1
|
Jentsch VL, Wolf OT, Otto T, Merz CJ. The impact of physical exercise on the consolidation of fear extinction memories. Psychophysiology 2023; 60:e14373. [PMID: 37350416 DOI: 10.1111/psyp.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
Based on the mechanisms of fear extinction, exposure therapy is the most common treatment for anxiety disorders. However, extinguished fear responses can reemerge even after successful treatment. Novel interventions enhancing exposure therapy efficacy are therefore critically needed. Physical exercise improves learning and memory and was also shown to enhance extinction processes. This study tested whether physical exercise following fear extinction training improves the consolidation of extinction memories. Sixty healthy men underwent a differential fearconditioning paradigm with fear acquisition training on day 1 and fear extinction training followed by an exercise or resting control intervention on day 2. On day 3, retrieval and reinstatement were tested including two additional but perceptually similar stimuli to explore the generalization of exercise effects. Exercise significantly increased heart rate, salivary alpha amylase, and cortisol, indicating successful exercise manipulation. Contrary to our expectations, exercise did not enhance but rather impaired extinction memory retrieval on the next day, evidenced by significantly stronger differential skin conductance responses (SCRs) and pupil dilation (PD). Importantly, although conditioned fear responses were successfully acquired, they did not fully extinguish, explaining why exercise might have boosted the consolidation of the original fear memory trace instead. Additionally, stronger differential SCRs and PD toward the novel stimuli suggest that the memory enhancing effects of exercise also generalized to perceptually similar stimuli. Together, these findings indicate that physical exercise can facilitate both the long-term retrievability and generalization of extinction memories, but presumably only when extinction was successful in the first place.
Collapse
Affiliation(s)
- Valerie L Jentsch
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tobias Otto
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
2
|
Fynn G, Porter M, Borchard T, Kazzi C, Zhong Q, Campbell L. The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:816-841. [PMID: 37291991 DOI: 10.1111/jir.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/16/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Individuals with intellectual disability (ID) are at higher risk of experiencing difficulties with anxiety than the general population. However, there are major barriers for individuals to receive appropriate services. There is a growing understanding of the importance of developing appropriate psychological interventions for this group. The objective of the current review was to systematically evaluate the findings of studies investigating the effectiveness of cognitive behavioural therapy (CBT) for individuals with ID and anxiety. Another aim was to explore which adaptions to CBT and treatment components were currently being utilised within the field. METHOD The electronic databases of CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection and Scopus were searched to identify relevant studies. The methodological quality of these studies was assessed using established quality assessment tools by the National Institutes of Health for pre and post studies and case series. RESULTS Nine studies were included in this systematic review, all of which reported improvements in anxiety severity for some participants (25%-100%; N = 60) following CBT. Only three studies reported moderate effect sizes for CBT interventions on anxiety for individuals with ID. DISCUSSION AND CONCLUSIONS There is emerging literature supporting the effectiveness of CBT for individuals with mild ID. Findings highlight that CBT for individuals with anxiety and mild ID, including cognitive components, may be feasible and tolerable. While the field is gradually receiving more attention, there are significant methodological flaws present, which limit the conclusions that can be drawn regarding the effectiveness of CBT for individuals with ID. However, there is emerging evidence for techniques such as cognitive restructuring and thought replacement and modifications such as visual aids, modelling and smaller groups based on this review. Future research is warranted to investigate whether individuals with more severe ID can benefit from CBT, as well as further exploring what are the necessary components and modifications.
Collapse
Affiliation(s)
- G Fynn
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - M Porter
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - T Borchard
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - C Kazzi
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Q Zhong
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - L Campbell
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
3
|
Caudle MM, Dugas N, Stout DM, Ball TM, Bomyea J. Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety. Psychiatry Res 2023; 327:115416. [PMID: 37604041 DOI: 10.1016/j.psychres.2023.115416] [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: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.
Collapse
Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - D M Stout
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - T M Ball
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305, United States
| | - J Bomyea
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
| |
Collapse
|
4
|
Chan GH. Therapeutic comparison in psychological capital. Front Psychiatry 2023; 14:1114170. [PMID: 37608996 PMCID: PMC10441124 DOI: 10.3389/fpsyt.2023.1114170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/18/2023] [Indexed: 08/24/2023] Open
Abstract
Aim This study aimed to investigate and compare the therapeutic outcomes of psychological capital between narrative therapy, cognitive-behavioral therapy, and play therapy in the context of hikikomori. Methods This study included 502 hikikomori. Correlation analysis was performed to investigate the relationship between the three forms of therapy and psychological capital, while one-way ANOVA and independent samples t-tests were performed to determine the differences in the outcomes of psychological capital between the three forms of therapies. Results Results indicated that all three forms of therapy were significantly positively related to psychological capital. Moreover, while cognitive-behavioral therapy performed better in psychological capital (overall score) than the other two, cognitive-behavioral therapy performed better in the subscales "self-efficacy" and "resilience," while narrative therapy performed better in the "hope" and "optimism" subscales. Also, combining features of play therapy helped enhance the outcomes of narrative therapy and cognitive-behavioral therapy on psychological capital. Conclusion Owing to the varied outcomes of psychological capital among different therapies, the differential use of therapies to deal with the unique needs resultant of hikikomori helps achieve optimal results.
Collapse
Affiliation(s)
- Gloria Hongyee Chan
- Department of Social and Behavioral Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| |
Collapse
|
5
|
Gromer D, Hildebrandt LK, Stegmann Y. The Role of Expectancy Violation in Extinction Learning: A Two-Day Online Fear Conditioning Study. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e9627. [PMID: 37732150 PMCID: PMC10508258 DOI: 10.32872/cpe.9627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 04/03/2023] [Indexed: 09/22/2023] Open
Abstract
Background Exposure therapy is at the core of the treatment of pathological anxiety. While the inhibitory learning model proposes a framework for the mechanisms underlying exposure therapy, in particular expectancy violation, causal evidence for its assumptions remains elusive. Therefore, the aim of the current study was to provide evidence for the influence of expectancy violation on extinction retention by manipulating the magnitude of expectancy violation during extinction learning. Method In total, 101 individuals completed a web-based fear conditioning protocol, consisting of a fear acquisition and extinction phase, as well as a spontaneous recovery and fear reinstatement test 24h later. To experimentally manipulate expectancy violation, participants were presented only with states of the conditioned stimulus that either weakly or strongly predicted the aversive outcome. Consequently, the absence of any aversive outcomes in the extinction phase resulted in low or high expectancy violation, respectively. Results We found successful fear acquisition and manipulation of expectancy violation, which was associated with reduced threat ratings for the high compared to the low expectancy violation group directly after extinction learning. On Day 2, inhibitory CS-noUS associations could be retrieved for expectancy ratings, whereas there were no substantial group differences for threat ratings. Conclusion These findings indicate that the magnitude of expectancy violation is related to the retrieval of conscious threat expectancies, but it is unclear how these changes translate to affective components (i.e., threat ratings) of the fear response and to symptoms of pathological anxiety.
Collapse
Affiliation(s)
- Daniel Gromer
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | | | - Yannik Stegmann
- Department of Psychology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
6
|
Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.
AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic.
METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined.
RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.
CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
Collapse
Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| |
Collapse
|
7
|
Melo-Carrillo A, Rodriguez R, Ashina S, Lipinski B, Hart P, Burstein R. Psychotherapy Treatment of Generalized Anxiety Disorder Improves When Conducted Under Narrow Band Green Light. Psychol Res Behav Manag 2023; 16:241-250. [PMID: 36726697 PMCID: PMC9885775 DOI: 10.2147/prbm.s388042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/18/2022] [Indexed: 01/28/2023] Open
Abstract
Background and Goals Psychotherapy is one of the most highly recommended and practiced approaches for the treatment of Generalized anxiety disorder (GAD). Commonly defined as excessive worry that is uncontrollable, GAD is one of the most prevalent psychiatric disorders. Anxiety is also one of the most common associated symptoms of migraine. Exposing migraineurs to narrow band green light (nbGL) reduces their anxiety and anxiety-like physiological symptoms such as throat tightness, shortness of breath, and palpitations. Here, we sought to determine whether the reduced anxiety described by our patients was secondary to the reduced headache or independent of it. The goal of the current study was therefore to determine whether exposure to nbGL can reduce anxiety in GAD patients who are not migraineurs. Patients and Methods Included in this open-label, proof-of-concept, prospective study were 13 patients diagnosed with moderate-to-severe GAD. We used the State-Trait Anxiety Inventory Questionnaire (Y-1) to compare anxiety level before and after each 45-minutes psychotherapy session conducted in white light (WL) (intensity = 100±5 candela/m2) vs nbGL (wavelength = 520±10nm (peak ± range), intensity = 10±5 candela/m2). Results Here, we show that psychotherapy sessions conducted under nbGL increase positive and decrease negative feelings significantly more than psychotherapy sessions conducted under regular room light (χ2 = 0.0001). Conclusion The findings provide initial evidence for the potential benefit of conducting psychotherapy sessions for patients suffering GAD under nbGL conditions. Given the absence of side effects or risks, we suggest that illuminating rooms used in psychotherapy with nbGL be considered an add-on to the treatment of GAD.
Collapse
Affiliation(s)
- Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | | | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | | | | | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Anesthesia, Harvard Medical School, Boston, MA, USA,Correspondence: Rami Burstein, Tel +1 617 735-2832, Fax +1 617 735-2833, Email
| |
Collapse
|
8
|
Knowles KA, Tolin DF. Mechanisms of Action in Exposure Therapy. Curr Psychiatry Rep 2022; 24:861-869. [PMID: 36399234 DOI: 10.1007/s11920-022-01391-8] [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] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness. RECENT FINDINGS Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction. Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.
Collapse
Affiliation(s)
- Kelly A Knowles
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA. .,Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
| |
Collapse
|
9
|
Muacevic A, Adler JR, Ghasib AM, Kabbarah AJ, Alnefaie SA, Hariri N, Altammar MA, Fadhel AM, Altowairqi FM. Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches. Cureus 2022; 14:e32687. [PMID: 36660516 PMCID: PMC9847330 DOI: 10.7759/cureus.32687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Social anxiety disorder (SAD) is a highly distressing chronic psychiatric disorder characterized by persistent fear of social situations in anticipation of being judged negatively by others. As shyness mimics some of the symptoms of SAD, people suffering from this debilitating disease are often underdiagnosed. It can have a devastating impact on all areas of life including academic performance, social growth, relationship status, and work performance. In recent years, research on anxiety and related disorders has proliferated due to the increased use of cognitive-behavioral models. The understanding of SAD has evolved greatly from distinguishing it from shyness to implementing modalities to comprehend the sophisticated underlying mechanism of disease prevalence and progression as well as methods to treat it. This review summarizes the concept of SAD, its epidemiology, symptoms, and diagnostic tools. Frequent comorbidities including other psychiatric disorders are also discussed. Additionally, we examine the latest evidence related to treatment options including psychotherapy and pharmacotherapy as well as recommendations for managing SAD.
Collapse
|
10
|
Early hypervigilance and later avoidance: Event-related potentials track the processing of threatening stimuli in anxiety. Behav Res Ther 2022; 158:104181. [DOI: 10.1016/j.brat.2022.104181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
|
11
|
Peters J, Visser RM, Kindt M. More than just fear: Development and psychometric evaluation of the Spider Distress Scale to assess spider fear and spider-related disgust. J Anxiety Disord 2022; 90:102602. [PMID: 35841782 DOI: 10.1016/j.janxdis.2022.102602] [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: 07/29/2021] [Revised: 05/20/2022] [Accepted: 07/02/2022] [Indexed: 11/19/2022]
Abstract
Spider fear is an excellent model to experimentally study processes in the maintenance and treatment of long-lasting fears. A valid, reliable, and practical tool to assess spider-related distress dimensionally, and to differentiate between spider-related fear and disgust in a time-sensitive manner, may help to better understand individual differences in these two emotions and to tailor treatments accordingly. We developed a concise self-report questionnaire, the Spider Distress Scale (SDS), that combines the strengths of established spider fear questionnaires and addresses their shortcomings. We explored (study 1 and 2) and confirmed (study 3) a two-factor structure of the SDS in samples from the general population (n = 370; n = 360; n = 423), recruited online via Prolific Academic from the United Kingdom, the Netherlands, and the United States. The fear and disgust factors of the SDS are highly internally consistent and the SDS has excellent test-retest reliability. We found good convergent and discriminant validity, based on self-report measures and spider behavioural approach tasks, and the SDS successfully differentiated between individuals with and without spider fear (study 4, n = 75). Our series of studies suggests that fear and disgust are functionally related, but that disgust towards spiders can be differentially assessed when focussing on unique elements of disgust-related information.
Collapse
Affiliation(s)
- Jacqueline Peters
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Renee M Visser
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Merel Kindt
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
12
|
Feurer C, Jimmy J, Bhaumik R, Duffecy J, Medrano GR, Ajilore O, Shankman SA, Langenecker SA, Craske MG, Phan KL, Klumpp H. Anterior cingulate cortex activation during attentional control as a transdiagnostic marker of psychotherapy response: a randomized clinical trial. Neuropsychopharmacology 2022; 47:1350-1357. [PMID: 34718341 PMCID: PMC8556845 DOI: 10.1038/s41386-021-01211-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Abstract
Anterior cingulate cortex (ACC) response during attentional control in the context of task-irrelevant emotional faces is a promising biomarker of cognitive behavioral therapy (CBT) outcome in patients with social anxiety disorder (SAD). However, it is unclear whether this biomarker extends to major depressive disorder (MDD) and is specific to CBT outcome. In the current study, 72 unmedicated patients with SAD (n = 39) or MDD (n = 33) completed a validated emotional interference paradigm during functional magnetic resonance imaging before treatment. Participants viewed letter strings superimposed on task-irrelevant threat and neutral faces under low perceptual load (high interference) and high perceptual load (low interference). Biomarkers comprised anatomy-based rostral ACC (rACC) and dorsal ACC (dACC) response to task-irrelevant threat (>neutral) faces under low and high perceptual load. Patients were randomly assigned to 12 weeks of CBT or supportive therapy (ST) (ClinicalTrials.gov identifier: NCT03175068). Clinician-administered measures of social anxiety and depression severity were obtained at baseline and every 2 weeks throughout treatment (7 assessments total) by an assessor blinded to the treatment arm. A composite symptom severity score was submitted to latent growth curve models. Results showed more baseline rACC activity to task-irrelevant threat>neutral faces under low, but not high, perceptual load predicted steeper trajectories of symptom improvement throughout CBT or ST. Post-hoc analyses indicated this effect was driven by subgenual ACC (sgACC) activation. Findings indicate ACC activity during attentional control may be a transdiagnostic neural predictor of general psychotherapy outcome.
Collapse
Affiliation(s)
- Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jagan Jimmy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Runa Bhaumik
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Jennifer Duffecy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Gustavo R. Medrano
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Olusola Ajilore
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Stewart A. Shankman
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL USA
| | - Scott A. Langenecker
- grid.223827.e0000 0001 2193 0096Department of Psychiatry, University of Utah, Salt Lake City, UT USA
| | - Michelle G. Craske
- grid.19006.3e0000 0000 9632 6718Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA USA
| | - K. Luan Phan
- grid.261331.40000 0001 2285 7943Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH USA
| | - Heide Klumpp
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Department of Psychology, University of Illinois at Chicago, Chicago, IL USA
| |
Collapse
|
13
|
Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review. Front Public Health 2022; 10:854673. [PMID: 35480569 PMCID: PMC9035831 DOI: 10.3389/fpubh.2022.854673] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 02/03/2023] Open
Abstract
During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.
