Zentralnervöse Korrelate der Verarbeitung bedrohungsrelevanter Reize bei Phobikern und Gesunden
Abstract
Zusammenfassung. Der verstärkte Einsatz bildgebender Verfahren, wie z.B. der funktionellen Magnetresonanztomographie, hat in den letzten Jahren zu zahlreichen Befunden geführt, die unser Wissen über die neuronalen Grundlagen der normalen und pathologischen Verarbeitung bedrohungsrelevanter Reize erweitert haben. Bei Phobikern konnten dadurch unter anderem Gehirnareale genauer identifiziert werden, die an der automatischen und kontrollierten Stimulusverarbeitung beteiligt sind. Die mittels funktioneller Bildgebung und elektrophysiologischer Methoden aufgezeigten zentralnervösen Aktivierungsmuster können nicht nur zu einem besseren Verständnis der neuronalen Basis von Angststörungen, sondern auch zur neurobiologischen Fundierung von Psychotherapieeffekten beitragen. Im vorliegenden Artikel werden aktuelle Befunde zur Gehirnaktivierung während der Verarbeitung von Bedrohungsreizen bei Gesunden und Phobikern dargestellt und im Rahmen gegenwärtiger Modellvorstellungen diskutiert.
Abstract. The increasing use of neuroimaging techniques, such as functional magnetic resonance imaging, resulted in numerous new findings, which extended the knowledge regarding the neuronal basis of normal and pathological processing of threat-relevant stimuli. This research identified brain areas, which are involved in automatic and controlled information processing in phobic subjects. The results provided by functional imaging and electrophysiological methods led to a deeper understanding of the neural basis of both the symptoms of anxiety disorders and the success of psychotherapeutic treatment. In this article, we review and discuss current models of fear elicitation and new findings on brain activation patterns during threat processing in healthy subjects and phobics.
Literatur
Adolphs, R. , Gosselin, F. , Buchanan, T. W. , Tranel, D. , Schyns, P. , Damasio, A. R. (2005). A mechanism for impaired fear recognition after amygdala damage. Nature , 433, 7021 68– 72Aggleton, J. P. , Passingham, R. E. (1981). Syndrome produced by lesions of the amygdala in monkeys (Macaca mulatta). Journal of Comparative and Physiological Psychology , 95, 961– 977Aggleton, J. P. (2003). The amygdala: a functional analysis . Oxford: Oxford Univ. PressAmir, N. , Foa, E. B. , Coles, M. E. (1998). Automatic activation and strategic avoidance of threat-relevant information in social phobia. Journal of Abnormal Psychology , 107, 2 285– 290Anderson, A. K. , Phelps, E. A. (2001). Lesions of the human amygdala impair enhanced perception of emotionally salient events. Nature , 411, 6835 305– 309Armony, J. L. , LeDoux, J. E. (1997). How the brain processes emotional information. Annals of the New York Academy of Sciences , 821, 259– 270Bechara, A. , Tranel, D. , Damasio, H. , Adolphs, R. , Rockland, C. , Damasio, A. R. (1995). Double dissociation of conditioning and declarative knowledge relative to the amygdala and hippocampus in humans. Science , 269, 1115– 1118Beck, A. T. , Emery, G. , Grennberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective . New York: Basic BooksBirbaumer, N. , Grodd, W. , Diedrich, O. , Klose, U. , Erb, M. , Lotze, M. , Schneider, F. , Weiss, U. , Flor, H. (1998). fMRI reveals amygdala activation to human faces in social phobics. Neuroreport , 9, 1223– 1226Bishop, S. J. , Duncan, J. , Lawrence, A. D. (2004). State anxiety modulation of the amygdala response to unattended threat-related stimuli. Journal of Neuroscience , 24, 10364– 10368Bögels, S. M. , Mansell, W. (2004). Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention. Clinical Psychology Review , 24, 827– 856Breiter, H. C. , Etcoff, N. L. , Whalen, P. J. , Kennedy, W. A. , Rauch, S. L. , Buckner, R. L. , Strauss, M. M. , Hyman, S. E. , Rosen, B. R. (1996). Response and habituation of the human amygdala during visual processing of facial expression. Neuron , 17, 875– 887Büchel, C. , Morris, J. , Dolan, R. J. , Friston, K. J. (1998). Brain systems mediating aversive conditioning: an event-related fMRI study. Neuron , 20, 947– 957Bush, G. , Luu, P. , Posner, M. I. (2000). Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Sciences , 4, 215– 222Carlsson, K. , Petersson, K. M. , Lundqvist, D. , Karlsson, A. , Ingvar, M. , Ohman, A. (2004). Fear and the amygdala: manipulation of awareness generates differential cerebral responses to phobic and fear-relevant (but nonfeared) stimuli. Emotion , 4, 340– 353Clark, D. M. , McManus, F. (2002). Information processing in social phobia. Biological Psychiatry , 51, 92– 100Cloitre, M. , Heimberg, R. G. , Holt, C. S. , Liebowitz, M. R. (1992). Reaction time to threat stimuli in panic disorder and social phobia. Behaviour Research and Therapy , 30, 609– 617Constantine, R. , McNally, R. J. , Hornig, C. D. (2001). Snake Fear und the Pictorial Emotional Stroop Paradigm. Cognitive Therapy & Research , 25, 757– 764Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience , 3, 655– 666Critchley, H. D. , Mathias, C. J. , Dolan, R. J. (2002). Fear conditioning in humans: the influence of awareness and autonomic arousal on functional neuroanatomy. Neuron , 33, 653– 663Critchley, H. D. , Mathias, C. J. , Josephs, O. , O’Doherty, J. , Zanini, S. , Dewar, B. K. , Cipolotti, L. , Shallice, T. , Dolan, R. J. (2003). Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain , 126, 2139– 2152Critchley, H. D. , Wiens, S. , Rotshtein, P. , Öhman, A. , Dolan, R. J. (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience , 7, 189– 195Damasio, A. R. , Grabowski, T. J. , Bechara, A. , Damasio, H. , Ponto, L. L. , Parvizi, J. , Hichwa, R. D. (2000). Subcortical and cortical brain activity during the feeling of self-generated emotions. Nature Neuroscience , 3, 1049– 1056Davis, M. , Whalen, P.J. (2001). The amygdala: vigilance and emotion. Molecular Psychiatry , 6, 1 13– 34Dilger, S. , Straube, T. , Mentzel, H. J. , Fitzek, C. , Reichenbach, J. R. , Hecht, H. , Krieschel, S. , Gutberlet, I. , Miltner, W. H. (2003). Brain activation to phobia-related pictures in spider phobic humans: an event-related functional magnetic resonance imaging study. Neuroscience Letters , 348, 29– 32Eysenck, M. W. (1997). Anxiety and cognition: a unified theory . Hove: Psychology PressFredrikson, M. , Wik, G. , Greitz, T. , Eriksson, L. , Stone-Elander, S. , Ericson, K. , Sedvall, G. (1993). Regional cerebral blood flow during experimental phobic fear. Psychophysiology , 30, 126– 130Furmark, T. , Tillfors, M. , Marteinsdottir, I. , Fischer, H. , Pissiota, A. , Langstrom, B. , Fredrikson, M. (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Archives of General Psychiatry , 59, 425– 433Gray, J. A. , McNaughton, N. (2000). The neuropsychology of anxiety . Oxford University PressGutberlet, I. , Krieschel, S. , Miltner, W. H. R. (1999a). Electrocortical processing of subliminally presented phobogenic stimuli. Psychophysiology , 36, S56– S56Gutberlet, I. , Krieschel, S. , Miltner, W. H. R. (1999b). Influence of recognition correctness and subjective certainty on electrocortical processing of subliminally applied phobogenic stimuli. Psychophysiology , 36, S56– S56Hamm, O. , Weike, A. I. , Melzig, C. (2005). Wenn Furcht und Angst entgleisen: Zur Pathologie des menschlichen Defensivsystems. Psychologische Rundschau , 57, 154– 164Johnson, R. (1984). P300: A model of the variables controlling its amplitude. Annals of the New York