1
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Teismann T, Forkmann T, Glaesmer H, Alpers GW, Brakemeier EL, Brockmeyer T, Christiansen H, Fehm L, Glombiewski J, Heider J, Hermann A, Hoyer J, Kaiser T, Klucken T, Lincoln TM, Lutz W, Margraf J, Pedersen A, Renneberg B, Rubel J, Rudolph A, Schöttke H, Schwartz B, Stark R, Velten J, Willutzki U, Wilz G, In-Albon T. Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment. J Affect Disord 2024; 351:971-976. [PMID: 38346649 DOI: 10.1016/j.jad.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.
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Affiliation(s)
- T Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.
| | - T Forkmann
- Clinical Psychology and Psychotherapy, Universität Duisburg-Essen, Germany.
| | - H Glaesmer
- Medical Psychology and Medical Sociology, Universität Leipzig, Germany.
| | - G W Alpers
- Otto Selz Institute & Department of Psychology, School of Social Sciences, University of Mannheim, Germany.
| | - E L Brakemeier
- Clinical Psychology and Psychotherapy, Universität Greifswald, Germany.
| | - T Brockmeyer
- Clinical Psychology and Psychotherapy, University of Goettingen, Germany.
| | - H Christiansen
- Clinical Child and Adolescent Psychology, Philipps-Universität Marburg, Germany.
| | - L Fehm
- Institute for Psychology, Humboldt-Universität zu Berlin, Germany.
| | - J Glombiewski
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Germany.
| | - J Heider
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Germany.
| | - A Hermann
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Germany.
| | - J Hoyer
- Faculty of Psychology, Technische Universität Dresden, Germany.
| | - T Kaiser
- Methods and Evaluation/Quality Assurance, Freie Universität Berlin, Germany.
| | - T Klucken
- Clinical Psychology and Psychotherapy, Universität Siegen, Germany.
| | - T M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Germany.
| | - W Lutz
- Clinical Psychology and Psychotherapy, Universität Trier, Germany.
| | - J Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - A Pedersen
- Clinical Psychology and Psychotherapy, Kiel University, Germany.
| | - B Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Germany.
| | - J Rubel
- Clinical Psychology and Psychotherapy of Adulthood, Universität Osnabrück, Germany.
| | - A Rudolph
- Clinical Psychology and Psychotherapy, Universität Leipzig, Germany.
| | - H Schöttke
- Clinical Psychology and Psychotherapy, Universität Osnabrück, Germany.
| | - B Schwartz
- Clinical Psychology and Psychotherapy, Universität Trier, Germany.
| | - R Stark
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Germany.
| | - J Velten
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - U Willutzki
- Clinical Psychology and Psychotherapy, Faculty of Health, University Witten/Herdecke, Germany.
| | - G Wilz
- Counseling and Clinical Intervention, Department of Psychology, Friedrich-Schiller Universität Jena.
| | - T In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-, Landau, Germany.
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2
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Heinzel S, Schwefel M, Sanchez A, Heinen D, Fehm L, Henze R, Terán C, Kallies G, Rapp MA, Fydrich T, Ströhle A, Heissel A. Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial. J Affect Disord 2022; 319:90-98. [PMID: 36113693 DOI: 10.1016/j.jad.2022.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date. METHODS 120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT. RESULTS Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response. LIMITATIONS The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included. CONCLUSIONS High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.
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Affiliation(s)
- Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Melanie Schwefel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Alba Sanchez
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Darlene Heinen
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Romy Henze
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Terán
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Gunnar Kallies
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heissel
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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3
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Keller F, Kühner C, Alexandrowicz RW, Voderholzer U, Meule A, Fegert JM, Legenbauer T, Holtmann M, Bräscher AK, Cordes M, Fehm L, Fladung AK, Fydrich T, Hamm A, Heider J, Hoyer J, In-Albon T, Lincoln TM, Lutz W, Margraf J, Renneberg B, Schlarb A, Schöttke H, Teismann T, Velten J, Willutzki U, Witthöft M, Ziem M, Hautzinger M. Zur Messqualität des Beck-Depressionsinventars (BDI-II) in unterschiedlichen klinischen Stichproben. Zeitschrift für Klinische Psychologie und Psychotherapie 2022. [DOI: 10.1026/1616-3443/a000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist.