Collapse
Affiliation(s)
- Rulin Wang
- Medical College, Xijing University, Xi'an, China
| | - Xin Huang
- Department of Psychiatry, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Wang
- Department of Psychiatry, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yuan Wang
| | - Masod Akbari
- Research Center for Psychiatric Diseases, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Slivjak ET, Pedersen EJ, Arch JJ. Evaluating the efficacy of common humanity-enhanced exposure for socially anxious young adults. J Anxiety Disord 2022; 87:102542. [PMID: 35151021 DOI: 10.1016/j.janxdis.2022.102542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Despite some evidence of the benefits of self-compassion training among socially anxious individuals, little is known about whether enhancing self-compassion prior to exposure therapy increases initial exposure engagement. Additionally, manipulations have relied on broad definitions of self-compassion, rendering it difficult to distinguish the impact of individual components. This study employed three experiential exercises designed to enhance one facet of self-compassion-common humanity. Socially anxious undergraduates (N = 63) were randomized in groups to 1) common humanity-enhanced exposure (n = 32) or 2) exposure alone (n = 31). In the common humanity condition, participants wrote self-compassionately, shared fears, and completed a common humanity-focused lovingkindness meditation. All participants then completed a speech exposure in front of live judges followed by an optional second exposure. Within the common humanity condition, positive self-responding to the speech exposure increased (b = 0.30, p = .026). Common humanity participants also remained in the first exposure longer, relative to exposure alone (b = -30.92, p = .002). Participants rated exercises as at least moderately helpful, with sharing fears rated most helpful. In sum, a brief group-based multi-modal common humanity induction represents a promising approach to improving initial engagement with feared contexts among socially anxious individuals.
Collapse
Affiliation(s)
- Elizabeth T Slivjak
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Eric J Pedersen
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
| | - Joanna J Arch
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA.
| |
Collapse
|
15
|
Knappe S, Martini J, Muris P, Wittchen HU, Beesdo-Baum K. Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life. J Anxiety Disord 2022; 86:102533. [PMID: 35092927 DOI: 10.1016/j.janxdis.2022.102533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 12/06/2021] [Accepted: 01/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is a notable comorbidity between externalizing disorders and anxiety disorders, which may be explained by the co-occurrence of two prevalent early-onset disorders, by shared vulnerability and risk factors, or as evidence that one disorder group might be causally related to the other. AIM To investigate the longitudinal trajectories of externalizing disorders, their interplay with anxiety disorders, and putative predictors for symptom progression in youth. METHODS 1053 adolescents (14-17 years) from the general population were assessed at baseline and prospectively at 2, 4, and 10-year follow-up using a standardized interview of mental disorders (DIA-X/M-CIDI) to assess "early" (oppositional-defiant disorder, conduct disorder, ADHD) and "late" (antisocial behavior, substance use disorders) externalizing disorders as well as anxiety disorders. Longitudinal associations and predictors for symptom progression were examined using Kaplan-Meier-analyses. RESULTS Lifetime prevalence of early externalizing disorders were 9.1% and 6.4% among those with and without any anxiety disorder. A late externalizing disorder was reported by 50.3% of those with an early externalizing disorder and in 26.6% of those with any anxiety disorder. Both early (HR: 1.5, 95%CI: 1.0-2.3) and late externalizing disorders (HR: 2.1, 95%CI: 1.7-2.6) were associated with incident anxiety disorders. Higher parental rejection, lower volitional inhibition, and higher volitional avoidance predicted incident anxiety disorders among those with early externalizing disorders. DISCUSSION Early externalizing disorders likely follow a homotypic continuity (to late externalizing disorders) and/or a heterotypic continuity to anxiety disorders, and thus appear as a useful target for prevention and early intervention.
Collapse
Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 36, 01187 Dresden, Germany; Evangelische Hochschule Dresden (ehs), University of Applied Sciences for Social Work, Education and Nursing, Dürerstr. 25, 01307 Dresden, Germany.
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 36, 01187 Dresden, Germany; Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Peter Muris
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 36, 01187 Dresden, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany.
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 36, 01187 Dresden, Germany.
| |
Collapse
|
16
|
Quantitative Electroencephalography (QEEG) as an Innovative Diagnostic Tool in Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042465. [PMID: 35206651 PMCID: PMC8879113 DOI: 10.3390/ijerph19042465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Quantitative electroencephalography (QEEG) is becoming an increasingly common method of diagnosing neurological disorders and, following the recommendations of The American Academy of Neurology (AAN) and the American Clinical Neurophysiology Society (ACNS), it can be used as a complementary method in the diagnosis of epilepsy, vascular diseases, dementia, and encephalopathy. However, few studies are confirming the importance of QEEG in the diagnosis of mental disorders and changes occurring as a result of therapy; hence, there is a need for analyses in this area. The aim of the study is analysis of the usefulness of QEEG in the diagnosis of people with generalized anxiety disorders. Our research takes the form of case studies. The paper presents an in-depth analysis of the QEEG results of five recently studied people with a psychiatric diagnosis: generalized anxiety disorder. The results show specific pattern amplitudes at C3 and C4. In all of the examined patients, two dependencies are repeated: low contribution of the sensorimotor rhythm (SMR) wave amplitudes and high beta2 wave amplitudes, higher or equal to the alpha amplitudes. The QEEG study provides important information about the specificity of brain waves of people with generalized anxiety disorder; therefore, it enables the preliminary and quick diagnosis of dysfunction. It is also possible to monitor changes due to QEEG, occurring as a result of psychotherapy, pharmacological therapy and EEG-biofeedback.
Collapse
|
17
|
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Portugal: Feasibility Study Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031782. [PMID: 35162806 PMCID: PMC8835210 DOI: 10.3390/ijerph19031782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023]
Abstract
The Unified Protocol for Children (UP-C) is a transdiagnostic Cognitive-Behavioral Therapy group intervention for children and caregivers targeting the treatment of children’s emotional disorders (EDs). The present study aims to assess the feasibility and acceptability of the UP-C in the Portuguese population using a single-armed design. The participants were 32 children (6–12 years of age) with an ED (anxiety and/or depressive disorder) as a main diagnosis and their parents. All participants received the UP-C intervention and were assessed at pretreatment, midtreatment, posttreatment, and 3 months posttreatment. Children, parents, the clinicians, and an external observer completed questionnaires to assess the feasibility and acceptability of the UP-C (e.g., satisfaction, motivation, and adherence). Children and parents also completed self-report measures assessing the children’s anxiety and depression and its interference and severity. The results of the present study support the feasibility and acceptability of the UP-C in Portugal; low dropout rates, high adherence rates, and high levels of child and parent satisfaction and motivation were observed. Moreover, significant reductions over time in children’s levels of anxiety and/or depression and of its interference and severity were found and were maintained after 3 months of follow-up. These results are promising and warrant a subsequent randomized controlled trial (RCT).
