Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia

Abstract Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a mar...

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Autores principales:	Jan Richter, Anne Pietzner, Julian Koenig, Julian F. Thayer, Christiane A. Pané-Farré, Alexander L. Gerlach, Andrew T. Gloster, Hans-Ulrich Wittchen, Thomas Lang, Georg W. Alpers, Sylvia Helbig-Lang, Jürgen Deckert, Thomas Fydrich, Lydia Fehm, Andreas Ströhle, Tilo Kircher, Volker Arolt, Alfons O. Hamm
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/07fe94bae055415b88d24768c6f5e249
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spelling	oai:doaj.org-article:07fe94bae055415b88d24768c6f5e2492021-12-02T14:30:33ZVagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia10.1038/s41598-021-86867-y2045-2322https://doaj.org/article/07fe94bae055415b88d24768c6f5e2492021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86867-yhttps://doaj.org/toc/2045-2322Abstract Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a marker of prefrontal inhibition of subcortical defensive activation. We investigated ultra-short-term changes of vagally controlled high frequency heart rate variability (HRV) during a standardized threat challenge (entrapment) in n = 232 patients with panic disorder and agoraphobia, and its interaction with various indices of defensive activation. We found a strong inverse relationship between HRV and heart rate during threat, which was stronger at the beginning of exposure. Patients with a strong increase in heart rate showed a deactivation of prefrontal vagal control while patients showing less heart rate acceleration showed an increase in vagal control. Moreover, vagal control collapsed in case of imminent threat, i.e., when body symptoms increase and seem to get out of control. In these cases of defensive action patients either fled from the situation or experienced a panic attack. Active avoidance, panic attacks, and increased sympathetic arousal are associated with an inability to maintain vagal control over the heart suggesting that teaching such regulation strategies during exposure treatment might be helpful to keep prefrontal control, particularly during the transition zone from post-encounter to circa strike defense. Trial Registration Number: ISRCTN80046034.Jan RichterAnne PietznerJulian KoenigJulian F. ThayerChristiane A. Pané-FarréAlexander L. GerlachAndrew T. GlosterHans-Ulrich WittchenThomas LangGeorg W. AlpersSylvia Helbig-LangJürgen DeckertThomas FydrichLydia FehmAndreas StröhleTilo KircherVolker AroltAlfons O. HammNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jan Richter Anne Pietzner Julian Koenig Julian F. Thayer Christiane A. Pané-Farré Alexander L. Gerlach Andrew T. Gloster Hans-Ulrich Wittchen Thomas Lang Georg W. Alpers Sylvia Helbig-Lang Jürgen Deckert Thomas Fydrich Lydia Fehm Andreas Ströhle Tilo Kircher Volker Arolt Alfons O. Hamm Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
description	Abstract Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a marker of prefrontal inhibition of subcortical defensive activation. We investigated ultra-short-term changes of vagally controlled high frequency heart rate variability (HRV) during a standardized threat challenge (entrapment) in n = 232 patients with panic disorder and agoraphobia, and its interaction with various indices of defensive activation. We found a strong inverse relationship between HRV and heart rate during threat, which was stronger at the beginning of exposure. Patients with a strong increase in heart rate showed a deactivation of prefrontal vagal control while patients showing less heart rate acceleration showed an increase in vagal control. Moreover, vagal control collapsed in case of imminent threat, i.e., when body symptoms increase and seem to get out of control. In these cases of defensive action patients either fled from the situation or experienced a panic attack. Active avoidance, panic attacks, and increased sympathetic arousal are associated with an inability to maintain vagal control over the heart suggesting that teaching such regulation strategies during exposure treatment might be helpful to keep prefrontal control, particularly during the transition zone from post-encounter to circa strike defense. Trial Registration Number: ISRCTN80046034.
format	article
author	Jan Richter Anne Pietzner Julian Koenig Julian F. Thayer Christiane A. Pané-Farré Alexander L. Gerlach Andrew T. Gloster Hans-Ulrich Wittchen Thomas Lang Georg W. Alpers Sylvia Helbig-Lang Jürgen Deckert Thomas Fydrich Lydia Fehm Andreas Ströhle Tilo Kircher Volker Arolt Alfons O. Hamm
author_facet	Jan Richter Anne Pietzner Julian Koenig Julian F. Thayer Christiane A. Pané-Farré Alexander L. Gerlach Andrew T. Gloster Hans-Ulrich Wittchen Thomas Lang Georg W. Alpers Sylvia Helbig-Lang Jürgen Deckert Thomas Fydrich Lydia Fehm Andreas Ströhle Tilo Kircher Volker Arolt Alfons O. Hamm
author_sort	Jan Richter
title	Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
title_short	Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
title_full	Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
title_fullStr	Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
title_full_unstemmed	Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
title_sort	vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/07fe94bae055415b88d24768c6f5e249
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Vagal control of the heart decreases during increasing imminence of interoceptive threat in patients with panic disorder and agoraphobia

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