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Affiliation(s)
- Ferdinand Keller
- Klinik für Kinder- und Jugendpsychiatrie / Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Christine Kühner
- AG Verlaufs- und Interventionsforschung, Zentralinstitut für Seelische Gesundheit, Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Deutschland
| | | | - Ulrich Voderholzer
- Klinik für Psychiatrie und Psychotherapie, Klinikum der LMU München, Deutschland
- Schön Klinik Roseneck, Prien am Chiemsee, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Deutschland
| | - Adrian Meule
- Klinik für Psychiatrie und Psychotherapie, Klinikum der LMU München, Deutschland
- Schön Klinik Roseneck, Prien am Chiemsee, Deutschland
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie / Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Tanja Legenbauer
- LWL-Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ruhr-Universität Bochum, Hamm, Deutschland
| | - Martin Holtmann
- LWL-Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Ruhr-Universität Bochum, Hamm, Deutschland
| | | | - Martin Cordes
- Institut für Psychologie, Poliklinische Psychotherapieambulanzen, Universität Osnabrück, Deutschland
| | - Lydia Fehm
- Institut für Psychologie, Humboldt-Universität zu Berlin, Deutschland
| | - Anne-Katharina Fladung
- Institut für Psychologie, Arbeitsbereich Klinische Psychologie und Psychotherapie, Universität Hamburg, Deutschland
| | - Thomas Fydrich
- Institut für Psychologie, Humboldt-Universität zu Berlin, Deutschland
| | - Alfons Hamm
- Zentrum für Psychologische Psychotherapie, Universität Greifswald, Deutschland
| | - Jens Heider
- Psychotherapeutische Universitätsambulanz, Campus Landau, Universität Koblenz-Landau, Deutschland
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
| | - Tina In-Albon
- Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters, Universität Koblenz-Landau, Deutschland
| | - Tania M. Lincoln
- Institut für Psychologie, Arbeitsbereich Klinische Psychologie und Psychotherapie, Universität Hamburg, Deutschland
| | - Wolfgang Lutz
- Poliklinische Psychotherapieambulanz, Klinische Psychologie und Psychotherapie, Universität Trier, Deutschland
| | - Jürgen Margraf
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Fakultät für Psychologie, Ruhr-Universität Bochum, Deutschland
| | - Babette Renneberg
- Hochschulambulanz für Psychotherapie, Diagnostik und Gesundheitsförderung, Freie Universität Berlin, Deutschland
| | - Angelika Schlarb
- Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters, Abteilung für Psychologie, Universität Bielefeld, Deutschland
| | - Henning Schöttke
- Institut für Psychologie, Klinische Psychologie und Psychotherapie, Universität Osnabrück, Deutschland
| | - Tobias Teismann
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Fakultät für Psychologie, Ruhr-Universität Bochum, Deutschland
| | - Julia Velten
- Forschungs- und Behandlungszentrum für psychische Gesundheit, Fakultät für Psychologie, Ruhr-Universität Bochum, Deutschland
| | - Ulrike Willutzki
- Department für Psychologie und Psychotherapie, Fakultät für Gesundheit, Universität Witten / Herdecke, Deutschland
| | - Michael Witthöft
- Psychologisches Institut, Johannes-Gutenberg-Universität Mainz, Deutschland
| | - Max Ziem
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
| | - Martin Hautzinger
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Eberhard-Karls-Universität Tübingen, Deutschland
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4
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Sommer K, Odenwald M, Fehm L. Stabilität und Prädiktion von Prüfungsangst bei Studierenden. Zeitschrift für Klinische Psychologie und Psychotherapie 2022. [DOI: 10.1026/1616-3443/a000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Obwohl Prüfungsangst ein häufiges Anliegen in psychologischen Beratungsstellen ist, wissen wir wenig über ihren zeitlichen Verlauf sowie über Risikofaktoren für hohe Prüfungsangst kurz vor den Prüfungen. Fragestellung: Diese Studie untersucht, ob sich die Intensität von Prüfungsangst während eines Semesters verändert und wie Personen mit hoher Belastung kurz vor der Prüfung früh identifiziert werden können. Methodik: Zu Beginn und kurz vor den Prüfungen des Wintersemesters 2014/15 wurden Prüfungsangst, Depressivität und Prokrastination bei 427 Studierenden (88.3 % Erstsemester; 68.4 % weiblich; Altersdurchschnitt 20.0 Jahre) erfasst. Ergebnisse: Die Analyse auf Einzelfallebene zeigte, dass sich die Prüfungsangst bei den meisten Studierenden nicht signifikant veränderte. Bei der Vorhersage der Prüfungsangst zum Semesterende stellten Prüfungsangst und Depressivität zu Semesterbeginn signifikante Prädiktoren dar. Diese wurden anhand von 80 % der Gesamtstichprobe ermittelt und an den anderen 20 % validiert. Schlussfolgerungen: Erhöhte Prüfungsangst und Depressivität zu Semesterbeginn können die frühe Identifikation von Studierenden mit bedeutsamer Prüfungsangst kurz vor Prüfungen ermöglichen.
