The anxiety spectrum and the reflex physiology of defense: from circumscribed fear to broad distress.
The anxiety spectrum and the reflex physiology of defense: from circumscribed fear to broad distress.
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DOI：
10.1002/da.21891
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发表时间：
2012-04
影响因子：
7.4
通讯作者：
Lang, Peter J.
中科院分区：
文献类型：
--
作者：
McTeague, Lisa M.;Lang, Peter J.
关键词：
在诊断分类学的指导下，焦虑患者预计在情感挑战期间表现出防御性亢进，无论其主要表型如何。在本研究中，代表整个焦虑症谱系的患者（即特定恐惧症、社交恐惧症、伴有或不伴有广场恐怖症的恐慌症、强迫症、广泛性焦虑症（GAD）、创伤后应激障碍（PTSD））和健康的社区对照参与者，完成了一个基于图像的恐惧激发范式，与传统干预技术平行。参与者想象威胁性和中性的叙述作为生理反应被记录下来。明确的证据表明，对临床相关图像的反应性被夸大了——最明显的是惊吓反射反应。然而，防御倾向在主要焦虑障碍中有所不同。以局灶性恐惧和损害为特征的障碍（例如，特定恐惧症）表现出强烈的恐惧增强。相反，对于具有广泛的焦虑和抑郁共病的长期、普遍的恐惧和回避障碍（例如，继发于累积性创伤的创伤后应激障碍，广泛性焦虑症），惊吓反应矛盾地减少到所有厌恶内容。在严重程度和慢性程度上表现出介于局灶性恐惧和广泛性焦虑痛苦之间的患者表现出更高但更普遍的防御性生理倾向。重要的是，这种防御性生理梯度——与自我报告的痛苦相反——不仅在疾病之间，而且在疾病内部都很明显。这些结果强调，慢性广泛性焦虑的恐惧回路可能失调，初步的功能性神经影像学结果表明，杏仁核募集不足可能是反射反应减弱的基础。总之，在想象过程中的适应性防御参与可能会受到长期烦躁不安和压力的影响，这是一种影响预后和治疗计划的现象。抑郁与焦虑，2012,29(2):264 - 281。
Guided by the diagnostic nosology, anxiety patients are expected to show defensive hyperarousal during affective challenge, irrespective of the principal phenotype. In the current study, patients representing the whole spectrum of anxiety disorders (i.e., specific phobia, social phobia, panic disorder with or without agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder (GAD), posttraumatic stress disorder(PTSD)), and healthy community control participants, completed an imagery-based fear elicitation paradigm paralleling conventional intervention techniques. Participants imagined threatening and neutral narratives as physiological responses were recorded. Clear evidence emerged for exaggerated reactivity to clinically relevant imagery—most pronounced in startle reflex responding. However, defensive propensity varied across principal anxiety disorders. Disorders characterized by focal fear and impairment (e.g., specific phobia) showed robust fear potentiation. Conversely, for disorders of long-enduring, pervasive apprehension and avoidance with broad anxiety and depression comorbidity (e.g., PTSD secondary to cumulative trauma, GAD), startle responses were paradoxically diminished to all aversive contents. Patients whose expressed symptom profiles were intermediate between focal fearfulness and broad anxious-misery in both severity and chronicity exhibited a still heightened but more generalized physiological propensity to respond defensively. Importantly, this defensive physiological gradient—the inverse of self-reported distress—was evident not only between but also within disorders. These results highlight that fear circuitry could be dysregulated in chronic, pervasive anxiety, and preliminary functional neuroimaging findings suggest that deficient amygdala recruitment could underlie attenuated reflex responding. In summary, adaptive defensive engagement during imagery may be compromised by long-term dysphoria and stress—a phenomenon with implications for prognosis and treatment planning. Depression and Anxiety 29:264–281, 2012.
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