Academy of Sciences , 425, 223– 229Johnson, R. (1986). A Triarchic Model of P300 amplitude. Psychophysiology , 23, 4 367– 384Junghöfer, M. , Bradley, M. M. , Elbert, T. R. , Lang, P. J. (2001). Fleeting images: a new look at early emotion discrimination. Psychophysiology , 38, 175– 178Kalin, N. H. , Shelton, S. E. , Davidson, R. J. , Kelley, A. E. (2001). The primate amygdala mediates acute fear but not the behavioral and physiological components of anxious temperament. Journal of Neuroscience , 21, 2067– 2074Kindt, M. , Bierman, D. , Brosschot, J. F. (1997). Cognitive bias in spider fear and control children: assessment of emotional interference by a card format and a single-trial format of the stroop task. Journal of Experimental Child Psychology , 66, 163– 179Kindt, M. , Brosschot, J. F. (1997). Phobia-related cognitive bias for pictorial and linguistic stimuli. Journal of Abnormal Psychology , 106, 644– 648Kindt, M. , van den Hout, M. A. (2001). Selective Attention and Anxiety: A Perspective on Developmental Issues and the Causal Status. Journal of Psychopathology and Behavioral Assessment , 23, 193– 202Klüver, H. , Bucy, P. (1937). “Psychic blindness“ and other symptoms following temporal lobectonomy in Rhesus monkeys. American Journal of Physiology , 119, 352– 352Kolassa, I.-T. , Musial, F. , Mohr, A. , Hecht, H. , Trippe, R. , Miltner, W. H. R. (2005). Electrophysiological correlates of threat processing in spider phobics. Psychophysiology , 42, 520– 530LaBar, K. S. , LeDoux, J. E. , Spencer, D. D. , Phelps, E. A. (1995). Impaired fear conditioning following unilateral temporal lobectomy in humans. Journal of Neuroscience , 15, 6846– 6855Lane, R. D. , Reiman, E. M. , Axelrod, B. , Yun, L. S. , Holmes, A. , Schwartz, G. E. (1998). Neural correlates of levels of emotional awareness. Evidence of an interaction between emotion and attention in the anterior cingulate cortex. Journal of Cognitive Neuroscience , 10, 525– 535LeDoux, J. (1998). Fear and the brain: where have we been, and where are we going?. Biological Psychiatry , 44, 1229– 1238LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience , 23, 155– 184Lang, P. J. , Davis, M. , Öhman, A. (2000). Fear and anxiety: animal models and human cognitive psychophysiology. Journal of Affective Disorders , 61, 3 37– 59Liberzon, I. , Taylor, S. F. , Amdur, R. , Jung, T. D. , Chamberlain, K. R. , Minoshima, S. , Koeppe, R. A. , Fig, L. M. (1999). Brain activation in PTSD in response to trauma-related stimuli. Biological Psychiatry , 45, 817– 26Liddell, B. J. , Williams, L. M. , Rathjen, J. , Shevrin, H. , Gordon, E. (2004). A temporal dissociation of subliminal versus supraliminal fear perception: an event-related potential study. Journal of Cognitive Neuroscience , 16, 3 479– 486MacLeod, C. , Mathews, A. , Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology , 95, 15– 20MacLeod, C. (1991). Half a century of research on the Stroop effect: an integrative review. Psychological Bulletin , 109, 163– 203Merckelbach, H. , Kenemans, L. J. , Dijkstra, A. , Schouten, E. (1993). No attentional bias for pictoral stimuli in spider-fearful subjects. Journal of Psychopathology and Behavioral Assessment , 15, 197– 206Miltner, W. H. , Krieschel, S. , Hecht, H. , Trippe, R. , Weiss, T. (2004). Eye movements and behavioral responses to threatening and nonthreatening stimuli during visual search in phobic and nonphobic subjects. Emotion , 4, 323– 39Miltner, W. H. , Trippe, R. , Krieschel, S. , Gutberlet, I. , Hecht, H. , Weiss, T. (2005). Event-related brain potentials and affective responses to threat in spider/snake-phobic and non-phobic subjects. International Journal of Psychophysiology , 57, 43– 52Mogg, K. , Bradley, B. P. (1999). Selective