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Affiliation(s)
- Klara Sommer
- Institut für Psychologie, Lebenswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Deutschland
| | - Michael Odenwald
- Fachbereich Psychologie, Mathematisch-Naturwissenschaftliche Sektion, Universität Konstanz, Deutschland
| | - Lydia Fehm
- Institut für Psychologie, Lebenswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Deutschland
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5
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O’Leary A, Fernàndez-Castillo N, Gan G, Yang Y, Yotova AY, Kranz TM, Grünewald L, Freudenberg F, Antón-Galindo E, Cabana-Domínguez J, Harneit A, Schweiger JI, Schwarz K, Ma R, Chen J, Schwarz E, Rietschel M, Tost H, Meyer-Lindenberg A, Pané-Farré CA, Kircher T, Hamm AO, Burguera D, Mota NR, Franke B, Schweiger S, Winter J, Heinz A, Erk S, Romanczuk-Seiferth N, Walter H, Ströhle A, Fehm L, Fydrich T, Lueken U, Weber H, Lang T, Gerlach AL, Nöthen MM, Alpers GW, Arolt V, Witt S, Richter J, Straube B, Cormand B, Slattery DA, Reif A. Behavioural and functional evidence revealing the role of RBFOX1 variation in multiple psychiatric disorders and traits. Mol Psychiatry 2022; 27:4464-4473. [PMID: 35948661 PMCID: PMC9734045 DOI: 10.1038/s41380-022-01722-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
Common variation in the gene encoding the neuron-specific RNA splicing factor RNA Binding Fox-1 Homolog 1 (RBFOX1) has been identified as a risk factor for several psychiatric conditions, and rare genetic variants have been found causal for autism spectrum disorder (ASD). Here, we explored the genetic landscape of RBFOX1 more deeply, integrating evidence from existing and new human studies as well as studies in Rbfox1 knockout mice. Mining existing data from large-scale studies of human common genetic variants, we confirmed gene-based and genome-wide association of RBFOX1 with risk tolerance, major depressive disorder and schizophrenia. Data on six mental disorders revealed copy number losses and gains to be more frequent in ASD cases than in controls. Consistently, RBFOX1 expression appeared decreased in post-mortem frontal and temporal cortices of individuals with ASD and prefrontal cortex of individuals with schizophrenia. Brain-functional MRI studies demonstrated that carriers of a common RBFOX1 variant, rs6500744, displayed increased neural reactivity to emotional stimuli, reduced prefrontal processing during cognitive control, and enhanced fear expression after fear conditioning, going along with increased avoidance behaviour. Investigating Rbfox1 neuron-specific knockout mice allowed us to further specify the role of this gene in behaviour. The model was characterised by pronounced hyperactivity, stereotyped behaviour, impairments in fear acquisition and extinction, reduced social interest, and lack of aggression; it provides excellent construct and face validity as an animal model of ASD. In conclusion, convergent translational evidence shows that common variants in RBFOX1 are associated with a broad spectrum of psychiatric traits and disorders, while rare genetic variation seems to expose to early-onset neurodevelopmental psychiatric disorders with and without developmental delay like ASD, in particular. Studying the pleiotropic nature of RBFOX1 can profoundly enhance our understanding of mental disorder vulnerability.
