Archive 1995–2023

Objectives. This paper describes two theories of the pathogenesis of anxiety disorders (by Jaak Panksepp and Joseph LeDoux) and analyses the impact of theory assumptions on the clinical aspects of pharmacotherapy and psychotherapy.

Literature review. In studying anxiety, Panksepp emphasises its evolutionary and neurobiological dimensions. He formulates his assumptions based on empirical research. He describes seven basic emotional systems, including at least two responsible for the response of individuals to danger, which proceeds unconsciously. Within the single fear system, LeDoux and Pine describe a two-system concept, consisting of a system based on a cognitive appraisal and a system based on defensive behaviours and physiological responses. Targeted anxiolytic treatment should be accompanied by the recognition of the pathomechanism of anxiety and the use of the best possible therapeutic method. Depending on the genesis of the patient’s response to danger, different therapeutic approaches can be used.

Conclusions. Both Panksepp and LeDoux refer to the original patterns of response to danger. However, the detailed exploration and characterisation of the neurobiology of the human brain, including the use of functional imaging, may make it possible to tailor anti-anxiety therapies (both pharmacotherapy and psychotherapy) to the individual patient.