attention and anxiety: A cognitive-motivational perspective. In T. Dalgleish & M. J. Power (Eds.), Handbook of cognition and emotion (pp. 145-170). Chichester: John Wiley & SonsMogg, K. , Bradley, B. P. (2002). Selective orienting of attention to masked threat faces in social anxiety. Behaviour Research and Therapy , 40, 1403– 1414Mogg, K. , Philippot, P. , Bradley, B. P. (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology , 113, 160– 165Morris, J. S. , Ohman, A. , Dolan, R. J. (1998). Conscious and unconscious emotional learning in the human amygdala. Nature , 393, 467– 470Mountz, J. M. , Modell, J. G. , Wilson, M. W. , Curtis, G. C. , Lee, M. A. , Schmaltz, S. , Kuhl, D. E. (1989). Positron emission tomographic evaluation of cerebral blood flow during state anxiety in simple phobia. Archives of General Psychiatry , 46, 501– 504Öhman, A. , Mineka, S. (2001). Fears, phobias, and preparedness: toward an evolved module of fear and fear learning. Psychological Review , 108, 483– 522Öhman, A. , Soares, J. J. F. (1994). Unconscious Anxiety - Phobic Responses to Masked Stimuli. Journal of Abnormal Psychology , 103, 231– 240Öst, L. G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy , 27, 1– 7Öst, L. G. (1996). One-session group treatment of spider phobia. Behaviour Research and Therapy , 34, 707– 715Paquette, V. , Levesque, J. , Mensour, B. , Leroux, J. M. , Beaudoin, G. , Bourgouin, P. , Beauregard, M. (2003). “Change the mind and you change the brain“: effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage , 18, 401– 409Pasley, B. N. , Mayes, L. C. , Schultz, R. T. (2004). Subcortical discrimination of unperceived objects during binocular rivalry. Neuron , 42, 163– 172Pegna, A. J. , Khateb, A. , Lazeyras, F. , Seghier, M. L. (2005). Discriminating emotional faces without primary visual cortices involves the right amygdala. Nature Neuroscience , 8, 24– 25Pauli, P. , Dengler, W. , Wiedemann, G. , Montoya, P. , Birbaumer, N. , Flor, H. , Buchkremer, G. (1997). Behavioral and neurophysiological evidence for altered processing of anxiety-related words in panic disorder. Journal of Abnormal Psychology , 106, 213– 220Pawlak, C. R. , Weyers, P. (2006). Tiermodelle für Angst und Angststörungen - Ausgewählte Modelle und Ansätze zur Untersuchung individueller Differenzen. Psychologische Rundschau , 57, 139– 153Pishyar, R. , Harris, L. M. , Menzies, R. G. (2004). Attentional Bias for Words and Faces in Social Anxiety. Anxiety, Stress & Coping , 17, 23– 36Rainville, P. , Duncan, G. H. , Price, D. D. , Carrier, B. , Bushnell, M. C. (1997). Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science , 277, 968– 971Rauch, S. L. , Savage, C. R. , Alpert, N. M. , Miguel, E. C. , Baer, L. , Breiter, H. C. , Fischman, A. J. , Manzo, P. A. , Moretti, C. , Jenike, M. A. (1995). A positron emission tomographic study of simple phobic symptom provocation. Archives of General Psychiatry , 52, 20– 28Rauch, S. L. , Savage, C. R. , Alpert, N. M. , Fischman, A. J. , Jenike, M. A. (1997). The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biological Psychiatry , 42, 446– 452Reiman, E. M. (1997). The application of positron emission tomography to the study of normal and pathologic emotions. Journal of Clinical Psychiatry , 58, Suppl. 