Indicated prevention of mental disorders in subjects with initial panic symptomatology: effectiveness and underlying mechanisms of action

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Mental disorders are common and associated with considerable individual and societal burden. Thus, increased research efforts are necessary to not only treat but also prevent psychopathology. Previous research has demonstrated that subjects with panic attacks (PA) and their milder forms, fearful spells (FS), are at increased risk for several types of psychopathology including panic but also other mental disorders (e.g., anxiety, depression, substance use). Additional findings suggest that FS/PA may constitute phenotypical indicators of underlying dysfunctions in brain circuits associated with fear/ anxiety (especially excessive threat responsivity) and may thus be useful as target points in prevention research. However, although early intervention in subjects with PA or subthreshold/ mild panic disorder has been shown to effectively reduce panic severity and associated adversity, it is unclear so far whether intervening at initial signs of panic (FS/PA) can prevent a further symptom progression towards panic disorder and various other types of psychopathology. This randomized controlled trial in high-risk subjects with initial panic symptomatology (FS/PA) but no full-threshold mental disorder aims to test whether a brief CBT-based panic-related preventive intervention can effectively reduce current psychopathological symptoms (intervention efficacy) and prospectively prevent the onset of full-threshold mental disorders (prevention efficacy). To identify central mechanisms of action, experimental paradigms (conditioning, NPU threat test and threat-looming test) will be applied examining whether intervention and prevention efficacy are mediated by favorable changes in defensive responsivity to acute threat and potential harm.