A new investigation published in the current issue of Psychotherapy and Psychosomatics disclosed important brain mechanisms for the action of psychotherapy in panic disorder. Patients with panic disorder (PD) and agoraphobia (AG) often suffer from other mental disorders, especially social anxiety disorder. Neurally, both disorders exhibit substantial neurofunctional overlap within the defensive system network. Those networks might be crucial in social anxiety due to the high relevance of detecting social cues.

Fear conditioning serves as a model for the development, maintenance, and treatment of anxiety disorders via cognitive-behavioral therapy (CBT). It involves several neural pathways that have been partly identified as pathophysiological correlates of panic, agoraphobia, and social anxiety. The aim of this study was to investigate whether CBT specifically tailored to target panic disorder and agoraphobia also targets clinical and neurofunctional correlates of secondary social anxiety.

Results suggested a signature associated with secondary social anxiety, encompassing two functional systems: first, this signature extends throughout the ventral object recognition pathway, which is related to the recognition of social cues and thus social anxiety symptomatology; second, comorbid social anxiety further amplifies the activation of defensive system structures (eg, hippocampus and inferior fronto-occipital fasciculus [IFO]) possibly indicating stronger conditionability as a function of comorbidity. Findings showed that both systems were effectively targeted by CBT, resulting in attenuated activation patterns to the level of patients with panic disorder, agoraphobia, and comorbid social anxiety.