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Morrison AS, Goldin PR, Gross JJ. Fear of negative and positive evaluation as mediators and moderators of treatment outcome in social anxiety disorder. J Anxiety Disord 2024; 104:102874. [PMID: 38754336 DOI: 10.1016/j.janxdis.2024.102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/29/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Elevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined. METHODS This sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up. RESULTS CBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist - higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT. DISCUSSION FNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.
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Affiliation(s)
- Amanda S Morrison
- Department of Psychology, California State University, East Bay, Hayward, CA 94542, USA.
| | - Philippe R Goldin
- UC Davis Medical Center, University of California, Davis, Davis, CA, 95616, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
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Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample. J Psychiatr Res 2024; 171:108-115. [PMID: 38266332 PMCID: PMC10922639 DOI: 10.1016/j.jpsychires.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample. METHODS Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network. RESULTS At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding. CONCLUSIONS Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
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Affiliation(s)
- Angela Fang
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525, USA.
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242-1407, USA
| | - Jamie D Feusner
- Centre for Addiction and Mental Health, Brain Imaging Health Center, Ontario, Toronto, Canada, M5T1R8; Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada, M5T1R8; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, 43210-1240, USA
| | - Clare C Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Jessica Crane
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525, USA
| | - Ryan J Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129-2020, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696, USA
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Sandell R, Falkenström F, Svensson M, Nilsson T, Johansson H, Viborg G, Perrin S. Moderators of short- and long-term outcomes in panic control treatment and panic-focused psychodynamic psychotherapy. Psychother Res 2024:1-11. [PMID: 38289698 DOI: 10.1080/10503307.2023.2294888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). METHOD Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up. RESULTS Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term. CONCLUSIONS These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.
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Rohrbach PJ, Fokkema M, Spinhoven P, Van Furth EF, Dingemans AE. Predictors and moderators of three online interventions for eating disorder symptoms in a randomized controlled trial. Int J Eat Disord 2023; 56:1909-1918. [PMID: 37431199 DOI: 10.1002/eat.24021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To optimize treatment recommendations for eating disorders, it is important to investigate whether some individuals may benefit more (or less) from certain treatments. The current study explored predictors and moderators of an automated online self-help intervention "Featback" and online support from a recovered expert patient. METHODS Data were used from a randomized controlled trial. For a period of 8 weeks, participants aged 16 or older with at least mild eating disorder symptoms were randomized to four conditions: (1) Featback, (2) chat or e-mail support from an expert patient, (3) Featback with expert-patient support, and (4) a waitlist. A mixed-effects partitioning method was used to see if age, educational level, BMI, motivation to change, treatment history, duration of eating disorder, number of binge eating episodes in the past month, eating disorder pathology, self-efficacy, anxiety and depression, social support, or self-esteem predicted or moderated intervention outcomes in terms of eating disorder symptoms (primary outcome), and symptoms of anxiety and depression (secondary outcome). RESULTS Higher baseline social support predicted less eating disorder symptoms 8 weeks later, regardless of condition. No variables emerged as moderator for eating disorder symptoms. Participants in the three active conditions who had not received previous eating disorder treatment, experienced larger reductions in anxiety and depression symptoms. DISCUSSION The investigated online low-threshold interventions were especially beneficial for treatment-naïve individuals, but only in terms of secondary outcomes, making them well-suited for early intervention. The study results also highlight the importance of a supportive environment for individuals with eating disorder symptoms. PUBLIC SIGNIFICANCE To optimize treatment recommendations it is important to investigate what works for whom. For an internet-based intervention for eating disorders developed in the Netherlands, individuals who had never received eating disorder treatment seemed to benefit more from the intervention than those who had received eating disorder treatment, because they experienced larger reductions in symptoms of depression and anxiety. Stronger feelings of social support were related to less eating disorder symptoms in the future.
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Affiliation(s)
- Pieter J Rohrbach
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
- Department of Clinical Psychology, Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Philip Spinhoven
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Eric F Van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Fang A, Baran B, Feusner JD, Phan KL, Beatty CC, Crane J, Jacoby RJ, Manoach DS, Wilhelm S. Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294878. [PMID: 37693433 PMCID: PMC10491350 DOI: 10.1101/2023.08.30.23294878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre- to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample. Methods Twenty-seven patients with primary social anxiety disorder (n=14) and primary body dysmorphic disorder (n=13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex/precuneus that delineated a self-other functional network. Results At pre-treatment, stronger positive connectivity of the seed with the cerebellum, insula, middle occipital gyrus, postcentral gyrus, and precuneus/superior parietal lobule, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre- to post-treatment, greater anticorrelation between the seed and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding. Conclusions Pre-treatment functional connectivity between regions involved in attentional salience, self-generated thoughts, and external attention predicted greater CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.
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Affiliation(s)
- Angela Fang
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242-1407
| | - Jamie D. Feusner
- Centre for Addiction and Mental Health, Brain Imaging Health Center, Ontario, Toronto, Canada, M5T1R8
- Department of Psychiatry, University of Toronto, Ontario, Toronto, Canada, M5T1R8
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, 43210-1240
| | - Clare C. Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500
| | - Jessica Crane
- Department of Psychology, University of Washington, Seattle, WA, 98195-1525
| | - Ryan J. Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
| | - Dara S. Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129-2020
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
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