Collapse
|
18
|
Cortisol before extinction generalization alters its neural correlates during retrieval. Psychoneuroendocrinology 2022; 136:105607. [PMID: 34864329 DOI: 10.1016/j.psyneuen.2021.105607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/21/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
While generalization of fear seems to be naturally acquired as frequently observed in fear-related disorders, extinction learning appears to be stimulus-specific. Thus, treatments aiming to generalize extinction learning comprise the chance to overcome stimulus-specificity and consequently reduce relapse. One suggested candidate is the timing-dependent administration of the stress hormone cortisol. In the present pre-registered, three-day fear conditioning study, we aimed to create a generalized extinction memory trace in 60 healthy men and women using multiple sizes of one conditioned stimulus (CS+G; generalized) during extinction training, whereas the other CS (CS+N; non-generalized) and the CS- were solely presented in their original sizes. Extinction training took place either after pharmacological administration of 20 mg cortisol or placebo. Following successful fear acquisition on day one, generalization effects during extinction training and retrieval were investigated in the comparison of CS+G and CS+N. Insula and dorsal anterior cingulate cortex (dACC) activation for CS+G as compared to CS+N extending to the second half of extinction training indicated prolonged fear processing during extinction training for the CS+G on day two. During retrieval on day three, an activation of the anterior hippocampus occurred for CS+N minus CS+G in the cortisol but not in the placebo group. Additionally, a more posterior hippocampal activation (compared to the other hippocampal activation) was observed for the contrast CS+G minus CS+N. In accordance with our hypotheses, amygdala and dACC responding during reinstatement test was reduced for the CS+G as compared to CS+N. However, cortisol did not modulate amygdala responding, but abolished the CS+G/CS+N differentiation in the dACC relative to placebo. Generalization and cortisol effects were not mirrored in skin conductance responses. In conclusion, extinction generalization processes appear to rely on prolonged fear processing still present in the second half of extinction training that in turn leads to reduced fear-related processing after reinstatement. Cortisol administration prior to extinction training, however, selectively reduced fear-related activation for standard extinction but did not further reduce fear-related activation for extinction generalization.
Collapse
|
19
|
Rasouli S, Gupta G, Nilsen E, Dautenhahn K. Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety. Int J Soc Robot 2022; 14:1-32. [PMID: 35096198 PMCID: PMC8787185 DOI: 10.1007/s12369-021-00851-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
AbstractSocial anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as ‘food for thought’ for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.
Collapse
Affiliation(s)
- Samira Rasouli
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Garima Gupta
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Elizabeth Nilsen
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Kerstin Dautenhahn
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario Canada
| |
Collapse
|
20
|
Moghimi E, Knyahnytska Y, Omrani M, Nikjoo N, Stephenson C, Layzell G, Frederic Simpson AI, Alavi N. Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review. Front Psychiatry 2022; 13:921527. [PMID: 35873240 PMCID: PMC9304966 DOI: 10.3389/fpsyt.2022.921527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/07/2022] [Indexed: 01/12/2023] Open
Abstract
Chronic exposure to stressors and potentially psychologically traumatic events contributes to the high prevalence of mental health disorders in correctional workers (CWs) and other public safety personnel (PSP). Digital mental health interventions are an accessible and scalable method of improving and maintaining the mental health of this population. The current review explores the benefits of digital mental health interventions for PSP-with a focus on CWs-and how these innovations can address the limitations in in-person mental health care. A systematic literature search of five databases (Medline, PsycInfo, Embase, CINAHL, Google Scholar) was conducted until March 2022. The search yielded 16 publications that focused on digital mental health interventions or care available to CWs and other PSP. The benefits of digital innovations were summarized into five categories which discussed (1) their ability to enhance accessibility and reduce stigma; (2) the provision of evidence-based and structured psychotherapy programs; (3) variability in the degree of therapist engagement; (4) the integration of proactive interventions; and (5) enhancing engagement by acknowledging unique experiences and interpersonal relationships. Although digital mental health technologies for CWs are still in their infancy, there is strong evidence to support their effectiveness in ameliorating symptoms of mental distress. Future research should consider how ethnicity, gender, culture, sexual orientation, and socioeconomic status can be integrated into these therapies and how the interplay between different stakeholders and organizations can impact the effectiveness of online therapies and programs.
Collapse
Affiliation(s)
- Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada
| | - Niloofar Nikjoo
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gina Layzell
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| |
Collapse
|
21
|
Moghimi E, Knyahnytska Y, Zhu Y, Kumar A, Knyahnytski A, Patel C, Omrani M, Gerritsen C, Martin M, Simpson AIF, Alavi N. A qualitative exploration of the mental health challenges and therapeutic needs of Canadian correctional workers. Front Psychiatry 2022; 13:1004143. [PMID: 36386978 PMCID: PMC9641701 DOI: 10.3389/fpsyt.2022.1004143] [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: 07/26/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Correctional work is described as a high-stress environment associated with increased prevalence of mental health disorders in employees. Identifying appropriate healthcare services necessitates investigating the mental health challenges and needs of correctional workers (CWs). METHODS Individual interviews (n = 9; 5 M and 4 W) and a mixed gender focus group (n = 6; 3 M and 3 W) were conducted to gather a general sense of the mental health landscape. Data were analyzed to develop a targeted and comprehensive question guide for gender-specific focus groups (n = 14 unique participants; 6 M and 8 W). RESULTS Eight themes emerged from the gender-specific focus groups. Themes focusing on work culture described the negative repercussions of job stress and the inability to discuss challenges openly due to confidentiality concerns and feelings of seclusion associated with the CW profession. Men were more likely to be subjected to physical violence and women to emotional and sexual harassment from staff and inmates. Themes related to mental health care described the benefits and limitations of the current services and digital mental healthcare. Stigma and accessibility were notable treatment barriers. Lastly, sector-specific therapy was seen as an important component in enhancing engagement and therapist interaction. CONCLUSION The study demonstrates the interconnection between work culture and CW mental health that needs to be acknowledged when addressing mental health care.
Collapse
Affiliation(s)
- Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Yiran Zhu
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada
| | - Cory Gerritsen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Michael Martin
- Correctional Service of Canada, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada.,Faculty of Health Sciences, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| |
Collapse
|
22
|
Rukmini S, Sudhir PM, Bhaskar A, Arumugham SS. Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
23
|
Zaboski BA, Romaker EK. Using Cognitive-Behavioral Therapy with Exposure for Anxious Students with Classroom Accommodations. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2021. [DOI: 10.1080/87568225.2021.1961110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
24
|
Mashima PA, Waldron-Perrine B, MacLennan D, Sohlberg MM, Perla LY, Eapen BC. Interprofessional Collaborative Management of Postconcussion Cognitive Symptoms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1598-1610. [PMID: 34170743 DOI: 10.1044/2021_ajslp-20-00313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this clinical focus article is to illustrate an interprofessional cognitive rehabilitation approach. Invited experts representing physical medicine and rehabilitation, clinical neuropsychology/rehabilitation psychology, registered nurse care coordination, and speech-language pathology share viewpoints from their discipline to engage in collaborative interventions with the goal of enhancing treatment outcomes. Conclusions Treating the multifactorial symptoms of concussion requires expertise from an interdisciplinary team (IDT) of professionals, contributing unique perspectives and providing integrative services to optimize rehabilitation outcomes for patients. Speech-language pathologists serve an important role on IDTs to deliver personalized, targeted therapies for prolonged or persistent postconcussion cognitive impairment.
Collapse
Affiliation(s)
- Pauline A Mashima
- Department of Communication Sciences and Disorders, University of Hawai'i at Mānoa, Honolulu
| | - Brigid Waldron-Perrine
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, Michigan Medicine/University of Michigan, Ann Arbor
| | | | | | - Lisa Y Perla
- U.S. Department of Veterans Affairs, Washington, DC
| | - Blessen C Eapen
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, CA
| |
Collapse
|
25
|
Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
Collapse
Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
26
|
Richter J, Pané-Farré CA, Gerlach AL, Gloster AT, Wittchen HU, Lang T, Alpers GW, Helbig-Lang S, Deckert J, Fydrich T, Fehm L, Ströhle A, Kircher T, Arolt V, Hamm AO. Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change. Behav Res Ther 2021; 142:103886. [PMID: 34023593 DOI: 10.1016/j.brat.2021.103886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023]
Abstract
Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT. Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period. We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects - one possible reason for the return of symptoms in new situations.
