Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis. (September 2021)

• Record Type: Journal Article
• Authors: Baroni, Marina; Frumento, Sergio; Cesari, Valentina; Gemignani, Angelo; Menicucci, Danilo; Rutigliano, Grazia
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 128(2021)
• Page Start: 136
• Page End: 151
• Publication Date: 2021-09
• Subjects: Subliminal processing -- Masked stimuli -- Panic disorder -- Attention bias -- Innate alarm system; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2021.06.023
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: All subjects have slower responses to unmasked threat vs neutral cues. PD subjects only present over-reactivity to masked panic-related cues. Neurobiological mechanisms of subliminal priming in PD are not fully understood. It is unclear if psychotherapy reduces unconscious over-reactivity to threat. We highlighted methodological weaknesses and priorities for future research. Abstract: Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I 2 = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.