16 4– 12Sabatinelli, D. , Bradley, M. M. , Fitzsimmons, J. R. , Lang, P. J. (2005). Parallel amygdala and inferotemporal activation reflect emotional intensity and fear relevance. Neuroimage , 24, 1265– 1270Schienle, A. , Schäfer, A. , Walter, B. , Stark, R. , Vaitl, D. (2005). Brain activation of spider phobics towards disorder-relevant, generally disgust- and fear-inducing pictures. Neuroscience Letters , 388, 1– 6Sharma, D. , McKenna, F. P. (2001). The role of time pressure on the emotional stroop task. British Journal of Psychology , 92, Pt 3 471– 481Shi, C. , Davis, M. (2001). Visual pathways involved in fear conditioning measured with fear-potentiated startle: behavioral and anatomic studies. Journal of Neuroscience , 21, 9844– 9855Simpson, J. R., Jr. , Drevets, W. C. , Snyder, A. Z. , Gusnard, D. A. , Raichle, M. E. (2001). Emotion-induced changes in human medial prefrontal cortex: II. During anticipatory anxiety. Proceedings of the National Academy of Sciences USA , 98, 688– 693Stein, M. B. , Goldin, P. R. , Sareen, J. , Zorrilla, L. T. , Brown, G. G. (2002). Increased amygdala activation to angry and contemptuous faces in generalized social phobia. Archives of General Psychiatry , 59, 1027– 1034Straube, T. , Kolassa, I. T. , Glauer, M. , Mentzel, H. J. , Miltner, W. H. (2004a). Effect of task conditions on brain responses to threatening faces in social phobics: An event-related functional magnetic resonance imaging study. Biological Psychiatry , 56, 921– 930Straube, T. , Mentzel, H. J. , Glauer, M. , Miltner, W. H. (2004b). Brain activation to phobia-related words in phobic subjects. Neuroscience Letters , 372, 204– 208Straube, T. , Mentzel, H. J. , Miltner, W. H. (2005). Common and distinct brain activation to threat and safety signals in social phobics. Neuropsychobiology , 52, 3 163– 168Straube, T. , Mentzel, H. J. , Miltner, W. H. (2006a). Neural mechanisms of automatic and direct processing of phobogenic stimuli in specific phobia. Biological Psychiatry , 59, 2 162– 170Straube, T. , Glauer, M. , Dilger, S. , Mentzel, H. J. , Miltner, W. H. (2006b). Effect of cognitive behavioural therapy on brain activation in specific phobia. Neuroimage , 29, 1 125– 135van den Hout, M. A. , De Jong, P. , Kindt, M. (2000). Masked fear words produce increased SCRs: an anomaly for Ohman’s theory of pre-attentive processing in anxiety. Psychophysiology , 37, 3 283– 288Veltman, D. J. , Tuinebreijer, W. E. , Winkelman, D. , Lammertsma, A. A. , Witter, M. P. , Dolan, R. J. , Emmelkamp, P. M. (2004). Neurophysiological correlates of habituation during exposure in spider phobia. Psychiatry Research , 132, 149– 158Vuilleumier, P. , Armony, J. L. , Driver, J. , Dolan, R. J. (2003). Distinct spatial frequency sensitivities for processing faces and emotional expressions. Nature Neuroscience , 6, 624– 631Vuilleumier, P. , Richardson, M. P. , Armony, J. L. , Driver, J. , Dolan, R. J. (2004). Distant influences of amygdala lesion on visual cortical activation during emotional face processing. Nature Neuroscience , 7, 1271– 1278Walker, D. L. , Toufexis, D. J. , Davis, M. (2003). Role of the bed nucleus of the stria terminalis versus the amygdala in fear, stress, and anxiety. European Journal of Pharmacology , 463, 199– 216Weike, A. I. , Hamm, A. O. , Schupp, H. T. , Runge, U. , Schroeder, H. W. , Kessler, C. (2005). Fear conditioning following unilateral temporal lobectomy: dissociation of conditioned startle potentiation and autonomic learning. Journal of Neuroscience , 25, 11117– 11124Weiskrantz, L. (1956). Behavioral changes associated with ablation of the amygdaloid complex in monkeys. Journal of Comparative Physiology and Psychology , 49, 381– 391Whalen, P. J. , Rauch, S. L. , Etcoff, N. L. , McInerney, S. C. , Lee, M. B. , Jenike, M. A. (1998). Masked presentations of emotional facial expressions modulate amygdala activity without explicit knowledge. Journal of Neuroscience , 18, 411– 418Williams, J. M. G. , Watts, F. N. , MacLeod, C. , Mathews, A. (1997). Cognitive psychology and emotional disorders (2nd ed.). Chichester: WileyZald, D. H. (2003). The human amygdala and the emotional evaluation of sensory stimuli. Brain Research Reviews , 41, 88– 123
