friedman, MJ, Resick, PA, Bryant, RA, Strain, J, Horowitz, M, Spiegel, D (2011). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety 28, 737–749.Google Scholar
Fujieda, T, Koganezawa, N, Ide, Y, Shirao, T, Sekino, Y (2015). An inhibitory pathway controlling the gating mechanism of the mouse lateral amygdala revealed by voltage-sensitive dye imaging. Neuroscience Letters 590, 126–131.Google Scholar
Hautzinger, M, Bailer, M, Worall, H, Keller, F (1995). Beck-Depressions-Inventar (BDI) . Testhandbuch, 2nd edn. Hans Huber: Bern.Google Scholar
Hayasaka, S, Nichols, TE (2004). Combining voxel intensity and cluster extent with permutation test framework. NeuroImage 23, 54–63.Google Scholar
Heimberg, RG, Horner, KJ, Juster, HR, Safren, SA, Brown, EJ, Schneier, FR, Liebowitz, MR (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine 29, 199–212.Google Scholar
Heitmann, CY, Feldker, K, Neumeister, P, Zepp, BM, Peterburs, J, Zwitserlood, P, Straube, T (2016). Abnormal brain activation and connectivity to standardized disorder-related visual scenes in social anxiety disorder. Human Brain Mapping 37, 1559–1572.Google Scholar
Holzschneider, K, Mulert, C (2011). Neuroimaging in anxiety disorders. Dialogues in Clinical Neuroscience 13, 453–461.Google Scholar
Ipser, JC, Singh, L, Stein, DJ (2013). Meta-analysis of functional brain imaging in specific phobia. Psychiatry and Clinical Neurosciences 67, 311–322.Google Scholar
Itoi, K, Sugimoto, N (2010). The brainstem noradrenergic systems in stress, anxiety and depression. Journal of Neuroendocrinology 22, 355–361.Google Scholar
Janak, PH, Tye, KM (2015). From circuits to behaviour in the amygdala. Nature 517, 284–292.Google Scholar
Jones, BE (2003). Arousal systems. Frontiers in Bioscience: A Journal and Virtual Library 8, s438–s451.Google Scholar
Kalisch, R, Gerlicher, AMV (2014). Making a mountain out of a molehill: on the role of the rostral dorsal anterior cingulate and dorsomedial prefrontal cortex in conscious threat appraisal, catastrophizing, and worrying. Neuroscience and Biobehavioral Reviews 42, 1–8.Google Scholar
Killgore, WDS, Britton, JC, Schwab, ZJ, Price, LM, Weiner, MR, Gold, AL, Rosso, IM, Simon, NM, Pollack, MH, Rauch, SL (2014). Cortico-limbic responses to masked affective faces across PTSD, panic disorder, and specific phobia. Depression and Anxiety 31, 150–159.Google Scholar
Kim, MJ, Loucks, RA, Palmer, AL, Brown, AC, Solomon, KM, Marchante, AN, Whalen, PJ (2011). The structural and functional connectivity of the amygdala: from normal emotion to pathological anxiety. Behavioural Brain Research 223, 403–410.Google Scholar
Kober, H, Barrett, LF, Joseph, J, Bliss-Moreau, E, Lindquist, K, Wager, TD (2008). Functional grouping and cortical–subcortical interactions in emotion: a meta-analysis of neuroimaging studies. NeuroImage 42, 998–1031.Google Scholar
Kriegeskorte, N, Simmons, WK, Bellgowan, PSF, Baker, CI (2009). Circular analysis in systems neuroscience: the dangers of double dipping. Nature Neuroscience 12, 535–540.Google Scholar
Lancaster, JL, Tordesillas-Gutiérrez, D, Martinez, M, Salinas, F, Evans, A, Zilles, K, Mazziotta, JC, Fox, PT (2007). Bias between MNI and Talairach coordinates analyzed using the ICBM-152 brain template. Human Brain Mapping 28, 1194–1205.Google Scholar
Laux, L, Glanzmann, P, Schaffner, P, Spielberger, C-D (1981). State-Trait-Angstinventar. Beltz Test Gesellschaft: Weinheim, Germany.Google Scholar
LeDoux, J (2003). The emotional brain, fear, and the amygdala. Cellular and Molecular Neurobiology 23, 727–738.Google Scholar
LeDoux, J (2007). The amygdala. Current Biology 17, R868–R874.Google Scholar
Lieberman, MD, Cunningham, WA (2009). Type I and type II error concerns in fMRI research: re-balancing the scale. Social Cognitive and Affective Neuroscience 4, 423–428.Google Scholar
