{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T11:01:50Z","timestamp":1768734110222,"version":"3.49.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Individuals with anxiety disorders (ADs) often display hypervigilance to threat information, although this response may be less pronounced following psychotherapy. This study aims to investigate the unconscious recognition performance of facial expressions in patients with panic disorder (PD) post-treatment, shedding light on alterations in their emotional processing biases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with PD (n=34) after (exposure-based) cognitive behavior therapy and healthy controls (n=43) performed a subliminal affective recognition task. Emotional facial expressions (fearful, happy, or mirrored) were displayed for 33 ms and backwardly masked by a neutral face. Participants completed a forced choice task to discriminate the briefly presented facial stimulus and an uncovered condition where only the neutral mask was shown. We conducted a secondary analysis to compare groups based on their four possible response types under the four stimulus conditions and examined the correlation of the false alarm rate for fear responses to non-fearful (happy, mirrored, and uncovered) stimuli with clinical anxiety symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patient group showed a unique selection pattern in response to happy expressions, with significantly more correct \u201chappy\u201d responses compared to controls. Additionally, lower severity of anxiety symptoms after psychotherapy was associated with a decreased false fear response rate with non-threat presentations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These data suggest that patients with PD exhibited a \u201chappy-face recognition advantage\u201d after psychotherapy. Less symptoms after treatment were related to a reduced fear bias. Thus, a differential facial emotion detection task could be a suitable tool to monitor response patterns and biases in individuals with ADs in the context of psychotherapy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2024.1375751","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T14:33:23Z","timestamp":1721399603000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Elevated accuracy in recognition of subliminal happy facial expressions in patients with panic disorder after psychotherapy"],"prefix":"10.3389","volume":"15","author":[{"given":"Zirong","family":"Qian","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunbo","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Domschke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander L.","family":"Gerlach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfons","family":"Hamm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Richter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J.","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Deckert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Arolt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Zwanzger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Lotze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Pfleiderer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Ulrich","family":"Wittchen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Str\u00f6hle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten","family":"Konrad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winfried","family":"Rief","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Suslow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tilo","family":"Kircher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Straube","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2007.01.009","article-title":"Information processing biases and panic disorder: Relationships among cognitive and symptom measures","volume":"45","author":"Teachman","year":"2007","journal-title":"Behav Res Ther"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2014.00580\/abstract","article-title":"Subliminal cues bias perception of facial affect in patients with social phobia: evidence for enhanced unconscious threat processing","volume":"8","author":"Jusyte","year":"2014","journal-title":"Front Hum Neurosci"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2010.07.020","article-title":"Attentional bias in untreated panic disorder","volume":"185","author":"Reinecke","year":"2011","journal-title":"Psychiatry Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2006.03.007","article-title":"Jumping to interpretations: Social anxiety disorder and the identification of emotional facial expressions","volume":"45","author":"Mohlman","year":"2007","journal-title":"Behav Res Ther"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-014-9619-7","article-title":"Perceptual sensitivity and response bias in social anxiety: an application of signal detection theory","volume":"38","author":"Yoon","year":"2014","journal-title":"Cognit Ther Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/00001756-199804200-00048","article-title":"fMRI reveals amygdala activation to human faces in social phobics","volume":"9","author":"Birbaumer","year":"1998","journal-title":"NeuroReport"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1467-9450.1993.tb01096.x","article-title":"Masking the face: Recognition of emotional facial expressions as a function of the parameters of backward masking","volume":"34","author":"Esteves","year":"1993","journal-title":"Scand J Psychol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2002.1220","article-title":"Facial expressions, their communicatory functions and neuro\u2013cognitive substrates","volume":"358","author":"Blair","year":"2003","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.psychres.2005.08.022","article-title":"Subliminal affective priming in clinical depression and comorbid anxiety: A longitudinal investigation","volume":"143","author":"Dannlowski","year":"2006","journal-title":"Psychiatry Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/(ISSN)1520-6394","article-title":"Emotion recognition