Panic Disorder (PD) is a prevalent anxiety disorder that significantly impairs day-to-day functioning. Lifetime prevalence estimates range from 1 % to 4 %, with a six-month prevalence between 0.5 % and 1 % (De Jonge et al., 2016; Manjunatha et al., 2022). Individuals with PD are at increased risk for suicide attempts, marital discord, and financial dependency (Teitbohl-Santos et al., 2019; Davidoff et al., 2012). The presence of recent panic attacks in particular is associated with marked impairments in general health, mental well-being, and physical functioning (Wilmer et al., 2021).

Neurobiologically, multiple central nervous system regions are involved in generating panic responses. These regions form a network of interconnected nuclei that ordinarily regulate the panic response as a survival mechanism (Dresler et al., 2013). Functional neuroimaging studies in PD have consistently shown prefrontal hypoactivity alongside hyperactivity in limbic areas, suggesting dysfunction in top-down inhibition of anxiety-related stimuli by the prefrontal cortex (Ironside et al., 2017; Sobanski et al., 2017; Kang et al., 2012; Goddard, 2017).

Meta-analyses have demonstrated that reduced working memory performance is a consistent finding across both state and trait anxiety (Moran, 2016). In PD, this may be attributed to hypofrontality during cognitive tasks, such as verbal fluency, even without emotional triggers (Nishimura et al., 2017, Ohta et al., 2008). During a panicogenic state, cognitive performance is likely to deteriorate due to heightened anxiety, making such states valuable for probing specific deficits. Hyperventilation is recognized as a cause, consequence, and correlate of anxiety (Papp et al., 1998). It has been utilized as a safe and effective method to provoke panic symptoms in experimental settings.

Functional near-infrared spectroscopy (fNIRS) is a non-invasive imaging technique that measures changes in oxygenated and deoxygenated haemoglobin using near-infrared light, thereby providing an indirect index of neuronal activity. fNIRS findings correlate strongly with those from functional MRI, supporting its validity (Kim et al., 2017). However, its application in PD research remains limited. One randomized controlled trial found significant prefrontal hypoactivation in PD patients compared to healthy controls (Deppermann et al., 2014).

This exploratory study seeks to investigate hemodynamic responses during cognitive tasks—before and after panic symptom provocation—using fNIRS in individuals with PD and healthy controls (HC). By doing so, it aims to elucidate the relationship between cerebral hypofrontality and cognitive performance in PD under experimentally induced anxiety.