Collapse
Affiliation(s)
- Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Christiane A Pané-Farré
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Alexander L Gerlach
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andrew T Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Institute for Clinical Psychology Bremen, Bremen, Germany; Department for Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Sylvia Helbig-Lang
- Department of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| |
Collapse
|
27
|
AlHadi AN, AlGhofili HH, Almujaiwel NA, Alsweirky HM, Albeshr MF, Almogbel GT. Perception and barriers to the use of cognitive-behavioral therapy in the treatment of depression in primary healthcare centers and family medicine clinics in Saudi Arabia. J Family Community Med 2021; 28:77-84. [PMID: 34194271 PMCID: PMC8213094 DOI: 10.4103/jfcm.jfcm_494_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND General practitioners (GPs) and family medicine physicians (FMPs) have a vital role to play in co-ordinating the care for mental disorders. The objective of this study was to determine the perception of GPs and FMPs on the use of cognitive-behavioral therapy (CBT) for depression in Saudi Arabia, and the barriers against the implementation of CBT in such settings. MATERIALS AND METHODS All physicians working in Primary Healthcare Centers and Family Medicine Clinics in Saudi Arabia were targeted and invited to participate in this cross-sectional study. A self-administered online questionnaire was sent via E-mail through the Saudi Commission for Health Specialties and the Saudi Society of Family and Community Medicine. Data was collected using an existing validated questionnaire and was modified to fit the objectives of current study. RESULTS A total of 469 FMPs and GPs completed the survey; the mean age of respondents was 38 years. More than half of the FMPs' and GPs' (53%) showed a positive perception of the use of CBT in primary healthcare settings. Most participants (91.9%) were willing to use CBT if they had adequate education and training. More than half of the participants (59.5%) thought it was time-consuming, while 39% thought that CBT training was a very time-intensive process. CONCLUSION We conclude that more than half of the physicians clearly had a good perception of the effectiveness of CBT administration in primary healthcare settings. Younger physicians were more perceptive. The most agreed-on barrier to CBT implementation was the lack of training and education.
Collapse
Affiliation(s)
- Ahmad N. AlHadi
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hesham H. AlGhofili
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nasser A. Almujaiwel
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Helmi M. Alsweirky
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed F. Albeshr
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gassan T. Almogbel
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
28
|
Emotion Regulation and Repetitive Negative Thinking Before and After CBT and SSRI Treatment of Internalizing Psychopathologies. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10222-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Hendrikx LJ, Krypotos AM, Engelhard IM. Enhancing extinction with response prevention via imagery-based counterconditioning: Results on conditioned avoidance and distress. J Behav Ther Exp Psychiatry 2021; 70:101601. [PMID: 32835958 DOI: 10.1016/j.jbtep.2020.101601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Maladaptive avoidance is a core characteristic of anxiety-related disorders. Its reduction is often promoted using extinction with response prevention (ExRP) procedures, but these effects are often short-lived. Research has shown that pairing a feared stimulus with a stimulus of an incompatible valence (i.e., counterconditioning) may be effective in reducing fear. This laboratory study tested whether positive imagery during ExRP (i.e., imagery counterconditioning protocol) can also reduce avoidance. METHODS In the counterconditioning procedure, participants imagined a positive sound. There were four phases. First, participants were presented with squares on a computer screen of which one (CS+) was paired with an aversive sound and another (CS-) was not. Second, they learned to avoid the negative sound in the presence of the CS+, via a key press. Third, they were assigned to either the Counterconditioning (that was asked to imagine a positive sound during ExRP) or No Counterconditioning group (standard ExRP). Finally, they performed a test phase that consisted of two parts: in the first part, avoidance responses were available for each CS and in the second part, these responses were prevented. RESULTS The Counterconditioning intervention resulted in a short-lived reduction of distress associated with the CS+. However, groups did not differ in avoidance or distress during the test phases. LIMITATIONS US-expectancy ratings were collected only at the end of the experiment. CONCLUSIONS The results indicate that positive imagery during ExRP may be effective in reducing distress during the intervention. Explanations for the persistence of avoidance and fear are discussed.
Collapse
Affiliation(s)
- Laura J Hendrikx
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Angelos-Miltiadis Krypotos
- Department of Clinical Psychology, Utrecht University, the Netherlands; Department of Healthy Psychology, KU Leuven, Belgium.
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands
| |
Collapse
|
30
|
Pittig A, Hoyer J, Noack R. Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Willems AL, Vervliet B. When nothing matters: Assessing markers of expectancy violation during omissions of threat. Behav Res Ther 2021; 136:103764. [DOI: 10.1016/j.brat.2020.103764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023]
|
32
|
Hosogoshi H, Takebayashi Y, Ito M, Fujisato H, Kato N, Nakajima S, Oe Y, Miyamae M, Kanie A, Horikoshi M. Expressive suppression of emotion is a moderator of anxiety in a unified protocol for transdiagnostic treatment of anxiety and depressive disorders: A secondary analysis. J Affect Disord 2020; 277:1-4. [PMID: 32777602 DOI: 10.1016/j.jad.2020.07.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Expressive suppression (ES) of emotion is considered a moderator that reduces the efficacy of cognitive behavioural therapy (CBT); however, whether and how ES moderates the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders (UP), a version of CBT targeting aversive/avoidant responses to emotions, including ES, remain unclear. We investigated whether and how emotion regulation, especially ES, moderates UP efficacy for anxiety symptoms in patients with anxiety and depressive disorders. METHODS We conducted a secondary analysis of data from a previous trial. Seventeen patients with anxiety and/or depressive disorders were included. Changes (slope estimates) in the Structured Interview Guide for the Hamilton Anxiety Rating Scale from pre-treatment to post-treatment were measured using a latent growth curve model with empirical Bayesian estimation. Pre-treatment ES, cognitive reappraisal, and depressive symptoms were used as slope factor predictors. RESULTS Only pre-treatment ES significantly predicted the slope in the latent growth curve model (estimate value = 0.45; standard deviation = 0.21; 95% credible interval = 0.03-0.87, one-tailed p-value = 0.004), and an inverse correlation between pre-treatment ES levels and improvement magnitude of anxiety symptoms was demonstrated. LIMITATIONS Because the data were obtained from a single-arm trial, this study did not have controls, and most participants received pharmacotherapy in addition to UP. Therefore, generalisability of the present findings might be compromised. CONCLUSIONS Low ES before UP was an effective predictor of greater improvement in anxiety symptoms after UP. The findings suggest that interventions intended to improve ES may improve UP efficacy.
Collapse
Affiliation(s)
- Hiroki Hosogoshi
- Psychology Major, Department of Sociology, Faculty of Sociology, Kansai University, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo 187-8511, Japan.