patterns in patients with panic disorder","volume":"24","author":"Kessler","year":"2007","journal-title":"Depress Anxiety"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2004.11.010","article-title":"Facial emotion recognition in trait anxiety","volume":"20","author":"Surcinelli","year":"2006","journal-title":"J Anxiety Disord"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1159\/000334252","article-title":"Recognition of facial expressions of emotion in panic disorder","volume":"45","author":"Cai","year":"2012","journal-title":"Psychopathology"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.1997.0245","article-title":"Disgust implicated in obsessive\u2013compulsive disorder","volume":"264","author":"Sprengelmeyer","year":"1997","journal-title":"Proc R Soc Lond B Biol Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.janxdis.2007.01.003","article-title":"Recognition of facial expressions in obsessive\u2013compulsive disorder","volume":"22","author":"Corcoran","year":"2008","journal-title":"J Anxiety Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"387","DOI":"10.5127\/jep.032112","article-title":"A laboratory investigation of anxious cognition: how subliminal cues alter perceptual sensitivity to threat","volume":"4","author":"Jusyte","year":"2013","journal-title":"J Exp Psychopathol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhr250","article-title":"Rapid processing of emotional expressions without conscious awareness","volume":"22","author":"Smith","year":"2012","journal-title":"Cereb Cortex"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2009.05.001","article-title":"First-line treatment: A critical appraisal of cognitive behavioral therapy developments and alternatives","volume":"32","author":"Arch","year":"2009","journal-title":"Psychiatr Clin North Am"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-012-9476-1","article-title":"The efficacy of cognitive behavioral therapy: A review of meta-analyses","volume":"36","author":"Hofmann","year":"2012","journal-title":"Cognit Ther Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.brat.2014.04.006","article-title":"Maximizing exposure therapy: An inhibitory learning approach","volume":"58","author":"Craske","year":"2014","journal-title":"Behav Res Ther"},{"key":"B20","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.cpr.2007.04.009","article-title":"Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders","volume":"28","author":"Hofmann","year":"2008","journal-title":"Clin Psychol Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/da.23204","article-title":"Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial","volume":"38","author":"Pittig","year":"2021","journal-title":"Depress Anxiety"},{"key":"B22","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.jad.2014.07.031","article-title":"Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions","volume":"169","author":"Fonzo","year":"2014","journal-title":"J Affect Disord"},{"key":"B23","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/2045-5380-1-6","article-title":"Altered amygdala activation during face processing in Iraqi and Afghanistani war veterans","volume":"1","author":"Simmons","year":"2011","journal-title":"Biol Mood Anxiety Disord"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2009.83","article-title":"The neurocircuitry of fear, stress, and anxiety disorders","volume":"35","author":"Shin","year":"2010","journal-title":"Neuropsychopharmacology"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2006.04.001","article-title":"Recognition of happy facial affect in panic disorder: An fMRI study","volume":"21","author":"Pillay","year":"2007","journal-title":"J Anxiety Disord"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2011.02.012","article-title":"Become more optimistic by imagining a best possible self: Effects of a two week intervention","volume":"42","author":"Meevissen","year":"2011","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s11682-023-00831-0","article-title":"Effects of psychotherapy on brain activation during negative emotional processing in patients with posttraumatic stress disorder: a systematic review and meta-analysis","author":"Aarts","year":"2023","journal-title":"Brain Imaging Behav"},{"key":"B28","doi-asserted-by":"crossref","DOI":"10.1037\/10385-015","article-title":"Optimism, pessimism, and psychotherapy: Implications for clinical practice","volume-title":"Optimism & pessimism: Implications for theory, research, and practice","author":"Pretzer","year":"2001"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19020202","article-title":"Effect of CBT on biased semantic network in panic disorder: A multicenter fMRI study using semantic priming","volume":"177","author":"Yang","year":"2020","journal-title":"Am J Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1037\/0033-2909.133.1.1","article-title":"Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study","volume":"133","author":"Bar-Haim","year":"2007","journal-title":"Psychol Bull"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.01.009","article-title":"Latent anxiety in clinical depression is associated with worse recognition of emotional stimuli","volume":"301","author":"Granger","year":"2022","journal-title":"J Affect Disord"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(92)90032-C","article-title":"Anxiety and the selective processing of emotional information: Mediating roles of awareness, trait and state variables, and personal relevance of stimulus materials","volume":"30","author":"MacLeod","year":"1992","journal-title":"Behav Res Ther"},{"key":"B33","doi-asserted-by":"publisher","first-page":"104069","DOI":"10.1016\/j.brat.2022.104069","article-title":"Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus","volume":"152","author":"Craske","year":"2022","journal-title":"Behav Res Ther"},{"key":"B34","volume-title":"Pictures of facial affect","author":"Friesen","year":"1976"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1198386","article-title":"A new short version of the Facial expressions of emotion: Stimuli