Treatment-related changes towards normalization of the abnormal external signal processing in panic disorder

Abstract

Despite the scientific consensus on the efficacy of psychotherapy for the treatment of psychological disorders, the evidence of treatment-related changes towards normalization of abnormal brain functions in patients is mixed. In the present experiment, we investigated whether treatment can affect early information processing, by testing abnormal eventrelated potentials (ERPs) evoked by internal and external signals in panic disorder. Sixteen patients with panic disorder and comorbid personality disorder and sixteen control participants performed a response-choice task and a passive viewing task in two testing sessions, separated by around 14 months. During this period, patients received psychological treatment. In agreement with previous studies of performance monitoring, the abnormal amplitude of the Ne/ERN-an index of error processing based on internal signals-did not change between the first and second testing session. However, treatment-related changes were evident for the abnormal vertex positive potential (VPP) evoked by external signals in the response-choice task and the passive viewing task. In patients, the VPP was smaller in the second session compared to the first session, whereas no significant changes occurred in controls. This result supplies evidence of treatment-related changes towards normalization in the early information processing of external visual stimuli in panic disorder. OPEN ACCESS Citation: Valt C, Huber D, Stürmer B (2020) Treatment-related changes towards normalization of the abnormal external signal processing in panic disorder. PLoS ONE 15(1): e0227673. https://doi.

The Processing of Visual Signals in Major Depressive Disorder

“…The results revealed that the VPP evoked by feedback signals in the response-choice task and by pictures in the passive viewing task was larger in PD patients than controls 23 and that 1 year of psychotherapy resulted in a significant normalization of this abnormal response. 24 An enhanced VPP in PD patients conforms well to the hypothesis that fear might determine hypervigilance, resulting in enhanced processing of the external world. However, in depression, the tendency towards the mental world might distract from the accurate processing of the external world, resulting in a significant reduction of the VPP evoked by visual stimuli.…”

“…Importantly, in a recent study on PD patients after 1 year of psychotherapy, Valt and collaborators showed that the VPP is sensitive to treatment-induced changes in visual processing. 24 The sensitivity of the VPP to functional normalizations induced by treatment might offer a potential tool for tracking the signs of progress also in MDD patients.…”

“…The present experiment aims to investigate perceptual processes in MDD patients and controls by employing an experimental design that has offered exciting outcomes in the study of external signal processing in panic disorder (PD) before the beginning of treatment 23 and after 1 year of psychotherapy. 24 In these studies, Valt and collaborators employed a response-choice task and a passive viewing task to detect potential differences in the amplitude of the VPP evoked by visual material in patients and controls. The results revealed that the VPP evoked by feedback signals in the response-choice task and by pictures in the passive viewing task was larger in PD patients than controls 23 and that 1 year of psychotherapy resulted in a significant normalization of this abnormal response.…”

Cautionary Observations Concerning the Introduction of Psychophysiological Biomarkers into Neuropsychiatric Practice

“…Valt et al [134] investigated a related internalizing disorder, panic disorder, and, consistent with prior literature, found that compared to controls, untreated participants had a greater ERN and also a greater vertex positive potential. In a subsequent treatment study, Valt et al [135] found that, as before, the ERN did not normalize in response to psychological treatment, but treatment-related normalization of the vertex positive potential was observed.…”

Cautionary Observations Concerning the Introduction of Psychophysiological Biomarkers into Neuropsychiatric Practice

“…Valt, et al [100] investigated a related internalizing disorder, panic disorder, and consistent with prior literature found that compared to controls untreated participants had a greater ERN and also a greater vertex positive potential. In a subsequent treatment study, Valt, et al [101] found that as before the ERN did not normalize in response to psychological treatment, but treatment related normalization of the vertex positive potential was observed.…”