OBJECTIVE Cognitive-behavioral therapy (CBT) has been hypothesized to act by reducing the pathologically enhanced semantic, anxiety-related associations of patients with panic disorder. This study investigated the effects of CBT on the behavioral and neural correlates of the panic-related semantic network in patients with panic disorder. METHODS An automatic semantic priming paradigm specifically tailored for panic disorder, in which panic symptoms (e.g., "dizziness") were primed by panic triggers (e.g., "elevator") compared with neutral words (e.g., "bottle"), was performed during functional MRI scanning with 118 patients with panic disorder (compared with 150 healthy control subjects) before and 42 patients (compared with 52 healthy control subjects) after an exposure-based CBT. Neural correlates were investigated by comparing 103 pairs of matched patients and control subjects at the baseline (for patients) or T1 (for control subjects) assessment and 39 pairs at the posttreatment or T2 assessment. RESULTS At baseline or T1, patients rated panic-trigger/panic-symptom word pairs with higher relatedness and higher negative valence compared with healthy control subjects. Patients made faster lexical decisions to the panic-symptom words when they were preceded by panic-trigger words. This panic-priming effect in patients (compared with control subjects) was reflected in suppressed neural activation in the left and right temporal cortices and insulae and enhanced activation in the posterior and anterior cingulate cortices. After CBT, significant clinical improvements in the patient group were observed along with a reduction in relatedness and negative valence rating and attenuation of neural activation in the anterior cingulate cortex for processing of panic-trigger/panic-symptom word pairs. CONCLUSIONS The findings support a biased semantic network in panic disorder, which is normalized after CBT. Attenuation of anterior cingulate cortex activation for processing of panic-related associations provides a potential mechanism for future therapeutic interventions.

中文翻译：

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CBT对恐慌症患者偏爱语义网络的影响：使用语义启动的多中心功能磁共振成像研究。

目的认知行为疗法（CBT）已被认为可以通过减少恐慌症患者在病理上增强的语义，焦虑相关联来发挥作用。这项研究调查了CBT对惊恐症患者惊恐相关语义网络的行为和神经相关性的影响。方法一种专门针对惊恐症而设计的自动语义启动范例，在该过程中，与中性词（例如“瓶”）相比，惊恐症状（例如“头晕”）由恐慌触发器（例如“电梯”）引发，功能性MRI扫描在基于暴露的CBT之前和之后对118位恐慌症患者（与150名健康对照者进行比较）和42位患者（与52名健康对照者相比）进行了MRI扫描。通过比较基线（针对患者）或T1（针对对照对象）评估的103对配对患者和对照受试者与治疗后或T2评估中的39对配对患者和对照受试者的神经相关性，进行了研究。结果在基线或T1时，与健康对照组相比，患者对恐慌触发/惊恐症状词对的关联性更高，负价也更高。当患者在惊恐触发词之前，他们会对惊恐症状词做出更快的词汇决定。对患者（与对照对象相比）的这种惊恐启动效果反映在左和右颞皮层和岛突的抑制的神经激活以及后扣带回和前扣带回的增强的激活中。在CBT之后，观察到患者组的临床显着改善，以及用于处理恐慌触发/恐慌症状对的前扣带回皮层的相关性和负价数降低以及神经激活减弱。结论研究结果支持恐慌症中有偏见的语义网络，该网络在CBT后可正常化。用于处理恐慌相关协会的前扣带回皮层激活的衰减为将来的治疗干预提供了潜在的机制。