and tests (FEEST) including prototype and morphed emotional stimuli","volume":"14","author":"Kuhlmann","year":"2023","journal-title":"Front Psychol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/da.1033.abs","article-title":"Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A)","volume":"13","author":"Shear","year":"2001","journal-title":"Depress Anxiety"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1159\/000066239","article-title":"On the validity of the beck depression inventory","volume":"31","author":"Richter","year":"1998","journal-title":"Psychopathology"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/0005-7967(86)90143-9","article-title":"Anxiety sensitivity, anxiety frequency and the prediction of fearfulness","volume":"24","author":"Reiss","year":"1986","journal-title":"Behav Res Ther"},{"key":"B39","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/0272-7358(92)90123-P","article-title":"Methodological issues in prediction of treatment outcome","volume":"12","author":"Steketee","year":"1992","journal-title":"Clin Psychol Rev"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/0022-460X(67)90197-6","article-title":"Signal detection theory and psychophysics","volume":"5","author":"Ingleby","year":"1967","journal-title":"J Sound Vib"},{"key":"B41","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1521\/jscp.2006.25.6.585","article-title":"Biased recognition of happy facial expressions in social anxiety","volume":"25","author":"Silvia","year":"2006","journal-title":"J Soc Clin Psychol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.psychres.2013.06.005","article-title":"Social anxiety is associated with general but not specific biases in emotion recognition","volume":"210","author":"Button","year":"2013","journal-title":"Psychiatry Res"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(92)90137-6","article-title":"Cognitive processing of emotional information in panic disorder","volume":"30","author":"McNally","year":"1992","journal-title":"Behav Res Ther"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jrp.2013.03.007","article-title":"Happy and angry faces: Subclinical levels of anxiety are differentially related to attentional biases in men and women","volume":"47","author":"Tran","year":"2013","journal-title":"J Res Personal"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0018686","article-title":"Impact of emotion on consciousness: positive stimuli enhance conscious reportability","volume":"6","author":"R\u00f8mer Thomsen","year":"2011","journal-title":"PloS One"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.542454","article-title":"The effects of subliminal goal priming on emotional response inhibition in cases of major depression","volume":"11","author":"Zhang","year":"2020","journal-title":"Front Psychol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2003.12.033","article-title":"Activation of the amygdala and anterior cingulate during nonconscious processing of sad versus happy faces","volume":"21","author":"Killgore","year":"2004","journal-title":"NeuroImage"},{"key":"B48","doi-asserted-by":"publisher","first-page":"fcad144","DOI":"10.1093\/braincomms\/fcad144","article-title":"Structural integrity of the insula and emotional facial recognition performance following stroke","volume":"5","author":"Klepzig","year":"2023","journal-title":"Brain Commun"},{"key":"B49","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1177\/1534582302001001003","article-title":"Recognizing emotion from facial expressions: psychological and neurological mechanisms","volume":"1","author":"Adolphs","year":"2002","journal-title":"Behav Cognit Neurosci Rev"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1007\/s00426-003-0157-2","article-title":"Positive facial expressions are recognized faster than negative facial expressions, but why","volume":"69","author":"Lepp\u00e4nen","year":"2004","journal-title":"Psychol Res Psychol Forsch"},{"key":"B51","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1037\/\/0021-843X.98.1.9","article-title":"Depression versus anxiety: A test of the content-specificity hypothesis","volume":"98","author":"Greenberg","year":"1989","journal-title":"J Abnorm Psychol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.115.4.705","article-title":"Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia","volume":"115","author":"Joormann","year":"2006","journal-title":"J Abnorm Psychol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1037\/\/0003-066X.36.2.129","article-title":"Mood and memory","volume":"36","author":"Bower","year":"1981","journal-title":"Am Psychol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s10608-010-9322-2","article-title":"Attention and memory biases in social anxiety disorder: the role of comorbid depression","volume":"36","author":"LeMoult","year":"2012","journal-title":"Cognit Ther Res"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(98)00063-1","article-title":"A cognitive-motivational analysis of anxiety","volume":"36","author":"Mogg","year":"1998","journal-title":"Behav Res Ther"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2019.00222","article-title":"Learning to look at the bright side of life: attention bias modification training enhances optimism bias","volume":"13","author":"Kress","year":"2019","journal-title":"Front Hum Neurosci"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2021.730011","article-title":"Mechanisms of false alarm in response to fear stimulus: an event-related potential study","volume":"15","author":"Wang","year":"2022","journal-title":"Front Hum Neurosci"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2024.1375751\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T14:33:27Z","timestamp":1721399607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2024.1375751\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,13]]},"references-count":57,"alternative-id":["10.3389\/fpsyt.2024.1375751"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2024.1375751","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,13]]},"article-number":"1375751"}}