Where does this panic attack come from? - about anxiety, its types and forms of therapy - Narrative review
DOI:
https://doi.org/10.12923/2353-8627/2025-0019Keywords:
anxiety, panic disorder, generalized anxiety, panic attack, anxiety disorders with panic attacksAbstract
Introduction: Anxiety disorders are common mental health problems that impact social functioning and public health. They result from interactions between environmental, biological, and genetic factors. Research focuses on brain mechanisms and structural changes linked to anxiety. Advances in neuroimaging and genetics allow for better identification of biomarkers, aiding diagnosis and therapy. This paper discusses the neurobiology of anxiety disorders and their clinical relevance, especially anxiety attacks.
Material and methods: This study is a narrative review of literature from the last five years in Scopus and PubMed on anxiety disorders with panic attacks. English-language publications, including original papers, systematic reviews, meta-analyses, and reviews, were considered. The aim was to provide a concise discussion of key neurobiological mechanisms, clinical concepts, and current therapeutic approaches.
Results: Research indicates that amygdala hyperactivity and reduced hippocampal volume correlate with intensified anxiety symptoms. Genetic variants predisposing to anxiety disorders have been identified. Dysfunction in serotonergic and GABAergic transmission plays a key role in emotion regulation. Stressful events in childhood and adolescence can permanently alter brain development, increasing the risk of later disorders. Findings also show that different anxiety disorders have distinct neurobiological profiles and functional consequences.
Conclusions: Anxiety disorders thus have a clear neurobiological basis, which can be identified through modern research methods. Genetic and environmental factors jointly increase the brain’s sensitivity to anxiety. Early psychological intervention is crucial, as it may prevent lasting changes in the nervous system Neurobiological differences between disorders highlight the need for individualized treatment. Current evidence supports the combined use of pharmacotherapy and psychotherapy targeting specific pathophysiological mechanisms.
References
1. Munir S, Takov V. Generalized Anxiety Disorder. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022
2. Cackovic C, Nazir S, Marwaha R. Panic Disorder.In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023
3. DeGeorge KC, Grover M, Streeter GS. Generalized Anxiety Disorder and Panic Disorder in Adults. Am Fam Physician. 2022;106(2):157-164.
4. Chand SP, Marwaha R. Anxiety. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023
5. Quagliato LA. MD, Carta MG, Nardi AE. Panic Disorder Seeks More Specific Drugs for Treatment: Might the Amygdala Be the Best Target?. Journal of Clinical Psychopharmacology. 2022; 42(5):p 427-428
6. Bandelow B, Allgulander C, Baldwin DS, Costa DLC, Denys D, Dilbaz N, et al. World Federation of Societies of Biological Psychiatry guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part
1. I: Anxiety disorders. The World Journal of Biological Psychiatry, 2022; 24(2), 79–117.
7. Freire RCR, Nardi AE. Is it possible to prevent relapse in panic disorder? Expert Review of Neurotherapeutics 2023; 23(8), 677 679.
8. Oft AC, Philip S, Holz E, Sathi S, Geng X, Hoge E. Effect of meditation or escitalopram on work performance in patients with anxiety disorders. J Affect Disord. 2024; 1;364:104-107.
9. Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. StatPearls.Treasure Island (FL): StatPearls Publishing; 2023
10. Kenwood M.M., Kalin N.H., Barbas H. The prefrontal cortex, pathological anxiety, and anxiety disorders. Neuropsychopharmacol. 2022;47, 260–275
11. Javaid S.F., Hashim I.J., Hashim M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry. 2023; 30:44
12. American Psychiatric Publishing: Diagnostic and Statistical manual of mental disorders Fifth Edition DSM-5, 2013, Washington
13. Leibold NK, Weidner MT, Ziegler C, Ortega G, Domschke K, Lesch KP et al.DNA methylation in the 5-HTT regulatory region is associated with CO2-induced fear in panic disorder patients. Eur Neuropsychopharmacol. 2020;36:154-159.
14. Loos E, Schicktanz N, Fastenrath M, Coynel D, Milnik A, Fehlmann B, et al.Reducing Amygdala Activity and Phobic Fear through Cognitive Top-Down Regulation. J Cogn Neurosci. 2020;32(6):1117-1129.
15. Kim HJ, Kim J, Yook KH, Choi TK, Lee SH. Early Trauma Subtypes are Differentially Related to Anxiety Symptomatology and Suicidal Ideation in Panic Disorder. Psychiatry Investig. 2023;20(12):1211-1220.
16. Wang ZJ, Shwani T, Liu J, Zhong P, Yang F, Schatz K, et al.Molecular and cellular mechanisms for differential effects of chronic social isolation stress in males and females. Mol Psychiatry. 2022;27(7):3056-3068.
17. Sambuco N, Bradley MM, Lang PJ. Hippocampal and amygdala volumes vary with transdiagnostic psychopathological dimensions of distress, anxious arousal, and trauma. Biol Psychol. 2023;177:108501.
18. Liu S, Cao L, Li H, Du Y, Wang M, Xiao H et al.Trait anxiety mediates the association between hippocampal-insula functional connectivity and anxiety symptom severity in adults with and without generalized anxiety disorder. J Affect Disord. 2024;344:1-7.
19. Atmaca M, Koc M, Mermi O, Korkmaz S, Aslan S, Yildirim H. Insula volumes are altered in patients with social anxiety disorder. Behav Brain Res. 2021;400:113012.
