Advertisement

Anxiety Disorders

  • Peter Hartwich
  • Heinz Boeker
  • Georg Northoff
Chapter

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.

Keywords

Typical case examples: agoraphobia and social phobia Neurobiological findings on pathological anxiety in psychiatric disorders Neuroimaging studies of the effects of psychotherapy Understanding the mechanisms of psychotherapy 

References

  1. Beutel ME, Stark R, Pan H, et al. Changes of brain activation in pre-post-short-term psychodynamic in-patient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Res Neuroimaging. 2010;184(2):96–104.CrossRefGoogle Scholar
  2. Bishop SJ. Neurocognitive mechanisms of anxiety: an integrative account. Trends Cogn Sci. 2007;11(7):307–16.CrossRefGoogle Scholar
  3. Bowlby J. The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the fiftieth Maudsley lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. Br J Psychiatry. 1977;130(3):201–10.CrossRefGoogle Scholar
  4. Brühl AB, Delsignore A, Komossa K, Weidt S. Neuroimaging in social anxiety disorder – a meta-analytic review resulting in a new neurofunctional model. Neurosci Biobehav Rev. 2014;47:260–80.CrossRefGoogle Scholar
  5. Brühl AB, Herwig U, Rufer M, Weidt S. Neurowissenschaftliche Befunde zur Psychotherapie von Angststörungen. Z Psychiatr Psychol Psychother. 2015;63(2):109–16.Google Scholar
  6. De Masi F. The psychodynamic of panic attacks: a useful integration of psychoanalysis and neuroscience. Int J Psychoanal. 2004;85:311–36.CrossRefGoogle Scholar
  7. Diekhof EK, Geier K, Falkai P, Gruber O. Fear is only as deep as the mind allows: a coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect. NeuroImage. 2011;58:275–85.CrossRefGoogle Scholar
  8. Etkin A. Neurobiology of anxiety disorders: from neural circuits to novel solutions? Depress Anxiety. 2012;29(5):355–8.CrossRefGoogle Scholar
  9. Freud S. Studien über Hysterie. Gesammelte Werke Bd 1, vol. 1977. Frankfurt/M: Fischer; 1892–1899. p. 75–312.Google Scholar
  10. Gabbard GO. Psychodynamic psychiatry in clinical practice. 5th ed. Washington, DC: American Psychiatric; 2014.Google Scholar
  11. Goisman RM, Goldenberg I, Vasile RG, et al. Comorbidity of anxiety disorders in a multicenter anxiety study. Compr Psychiatry. 1995;36:303–11.CrossRefGoogle Scholar
  12. Greenson RR. Phobia, anxiety and depression. J Am Psychoanal Assoc. 1959;7:663–74.CrossRefGoogle Scholar
  13. Gross CT, Canteras NS. The many paths to fear. Nat Rev Neurosci. 2012;13(9):651–8.CrossRefGoogle Scholar
  14. Kendler KS, Neale MC, Kessler RC, et al. Childhood parental loss and adult psychopathology in women: a twin study perspective. Arch Gen Psychiatry. 1992;49:109–16.CrossRefGoogle Scholar
  15. Kiekegaard S. Der Begriff Angst. GW Abt 11/12. Gütersloher Taschenbücher. Gütersloh: Siebenstern; 1981. (Erstveröff. 1844) [893].Google Scholar
  16. Kohn N, Eickhoff SB, Scheller M, et al. Neural network of cognitive emotion regulation–an ALE meta-analysis and MACM analysis. NeuroImage. 2014;87:345–55.CrossRefGoogle Scholar
  17. Kossowsky J, Pfaltz MC, Schneider S, Taeymans J, Locher C, Gaab J. The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry. 2013;170:768–81.CrossRefGoogle Scholar
  18. LeDoux J. The emotional brain: the mysterious underpinnings of emotional life. London: Weidenfeld & Nicolson; 1996.Google Scholar
  19. Leichsenring F, Salzer S, Jäger U, et al. Short-term psychodynamic psychotherapy and cognitive-behavioral psychotherapy in generalized anxiety disorder: a randomized, controlled study. Am J Psychiatry. 2009;166:875–81.CrossRefGoogle Scholar
  20. Leichsenring F, Salzer S, Beutel ME, et al. Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. Am J Psychiatry. 2013;170:759–67.CrossRefGoogle Scholar
  21. Leichsenring F, Salzer S, Beutel ME, et al. Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. Am J Psychiatry. 2014;171:1074–82.CrossRefGoogle Scholar
  22. Mentzos S. Lehrbuch der Psychodynamik. Die Funktion der Dysfunktionalität psychischer Störungen. 5th ed. Göttingen: Vandenhoeck & Ruprecht; 2011.Google Scholar
  23. Paquette V, Levesque J, Mensour B, et al. “Change the mind and you change the brain”: effects of cognitive behavioral therapy on the neural correlates of spider phobia. NeuroImage. 2003;18(2):401–9.CrossRefGoogle Scholar
  24. Rüger U. Angst. In: Müller C, editor. Lexikon der Psychiatrie. 2nd ed. Heidelberg: Springer; 1986. p. S 43–8.Google Scholar
  25. Sartre JP. Being and nothingness. An essay on phenomenological ontology. Translated by Barnes HE, New York: Philosophical library, Inc., L’é’tre et le néant. Essai d’ontologie phénoménologique (1943), Paris: Librairie Gallimard; 1956.Google Scholar
  26. Scharfetter C. Allgemeine psychopathologie. 2nd ed. Stuttgart: Thieme; 1985.Google Scholar
  27. Shear MK, Cooper AM, Klerman GL, et al. A psychodynamic model of panic disorder. Am J Psychiatry. 1993;150:859–79.CrossRefGoogle Scholar
  28. Stein MB, Walker JR, Anderson G, et al. Childhood physical and sexual abuse in patients with anxiety disorders and in a community sample. Am J Psychiatry. 1996;153:275–7.CrossRefGoogle Scholar
  29. Tabbert-Haugg C. Alptraum Prüfung, Gestörtes Prüfungsverhalten als Ausdruck von Schwellenängsten und Identitätskrisen. Stuttgart: Pfeiffer, Klett-Cotta; 2003.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Psychotherapy, PsychosomaticsGeneral Hospital of Frankfurt am Main, Teaching Hospital University FrankfurtFrankfurtGermany
  2. 2.Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric University Hospital Zurich, University of ZurichZurichSwitzerland
  3. 3.Mind, Brain Imaging, and Neuroethics, Institute of Mental Health ResearchUniversity of OttawaOttawaCanada

Personalised recommendations