Anxiety Disorders

Abstract

This chapter is about pathological anxiety in psychiatric disorders: phobic disorders, panic disorders, generalized anxiety disorder, and separation anxiety. We describe two typical case examples: agoraphobia and social phobia with all their complexity.

Neurobiological research emphasizes that the perception of new, threatening stimulus constellations generates an unspecific activity pattern in memory-storing associative cortical and subcortical structures. The activity of the HPA axis presents a protecting function in the sense of an emergency reaction. This has sustaining consequences for the functions of neurons and glial cells: gene expression of neurons, production of nervous growth factors, dendritic and axonal growth, development of dendritic spines and synaptic contacts, and reorganization of neural and synaptic connections in the brain.

Neuroimaging studies of the effects of psychotherapy in patients with anxiety disorders show that psychotherapy leads to a decrease of the differences between patients and healthy persons in the sense of normalization. This is not only interesting as a demonstration of the neurobiological effects of psychotherapy but also enables a better understanding of the effects and mechanisms of psychotherapy. Accordingly, in neuropsychodynamic psychotherapy not new or compensatory networks are developed, but instead functional networks are trained, regulated, and normalized, which also can be found in healthy persons. Especially a reduction of the amygdala activity is found in anxiety disorders. In some anxiety disorders, the PFC activity is reduced and on this way “normalized”; in others rather the control of the PFC on the amygdala is improved, without changes of the PFC activity. On this background the neurobiological models of anxiety especially start from a disturbed balance between hyperactive limbic emotional regions (amygdala and insula) and the dysfunctional cingulate control.