20. Reddy DS. Neurosteroid replacement therapy for catamenial epilepsy, postpartum depression and neuroendocrine disorders in women. J Neuroendocrinol. 2022;34(2):e13028.
21. Burani K, Nelson BD. Gender differences in anxiety: The mediating role of sensitivity to unpredictable threat. Int J Psychophysiol. 2020;153:127-134.
22. McGinnis E, O'Leary A, Gurchiek R, Copeland WE, McGinnis R. A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study. JMIR Form Res. 2022;6(2):e32982.
23. Tsai S-J, Cheng C-M, Chang W-H, et al. Panic disorder and suicide. Psychological Medicine. 2025;55:e38.
24. Arnfred B, Bang P, Hjorthøj C, Christensen CW, Stengaard Moeller K, Hvenegaard M et al. Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia. BMJ Open. 2022;12(2):e051147.
25. Zsido AN, Kiss BL, Basler J, Birkas B, Coelho CM. Key factors behind various specific phobia subtypes. Sci Rep. 2023;13(1):22281.
26. Benke C, Alius MG, Hamm AO, Pané-Farré CA. Decreased defensive reactivity to interoceptive threat after successful exposure-based psychotherapy in patients with panic disorder. Transl Psychiatry. 2021;11(1):177.
27. Tung ES, Brown TA. Distinct Risk Profiles in Social Anxiety Disorder. Clin Psychol Sci. 2020;8(3):477-490.
28. Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry. 2020;59(10):1107-1124.
29. Zhou Z, Li Y, Zhang Y, Liu J, Ai H, Liu M et al.Differential effects of generalized anxiety and separation anxiety on brain structural development during adolescence. J Affect Disord. 2023;339:478¬485.
30. McAfee SS, Robinson G, Gajjar A, Zhang S, Bag AK, Raches D et al. Cerebellar mutism is linked to midbrain volatility and desynchronization from speech cortices. Brain. 2023;146(11):4755-4765.
31. Suresh H, Morgan BR, Mithani K, Warsi NM, Yan H, Germann J et al.Postoperative cerebellar mutism syndrome is an acquired autism-like network disturbance. Neuro Oncol. 2024;26(5):950-964.
32. Su Xi, Li Wenqiang, Lv Luxian, Li Xiaoyan, Yang Jinfeng, Luo Xiong-Jian et al.Transcriptome-Wide Association Study Provides Insights Into the Genetic Component of Gene Expression in Anxiety. Front. Genet. 2021;12:740134.
33. Levey DF, Gelernter J, Polimanti R, Zhou H, Cheng Z, Aslan M et al. Reproducible Genetic Risk Loci for Anxiety. Am J Psychiatry. 2020 Jan 177(3):223–232.
34. Chang HA, Fang WH, Liu YP, Tzeng NS, Shyu JF, Wan FJ et al. Sex-specific pathways among tri-allelic serotonin transporter polymorphism, trait neuroticism and generalized anxiety disorder. J Psychiatry Neurosci. 2020;45(6):379-386.
35. Khanal P, Ståhlberg T, Upadhyaya S, Heinonen E, Ortin-Peralta A, Sourander A. Parental psychopathology and offspring anxiety disorders in childhood and adolescence: A Finnish nationwide register study, Journal of Affective Disorders. 2025;368:374-382
36. Chan II, Wu AMS, Assessing the Role of Cortisol in Anxiety, Major Depression, and Neuroticism: A Mendelian Randomization Study Using SERPINA6/SERPINA1 Variants, Biological Psychiatry Global Open Science. 2024;4(3):1000294
37. Marchetti I, Pedretti LM, Iannattone S, Colpizzi I, Farina A, Di Blas L et al. Is intolerance of uncertainty a necessary condition for anxiety symptoms in adolescents? Journal of Anxiety Disorders. 2025;112:102999
38. Awad MH, Elmutasim M, Mohamed MM, Hemmeda L. Generalized anxiety disorder and associated factors among Sudanese adolescents during the Sudan Army conflict. Global Epidemiology. 2025;9:100190
39. Ratering C, van der Heijden R, Martens K, Moving around with an anxiety disorder, Transportation Research Part F: Traffic Psychology and Behaviour. 2024;100:493-506
40. Byam LJ, Penney AM, COVID-19 anxiety and its relation to anxiety-related disorder symptoms and mechanisms, Acta Psychologica. 2024;244:104179
41. Alharbi AA, Alqassim AY, Muaddi MA, Makeen AM, Hagawi AM, Shaabi LA, et al. Generalized anxiety disorder symptoms during COVID-19 pandemic in Jazan, Saudi Arabia, Heliyon. 2022;8(5):e09424
42. M.Hasanpour, S.Maroufizadeh, H.Mousavi, F.Noughani, M.Afshari. Prevalence of generalized anxiety disorder among nursing students in Iran during the COVID-19 pandemic: A web-based cross-sectional study, International Journal of Africa Nursing Sciences. 2021;15:100360
43. Park SM, Kim DB, Joo MJ, Park EC, Association between living alone and generalized anxiety disorder in Korean adults, Journal of Affective Disorders. 2024;362:630-637
44. Faro A, Eaton WW. A Diagnostic-Oriented Screening Scale for Anxiety Disorders: The Center for Epidemiologic Studies Anxiety Scale (CESA). Front Psychol. 2020;11:957.
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