| | - Hiroko Fujisato
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Noriko Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Japan
| | - Shun Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo 187-8511, Japan
| | - Yuki Oe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Japan
| | - Mitsuhiro Miyamae
- National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | - Ayako Kanie
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo 187-8511, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo 187-8511, Japan
| |
Collapse
|
33
|
Koszycki D, Guérin E, DiMillo J, Bradwejn J. Randomized trial of cognitive behaviour group therapy and a mindfulness‐based intervention for social anxiety disorder: Preliminary findings. Clin Psychol Psychother 2020; 28:200-218. [DOI: 10.1002/cpp.2502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Koszycki
- Faculty of Education (Counselling Psychology) University of Ottawa Ottawa Ontario Canada
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
- University of Ottawa Brain and Mind Research Institute Ottawa Ontario Canada
| | - Eva Guérin
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Julia DiMillo
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Jacques Bradwejn
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
| |
Collapse
|
34
|
Shepardson RL, Minnick MR, Funderburk JS. Anxiety interventions delivered in primary care behavioral health routine clinical practice. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:193-199. [PMID: 32525354 PMCID: PMC8314503 DOI: 10.1037/fsh0000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Although anxiety is highly prevalent in primary care and a top reason for referral to primary care behavioral health (PCBH) services, there are limited data on which anxiety interventions are used in routine PCBH practice. The objective of this study was to identify interventions delivered when treating anxiety in PCBH practice. METHOD We conducted an online survey of PCBH providers regarding their clinical practice with patients who present for treatment of anxiety symptoms. The final sample comprised 209 PCBH providers recruited from e-mail listservs of national professional organizations (59.3% psychologists, 23.4% social workers, 12.4% counselors, 4.8% other). Providers reported on use (yes/no) of 17 interventions in their most recent session with their most recent adult patient presenting with a primary concern of non-trauma-related anxiety. RESULTS On average, patients were reported to be 42.2 (14.73) years old, White (73.7%), and male (56.5%) with anxiety symptoms of moderate severity (65.6%). Most reportedly had comorbid sleep difficulties (63.6%), depressive symptoms (58.4%), and/or stress/adjustment (56.0%). Providers reported delivering an average of 5.77 (2.05, range: 1-15) interventions, with psychoeducation (94.7%), relaxation training (64.1%), and supportive therapy (60.8%) being most common. Several highly efficacious evidence-based interventions for anxiety, including cognitive therapy (45.0%) and exposure (21.1%), were less common. DISCUSSION While PCBH providers delivered numerous brief interventions for anxiety, cognitive therapy and exposure were underutilized. Furthermore, PCBH patients with anxiety symptoms were complex, with significant severity and comorbidity. These results suggest implications for research, clinical training, intervention design, and future implementation efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
35
|
Rozenman M, Gonzalez A, Logan C, Goger P. Cognitive bias modification for threat interpretations: Impact on anxiety symptoms and stress reactivity. Depress Anxiety 2020; 37:438-448. [PMID: 32301579 PMCID: PMC7299169 DOI: 10.1002/da.23018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/15/2019] [Accepted: 06/15/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cognitive bias modification for interpretations (CBM-I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety. Initial CBM-I trials with clinical populations suggest the potential utility of this approach. However, most CBM-I experiments have been conducted with unaffected samples, few (one or two) training sessions, and have not examined transfer effects to anxiety-related constructs such as stress reactivity. METHOD This study compared a 12-session CBM-I intervention (n = 12) to an interpretation control condition (ICC; n = 12) in individuals (N = 24) with elevated trait anxiety on interpretation bias, anxiety symptom, and stress reactivity outcomes (electrodermal activity, heart rate, and respiratory sinus arrhythmia). RESULTS Compared to the ICC group, participants assigned to CBM-I experienced significantly greater improvements in interpretation bias and anxiety symptoms by post-intervention 4 weeks later, with impact on anxiety maintained at 1-month follow-up. While CBM-I and ICC groups did not differ in stress reactivity during an acute stressor at pre-intervention, the CBM-I group evidenced improved stress reactivity at post-intervention compared to ICC on two psychophysiological indices, electrodermal activity and heart rate. CONCLUSIONS The results of this pilot study suggest that CBM-I may hold promise for reducing anxiety symptoms, as well as impact psychophysiological arousal during an acute stressor.
Collapse
Affiliation(s)
- Michelle Rozenman
- University of Denver Department of Psychology / UCLA Division of Child & Adolescent Psychiatry
| | | | - Christina Logan
- California State University Long Beach Department of Psychology
| | - Pauline Goger
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology
| |
Collapse
|
36
|
Ferreira de Sá DS, Römer S, Brückner AH, Issler T, Hauck A, Michael T. Effects of intranasal insulin as an enhancer of fear extinction: a randomized, double-blind, placebo-controlled experimental study. Neuropsychopharmacology 2020; 45:753-760. [PMID: 31896118 PMCID: PMC7076012 DOI: 10.1038/s41386-019-0593-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 01/27/2023]
Abstract
Fear-extinction based psychotherapy (exposure) is the most effective method for treating anxiety disorders. Notwithstanding, since some patients show impairments in the unlearning of fear and insufficient fear remission, there is a growing interest in using cognitive enhancers as adjuvants to exposure. As insulin plays a critical role in stress processes and acts as a memory enhancer, this study aimed to assess the capacity of intranasal insulin to augment fear extinction. A double-blind, placebo-controlled differential fear-conditioning paradigm was conducted in 123 healthy participants (63 females). Pictures of faces with neutral expressions were used as conditioned stimuli and electric shocks as unconditioned stimuli. The paradigm consisted of four phases presented on three consecutive days: acquisition (day 1), extinction (day 2), reinstatement and re-extinction (day 3). A single intranasal dose of insulin (160 IU) or placebo was applied on day 2, 45 min before fear extinction. Skin conductance response (SCR), fear-potentiated startle (FPS) and expectancy ratings were assessed. During extinction, the insulin group (independent of sex) showed a significantly stronger decrease in differential FPS in comparison with the placebo group. Furthermore, a sex-specific effect was found for SCR, with women in the insulin group showing a greater decrease of differential SCR both at early extinction and at late re-extinction. Our results provide first evidence that intranasal insulin facilitates fear extinction processes and is therefore a promising adjuvant for extinction-based therapies in anxiety and related disorders. Sex-specific effects should be taken into consideration in future studies.
Collapse
Affiliation(s)
- Diana S. Ferreira de Sá
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Sonja Römer
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Alexandra H. Brückner
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tobias Issler
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Alexander Hauck
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| |
Collapse
|
37
|
Tagliabue M, Squatrito V, Presti G. Models of Cognition and Their Applications in Behavioral Economics: A Conceptual Framework for Nudging Derived From Behavior Analysis and Relational Frame Theory. Front Psychol 2019; 10:2418. [PMID: 31736824 PMCID: PMC6838970 DOI: 10.3389/fpsyg.2019.02418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022] Open
Abstract
This paper puts forward a rounder conceptual model for interpreting short- and long-term effects of choice behavior. As a further development of dual-process theory, Kahneman (2003) distinguished between intuition and reasoning, which served as the respective precursors of the cognitive processing systems 1 and 2. We maintain that they reflect the more rigorous distinction between brief and immediate and extended and elaborated relational responding, which may be reinterpreted through an analysis of their functional properties. Repertoires of relational responding are offered by the multi-dimensional multi-level model. Specifically, we provide a conceptual account of how nudging, or the manipulation of environmental contingencies, works on the creation and modification of relational framing. Educative nudges, or boosts, are a subset of nudges that may more easily maintain target choice behavior in the future. The central role of verbal behavior is essential toward formulating rules, which inform and guide choice behavior over time. Although nudges are traditionally regarded as System 1-steered aspects, they are herein regarded as cues for responding to relational frames, which may induce System 2-steered aspects. We suggest adopting the implicit relational assessment procedure (IRAP) to inform how coherent and immediate responding to novel relational responding may occur in the presence of choice behavior. Several examples are included to support the claim of encompassing relational responding and choice behavior. We address the instances of consumer behavior, stereotypy and prejudices, eating behavior, and overcoming cognitive biases. The conclusions depict a promising way forward for the study of choice: an improved model for interpreting and overcoming human errors, due to changes in the contingencies of behavior.
Collapse
Affiliation(s)
- Marco Tagliabue
- Cultural Selection and Behavioral Economics Lab, Department of Behavioural Sciences, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
| | - Valeria Squatrito
- Kore University Behavioral Lab, Faculty of Human and Social Sciences, Kore University, Enna, Italy
| | - Giovambattista Presti
- Kore University Behavioral Lab, Faculty of Human and Social Sciences, Kore University, Enna, Italy
| |
Collapse
|
38
|
Heather ALJ, Waters AM. Attention narrowing followed by broadening enhances threat reactivity and generalisation during extinction but reduces physiological arousal at retest: A preliminary examination. LEARNING AND MOTIVATION 2019. [DOI: 10.1016/j.lmot.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
39
|
Zaboski BA, Joyce-Beaulieu D, Kranzler JH, McNamara JP, Gayle C, MacInnes J. Group exposure and response prevention for college students with social anxiety: A randomized clinical trial. J Clin Psychol 2019; 75:1489-1507. [PMID: 31022313 DOI: 10.1002/jclp.22792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/29/2019] [Accepted: 03/28/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Social anxiety increases college student drop-out risk and stifles employment opportunities. Group cognitive-behavioral therapy with exposure (CBT ERP) has the potential to alleviate campus resource strain but remains under-researched with college students. The present study investigated the efficacy of group CBT ERP in a randomized clinical trial on a college campus. METHOD Thirty-one postsecondary students were randomly assigned to an exposure-only group or an active control. RESULTS Linear mixed-effects models indicated significant Group × Time interactions for general social anxiety (t = -2.02, g = 0.62) and depression (t = -2.77, g = 0.55); nonsignificant main effects were found for group and time variables. On a measure of fear of negative evaluation, only the main effect of time was significant (t = 2.15, p = 0.032). CONCLUSIONS When compared to an active control group, CBT ERP is an efficacious and time-effective treatment for college students experiencing social anxiety.