Mai, J, Assheur, J, Paxinos, G (2004). Atlas of the Human Brain, 2nd edn. Elsevier/Academic Press: Amsterdam.Google Scholar
Maier, S, Szalkowski, A, Kamphausen, S, Perlov, E, Feige, B, Blechert, J, Philipsen, A, van Elst, LT, Kalisch, R, Tüscher, O (2012). Clarifying the role of the rostral dmPFC/dACC in fear/anxiety: learning, appraisal or expression? PLOS ONE 7, e50120.Google Scholar
Maldjian, JA, Laurienti, PJ, Kraft, RA, Burdette, JH (2003). An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets. NeuroImage 19, 1233–1239.Google Scholar
Maris, E, Oostenveld, R (2007). Nonparametric statistical testing of EEG- and MEG-data. Journal of Neuroscience Methods 164, 177–190.Google Scholar
Menon, V, Uddin, LQ (2010). Saliency, switching, attention and control: a network model of insula function. Brain Structure and Function 214, 655–667.Google Scholar
Nagai, M, Kishi, K, Kato, S (2007). Insular cortex and neuropsychiatric disorders: a review of recent literature. European Psychiatry: The Journal of the Association of European Psychiatrists 22, 387–394.Google Scholar
Neumeister, P, Feldker, K, Heitmann, CY, Helmich, R, Gathmann, B, Becker, M, Straube, T (in press). Interpersonal violence in posttraumatic women: brain networks triggered by trauma-related pictures. Social Cognitive and Affective Neuroscience. Google Scholar
Ochsner, KN, Gross, JJ (2005). The cognitive control of emotion. Trends in Cognitive Sciences 9, 242–249.Google Scholar
Oldfield, RC (1971). The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologia 9, 97–113.Google Scholar
Olesen, J, Gustavsson, A, Svensson, M, Wittchen, H-U, Jönsson, B, CDBE2010 Study Group, European Brain Council (2012). The economic cost of brain disorders in Europe. European Journal of Neurology 19, 155–162.Google Scholar
Pantazatos, SP, Talati, A, Schneier, FR, Hirsch, J (2014). Reduced anterior temporal and hippocampal functional connectivity during face processing discriminates individuals with social anxiety disorder from healthy controls and panic disorder, and increases following treatment. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 39, 425–434.Google Scholar
Paulus, MP, Stein, MB (2006). An insular view of anxiety. Biological Psychiatry 60, 383–387.Google Scholar
Phelps, EA (2006). Emotion and cognition: insights from studies of the human amygdala. Annual Review of Psychology 57, 27–53.Google Scholar
Phelps, EA, LeDoux, J (2005). Contributions of the amygdala to emotion processing: from animal models to human behavior. Neuron 48, 175–187.Google Scholar
Pitkänen, A, Savander, V, LeDoux, J (1997). Organization of intra-amygdaloid circuitries in the rat: an emerging framework for understanding functions of the amygdala. Trends in Neurosciences 20, 517–523.Google Scholar
Raczka, KA, Gartmann, N, Mechias, M-L, Reif, A, Büchel, C, Deckert, J, Kalisch, R (2010). A neuropeptide S receptor variant associated with overinterpretation of fear reactions: a potential neurogenetic basis for catastrophizing. Molecular Psychiatry 15, 1067–1074.Google Scholar
Rauch, SL, Shin, LM, Wright, CI (2003). Neuroimaging studies of amygdala function in anxiety disorders. Annals of the New York Academy of Sciences 985, 389–410.Google Scholar
Schienle, A, Scharmüller, W, Leutgeb, V, Schäfer, A, Stark, R (2012). Sex differences in the functional and structural neuroanatomy of dental phobia. Brain Structure and Function 218, 779–787.Google Scholar
Sehlmeyer, C, Schöning, S, Zwitserlood, P, Pfleiderer, B, Kircher, T, Arolt, V, Konrad, C (2009). Human fear conditioning and extinction in neuroimaging: a systematic review. PLoS ONE 4, e5865.Google Scholar
Sergerie, K, Chochol, C, Armony, JL (2008). The role of the amygdala in emotional processing: a quantitative meta-analysis of functional neuroimaging studies. Neuroscience and Biobehavioral Reviews 32, 811–830.Google Scholar
Shin, LM, Liberzon, I (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 35, 169–191.Google Scholar
Shin, R-M (2012). Cellular mechanisms in the amygdala involved in memory of fear conditioning. In The Amygdala – A Discrete Multitasking Manager (ed. Ferry, B). InTech. (http://www.intechopen.com/books/the-amygdala-a-discrete-multitasking-manager/cellular-mechanisms-in-the-amygdala-involved-in-memory-of-fear-conditioning).Google Scholar
Stangier, U, Heidenreich, T (2005). Liebowitz Social Anxiety Scale – German version. Hogrefe: Göttingen.Google Scholar
Sterzer, P, Kleinschmidt, A (2010). Anterior insula activations in perceptual paradigms: often observed but barely understood. Brain Structure and Function 214, 611–622.Google Scholar
Straube, T, Mentzel, H-J, Miltner, WHR (2006). Neural mechanisms of automatic and direct processing of phobogenic stimuli in specific phobia. Biological Psychiatry 59, 162–170.Google Scholar
Sullivan, GM, Coplan, JD, Kent, JM, Gorman, JM (1999). The noradrenergic system in pathological anxiety: a focus on panic with relevance to generalized anxiety and phobias. Biological Psychiatry 46, 1205–1218.Google Scholar
Sylvester, CM, Corbetta, M, Raichle, ME, Rodebaugh, TL, Schlaggar, BL, Sheline, YI, Zorumski, CF, Lenze, EJ (2012). Functional network dysfunction in anxiety and anxiety disorders. Trends in Neurosciences 35, 527–535.Google Scholar
Talairach, J, Tournoux, P (1988). Co-Planar Stereotaxic Atlas of the Human Brain. Thieme: New York.Google Scholar
Taylor, JM, Whalen, PJ (2015). Neuroimaging and anxiety: the neural substrates of pathological and non-pathological anxiety. Current Psychiatry Reports 17, 49.Google Scholar
Taylor, SF, Liberzon, I, Fig, LM, Decker, LR, Minoshima, S, Koeppe, RA (1998). The effect of emotional content on visual recognition memory: a PET activation study. NeuroImage 8, 188–197.Google Scholar
Tovote, P, Fadok, JP, Lüthi, A (2015). Neuronal circuits for fear and anxiety. Nature Reviews. Neuroscience 16, 317–331.Google Scholar
Tzourio-Mazoyer, N, Landeau, B, Papathanassiou, D, Crivello, F, Etard, O, Delcroix, N, Mazoyer, B, Joliot, M (2002). Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage 15, 273–289.Google Scholar
van den Heuvel, OA, Veltman, DJ, Groenewegen, HJ, Witter, MP, Merkelbach, J, Cath, DC, van Balkom, AJLM, van Oppen, P, van Dyck, R (2005). Disorder-specific neuroanatomical correlates of attentional bias in obsessive–compulsive disorder, panic disorder, and hypochondriasis. Archives of General Psychiatry 62, 922–933.Google Scholar
Wessa, M, Kanske, P, Neumeister, P, Bode, K, Heissler, J, Schönfelder, S (2010). EmoPics: Subjektive und psychophysiologische Evaluationen neuen Bildmaterials für die klinisch-bio-psychologische Forschung. Zeitschrift für Klinischer Psychologie und Psychotherapie 39 (Suppl. 1/11), 77.Google Scholar
Wittchen, H-U, Wunderlich, U, Gruschwitz, S, Zaudig, M (1997). SKID I. Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen. Interviewheft und Beurteilungsheft. Eine deutschsprachige, erweiterte Bearb. d. amerikanischen Originalversion des SKID I. Hogrefe: Göttingen.Google Scholar
Zald, DH (2003). The human amygdala and the emotional evaluation of sensory stimuli. Brain Research Reviews 41, 88–123.Google Scholar
Zoellner, LA, Rothbaum, BO, Feeny, NC (2011). PTSD not an anxiety disorder? DSM Committee proposal turns back the hands of time. Depression and Anxiety 28, 853–856.Google Scholar
Supplementary material: File

Feldker supplementary material

Tables S1-S3

Download Feldker supplementary material(File)
File 60.4 KB