Collapse
Affiliation(s)
- Brian A Zaboski
- Department of Special Education, School Psychology, & Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Diana Joyce-Beaulieu
- Department of Special Education, School Psychology, & Early Childhood Studies, University of Florida, Gainesville, Florida
| | - John H Kranzler
- Department of Special Education, School Psychology, & Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Joseph P McNamara
- Department of Psychiatry, Division of Medical Psychology, University of Florida, Gainesville, Florida
| | | | - Jann MacInnes
- Department of Human Development and Organization Studies, University of Florida, Gainesville, Florida
| |
Collapse
|
40
|
Reconceptualising Exposure and Some Implications for Cognitive-Behavioural and Psychodynamic Practice. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.
Collapse
|
41
|
Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms. Eur Arch Psychiatry Clin Neurosci 2019; 269:161-170. [PMID: 28712090 DOI: 10.1007/s00406-017-0823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
Although cognitive behavioral therapy (CBT) is highly effective in the treatment of anxiety disorders, many patients still do not benefit. This study investigates whether a history of traumatic event experience is negatively associated with outcomes of CBT for panic disorder. The moderating role of the monoamine oxidase A (MAOA) gene and depression symptoms as well as the association between trauma history and fear reactivity as a potential mechanism are further analyzed. We conducted a post-hoc analysis of 172 male and 60 female patients with panic disorder treated with CBT in a multi-center study. Treatment outcome was assessed at post-treatment using self-report and clinician rating scales. Fear reactivity before treatment was assessed via heart rate and self-reported anxiety during a behavioral avoidance test. Among females, we did not find any differences in treatment response between traumatized and non-traumatized individuals or any two-way interaction trauma history × MAOA genotype. There was a significant three-way interaction trauma history × MAOA genotype × depression symptoms on all treatment outcomes indicating that in traumatized female patients carrying the low-activity allele, treatment effect sizes decreased with increasing depression symptoms at baseline. No such effects were observed for males. In conclusion, we found no evidence for a differential treatment response in traumatized and non-traumatized individuals. There is preliminary evidence for poorer treatment outcomes in a subgroup of female traumatized individuals carrying the low-active variant of the MAOA gene. These patients also report more symptoms of depression symptomatology and exhibit a dampened fear response before treatment which warrants further investigation.
Collapse
|
42
|
Pittig A, Kotter R, Hoyer J. The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions. Behav Ther 2019; 50:353-366. [PMID: 30824251 DOI: 10.1016/j.beth.2018.07.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/30/2023]
Abstract
Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
Collapse
Affiliation(s)
- Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Roxana Kotter
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| |
Collapse
|
43
|
Pittig A, Dehler J. Same fear responses, less avoidance: Rewards competing with aversive outcomes do not buffer fear acquisition, but attenuate avoidance to accelerate subsequent fear extinction. Behav Res Ther 2019; 112:1-11. [DOI: 10.1016/j.brat.2018.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/17/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022]
|
44
|
Computerized Exposure Therapy for Spider Phobia: Effects of Cardiac Timing and Interoceptive Ability on Subjective and Behavioral Outcomes. Psychosom Med 2019; 81:90-99. [PMID: 30300237 DOI: 10.1097/psy.0000000000000646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia. METHOD Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on interoceptive accuracy. RESULTS MANCOVA analysis showed that timing group affected the outcome measures (F(10,80) = 2.405, p = .015) and there was a group interaction with interoception ability (F(15,110) = 1.808, p = .045). Subjective symptom reduction was greatest in the systolic group relative to the other two groups (diastolic (t = 3.115, ptukey = .009); random (t = 2.438, ptukey = .048)), with greatest reductions in those participants with lower interoceptive accuracy. Behavioral aversion reduced more in cardiac-contingent groups than the noncontingent (random) group (diastolic (t = 3.295, ptukey = .005); systolic (t = 2.602, ptukey = .032)). Physiological (skin conductance response) responses remained strongest for spider stimuli presented at cardiac systole. CONCLUSIONS Interoceptive information influences exposure benefit. The reduction in the subjective expression of fear/phobia is facilitated by "bottom-up" afferent signals, whereas improvement in the behavioral expression is further dependent on "top-down" representation of self-related physiology (heart rhythm). Individual interoceptive differences moderate these effects, suggesting means to personalize therapy.
Collapse
|
45
|
Pittig A, Hengen K, Bublatzky F, Alpers GW. Social and monetary incentives counteract fear-driven avoidance: Evidence from approach-avoidance decisions. J Behav Ther Exp Psychiatry 2018; 60:69-77. [PMID: 29747141 DOI: 10.1016/j.jbtep.2018.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/10/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The reduction of avoidance behavior is a central target in the treatment of anxiety disorders, but it has rarely been studied how approach of fear-relevant stimuli may be initiated. In two studies, the impact of hypothetical monetary and symbolic social incentives on approach-avoidance behavior was examined. METHODS In Study 1, individuals high or low on fear of spiders (N = 84) could choose to approach a fear-relevant versus a neutral stimulus, which were equally rewarded. In a subsequent micro-intervention, approaching the fear-relevant stimulus was differentially rewarded either by monetary or social incentives. In Study 2 (N = 76), initial incentives for approach were discontinued to investigate the stability of approach. RESULTS Hypothetical monetary and symbolic social incentives reduced or eliminated initial avoidance, even in highly fearful individuals. Approach resulted in a decrease of self-reported aversiveness towards the fear-relevant stimulus. However, even after successful approach, fearful individuals showed significant avoidance behavior when incentives for approach were discontinued. LIMITATIONS Future research should investigate the long-term effects of prolonged approach incentives on multiple levels of fear (e.g., self-report, behavioral, physiological). It should also be tested if such an intervention actually improves compliance with exposure based interventions. CONCLUSIONS The present findings highlight that incentives are useful to initiate initial approach towards a feared stimulus. Although incentive-based approach may neither fully eliminate avoidance nor negative feelings towards the feared stimulus, such operant interventions may set the stage for more extensive extinction training.
Collapse
Affiliation(s)
- Andre Pittig
- Clinical Psychology and Biological Psychology and Psychotherapy, Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Kristina Hengen
- Clinical Psychology and Biological Psychology and Psychotherapy, Department of Psychology, School of Social Sciences, University of Mannheim, Germany
| | - Florian Bublatzky
- Clinical Psychology and Biological Psychology and Psychotherapy, Department of Psychology, School of Social Sciences, University of Mannheim, Germany
| | - Georg W Alpers
- Clinical Psychology and Biological Psychology and Psychotherapy, Department of Psychology, School of Social Sciences, University of Mannheim, Germany
| |
Collapse
|
46
|
Mulders AEP, Moonen AJH, Dujardin K, Kuijf ML, Duits A, Flinois B, Handels RLH, Lopes R, Leentjens AFG. Cognitive behavioural therapy for anxiety disorders in Parkinson's disease: Design of a randomised controlled trial to assess clinical effectiveness and changes in cerebral connectivity. J Psychosom Res 2018; 112:32-39. [PMID: 30097133 DOI: 10.1016/j.jpsychores.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anxiety disorders occur in up to 35% of patients with Parkinson's disease (PD) and have a negative effect on motor symptoms and quality of life. To date, no clinical trials specifically targeting anxiety in PD patients have been published. OBJECTIVE To describe the rationale and methodology of a randomised controlled trial (RCT) that aims to study the clinical effectiveness, alterations in brain circuitry, and cost-effectiveness of cognitive behavioural therapy (CBT) for anxiety in PD. METHODS This study is a prospective, two-centre RCT in which sixty PD patients with anxiety will be randomised to CBT treatment and clinical monitoring (intervention group) or to clinical monitoring only (control group). The CBT module used in this study was specifically developed to address symptoms of anxiety in PD patients. Participants will undergo standardised clinical, cognitive and behavioural assessment at baseline and at 2 follow-up measurements, as well as resting-state fMRI and DTI scanning before and after the intervention. The primary outcome measure is changes in severity of anxiety symptoms. Secondary outcome measures involve long-term changes in anxiety symptoms, changes in functional and structural connectivity between limbic and frontal cortices, and cost-effectiveness of the treatment. The study is registered at the ClinicalTrials.gov database under registration number NCT02648737. CONCLUSION This study is the first that evaluates both the clinical effectiveness, cost-effectiveness, as well as the biological impact of CBT for anxiety in PD patients that, if proven effective, will hopefully contribute to a better and evidence-based approach for these non-motor symptoms.
Collapse
Affiliation(s)
- A E P Mulders
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A J H Moonen
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - K Dujardin
- Degenerative & Vascular Cognitive Disorders, University of Lille, Lille, France; Neurology and Movement Disorders Department, CHU, Lille, France
| | - M L Kuijf
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B Flinois
- Neurology and Movement Disorders Department, CHU, Lille, France
| | - R L H Handels
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R Lopes
- Degenerative & Vascular Cognitive Disorders, University of Lille, Lille, France; Neuroimaging Department, CHU Lille, Lille, France
| | - A F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| |
Collapse
|
47
|
Klumpp H, Fitzgerald JM. Neuroimaging Predictors and Mechanisms of Treatment Response in Social Anxiety Disorder: an Overview of the Amygdala. Curr Psychiatry Rep 2018; 20:89. [PMID: 30155657 PMCID: PMC9278878 DOI: 10.1007/s11920-018-0948-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Aberrant amygdala activity is implicated in the neurobiology of social anxiety disorder (SAD) and is, therefore, a treatment target. However, the extent to which amygdala predicts clinical improvement or is impacted by treatment has not been critically examined. This review highlights recent neuroimaging findings from clinical trials and research that test links between amygdala and mechanisms of action. RECENT FINDINGS Neuropredictor studies largely comprised psychotherapy where improvement was foretold by amygdala activity and regions beyond amygdala such as frontal structures (e.g., anterior cingulate cortex, medial prefrontal cortex) and areas involved in visual processes (e.g., occipital regions, superior temporal gyrus). Pre-treatment functional connectivity between amygdala and frontal areas was also shown to predict improvement signifying circuits that support emotion processing and regulation interact with treatment. Pre-to-post studies revealed decreases in amygdala response and altered functional connectivity in amygdala pathways regardless of treatment modality. In analogue studies of fear exposure, greater reduction in anxiety was predicted by less amygdala response to a speech challenge and amygdala activity decreased following exposures. Yet, studies have also failed to detect amygdala effects reporting instead treatment-related changes in regions and functional systems that support sensory, emotion, and regulation processes. An array of regions in the corticolimbic subcircuits and extrastriate cortex appear to be viable sites of action. The amygdala and amygdala pathways predict treatment outcome and are altered following treatment. However, further study is needed to establish the role of the amygdala and other candidate regions and brain circuits as sites of action.
Collapse
Affiliation(s)
- Heide Klumpp
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Chicago, IL, 60608, USA.
| | | |
Collapse
|
48
|
Cooper SE, Grillon C, Lissek S. Impaired discriminative fear conditioning during later training trials differentiates generalized anxiety disorder, but not panic disorder, from healthy control participants. Compr Psychiatry 2018; 85:84-93. [PMID: 30005181 PMCID: PMC6100804 DOI: 10.1016/j.comppsych.2018.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fear conditioning is implicated as a central psychopathological mechanism of anxiety disorders. People with anxiety disorders typically demonstrate reduced affective discrimination between conditioned danger and safety cues. Here, affective discrimination refers to the ability to selectively display fear to dangerous but not safe situations. Though both generalized anxiety disorder (GAD) and panic disorder (PD) are linked to impaired affective discrimination, the clinical phenomenology of these disorders suggests that people with GAD versus PD might be less able to overcome such deficits. It is unclear how this potential difference would manifest during lab-based conditioning. METHODS We used a classical fear conditioning paradigm over two discrimination training sessions to examine whether those with GAD, but not PD, would display persistent discrimination deficits. Sixty-seven participants (21 GAD, 19 PD, 27 Healthy Controls) completed a task in which conditioned fear was measured psychophysiologically (fear-potentiated startle), behaviorally, and via self-report. RESULTS Although similar levels of impaired discrimination were found for both GAD and PD groups during initial training, such impairments tended to persist across a subsequent training session only for patients with GAD when compared with Controls. CONCLUSION Our results provide a foundation for additional research of discrimination deficits in specific anxiety disorders, with an ultimate goal of improved customization of psychological treatments.
Collapse
Affiliation(s)
- Samuel E Cooper
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Twin City Campus, United States of America
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, DIRP, NIMH, United States of America
| | - Shmuel Lissek
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Twin City Campus, United States of America.
| |
Collapse
|
49
|
Sun KS, Lam TP, Wu D. Chinese perspectives on primary care for common mental disorders: Barriers and policy implications. Int J Soc Psychiatry 2018; 64:417-426. [PMID: 29781372 DOI: 10.1177/0020764018776347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. AIMS This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. METHODS A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. RESULTS Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. CONCLUSION Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients' intention to seek help and PCPs' competency in mental health care are other fundamental factors to be addressed.
Collapse
Affiliation(s)
- Kai Sing Sun
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- 2 University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| |
Collapse
|
50
|
Contractor AA, Brown LA, Caldas SV, Banducci AN, Taylor DJ, Armour C, Shea MT. Posttraumatic stress disorder and positive memories: Clinical considerations. J Anxiety Disord 2018; 58:23-32. [PMID: 30025253 DOI: 10.1016/j.janxdis.2018.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 12/31/2022]
Abstract
Encoding and retrieval difficulties, and avoidance of both traumatic and positive memories, are associated with posttraumatic stress disorder (PTSD) symptoms. However, most PTSD research and clinical work has solely examined the role of traumatic memories in the maintenance/resolution of PTSD symptoms. This review provides a comprehensive discussion of the literature on positive memories and PTSD. First, we review theories and evidence on the relations between trauma, PTSD, and memory processes (particularly positive memories). Next, we propose a conceptual model that integrates evidence from experimental and positive/memory-based intervention research and highlights hypothesized mechanisms underlying the potential effectiveness of targeting positive memories in PTSD interventions. Specifically, we discuss how targeting positive memories could (1) increase positive affect and reduce negative affect, (2) correct negative cognitions, (3) increase specificity of retrieving autobiographical memories, and (4) be effectively integrated/sequenced with and enhance the effects of trauma-focused interventions. Lastly, we suggest clinical research avenues for investigating the relations between positive memories and PTSD, to possibly alter the current PTSD intervention paradigm focused only on traumatic memories. Overall, our proposed model drawing from experimental and intervention research, and outlining potential effects of targeting positive memories to reduce PTSD severity, needs further empirical investigation.
Collapse
Affiliation(s)
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Cherie Armour
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Northern Ireland, UK
| | - M Tracie Shea
- Providence Veterans Affairs Medical Center, Providence, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
| |
Collapse
|