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Affiliation(s)
- Aet O’Leary
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.10939.320000 0001 0943 7661Department of Neuropscyhopharmacology, Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - Noèlia Fernàndez-Castillo
- grid.5841.80000 0004 1937 0247Department de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, and Institut de Biomedicina de la Universitat de Barcelona (IBUB); Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII); Madrid, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Barcelona, Catalonia Spain
| | - Gabriela Gan
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Yunbo Yang
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy and Center for Mind, Brain and Behavior - CMBB, University of Marburg, Marburg, Germany
| | - Anna Y. Yotova
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.7839.50000 0004 1936 9721Institute of Cell Biology and Neuroscience, Faculty of Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thorsten M. Kranz
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lena Grünewald
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Freudenberg
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ester Antón-Galindo
- grid.5841.80000 0004 1937 0247Department de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, and Institut de Biomedicina de la Universitat de Barcelona (IBUB); Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII); Madrid, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Barcelona, Catalonia Spain
| | - Judit Cabana-Domínguez
- grid.5841.80000 0004 1937 0247Department de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, and Institut de Biomedicina de la Universitat de Barcelona (IBUB); Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII); Madrid, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Barcelona, Catalonia Spain
| | - Anais Harneit
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Janina I. Schweiger
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristina Schwarz
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ren Ma
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Junfang Chen
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Emanuel Schwarz
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcella Rietschel
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christiane A. Pané-Farré
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy and Center for Mind, Brain and Behavior - CMBB, University of Marburg, Marburg, Germany ,grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy and Center for Mind, Brain and Behavior - CMBB, University of Marburg, Marburg, Germany
| | - Alfons O. Hamm
- grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Demian Burguera
- grid.4491.80000 0004 1937 116XDepartment of Zoology, Charles University, Prague, Czech Republic
| | - Nina Roth Mota
- grid.10417.330000 0004 0444 9382Department of Human Genetics and Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Barbara Franke
- grid.10417.330000 0004 0444 9382Department of Human Genetics and Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Susann Schweiger
- grid.10388.320000 0001 2240 3300Mainz University Medical Center, Institute of Human Genetics, Mainz, Germany
| | - Jennifer Winter
- grid.10388.320000 0001 2240 3300Mainz University Medical Center, Institute of Human Genetics, Mainz, Germany
| | - Andreas Heinz
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Susanne Erk
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Henrik Walter
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Andreas Ströhle
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Lydia Fehm
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Lueken
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany ,grid.8379.50000 0001 1958 8658Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Lang
- grid.15078.3b0000 0000 9397 8745Christoph-Dornier-Foundation for Clinical Psychology, Institute for Clinical Psychology Bremen; Bremen, Germany and Department for Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Alexander L. Gerlach
- grid.6190.e0000 0000 8580 3777Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Markus M. Nöthen
- grid.10388.320000 0001 2240 3300Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Georg W. Alpers
- grid.5601.20000 0001 0943 599XDepartment of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Volker Arolt
- grid.5949.10000 0001 2172 9288Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Stephanie Witt
- grid.7700.00000 0001 2190 4373Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Richter
- grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany ,grid.9463.80000 0001 0197 8922Department of Experimental Psychopathology, University of Hildesheim, Hildesheim, Germany
| | - Benjamin Straube
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy and Center for Mind, Brain and Behavior - CMBB, University of Marburg, Marburg, Germany
| | - Bru Cormand
- grid.5841.80000 0004 1937 0247Department de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, and Institut de Biomedicina de la Universitat de Barcelona (IBUB); Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII); Madrid, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Barcelona, Catalonia Spain
| | - David A. Slattery
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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6
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Pittig A, Heinig I, Goerigk S, Thiel F, Hummel K, Scholl L, Deckert J, Pauli P, Domschke K, Lueken U, Fydrich T, Fehm L, Plag J, Ströhle A, Kircher T, Straube B, Rief W, Koelkebeck K, Arolt V, Dannlowski U, Margraf J, Totzeck C, Schneider S, Neudeck P, Craske MG, Hollandt M, Richter J, Hamm A, Wittchen HU. Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial. Depress Anxiety 2021; 38:1169-1181. [PMID: 34293223 DOI: 10.1002/da.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. METHODS This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. RESULTS Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. CONCLUSIONS Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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Affiliation(s)
- Andre Pittig
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany.,Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Stephan Goerigk
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Freya Thiel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katrin Hummel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lucie Scholl
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin 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 & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology & Center for Mind, Brain and Behavior - CMBB, Philipps-University of Marburg, Marburg, Germany
| | - Katja Koelkebeck
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Christina Totzeck
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Neudeck
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Protect-AD Study Site Cologne, Cologne, Germany
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Maike Hollandt
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Jan Richter
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Alfons Hamm
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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8
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Bolbeth A, Ziegler M, Fehm L. [Broad scope symptom questionnaires in psychotherapy: Comparing Brief Symptom Inventory and ICD-10 Symptom Rating]. Psychother Psychosom Med Psychol 2020; 71:202-208. [PMID: 33246345 DOI: 10.1055/a-1264-0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Our study compared the psychometric properties of two broad scope symptom questionnaires, the Brief Symptom Inventory [7] and the ICD-10 Symptom Rating Scale [8], in a naturalistic data set of 507 patients in outpatient psychotherapeutic treatment. Reliability of total scores and subscale scores were estimated via internal consistency coefficients Cronbach's α and McDonald's ω. Measurement precision was operationalized via the uncertainty interval. Validity of the total scores as measures of symptom load was operationalized via convergence analysis with measures similar and dissimilar to that concept. Validity of the internal structure of each scale was operationalized via confirmatory factor analysis of multiple models established in literature. Reliability and measurement precision were comparable for the two questionnaires. The convergent and discriminant validity of both instruments appear to be similarly sufficient. The ISR clearly showed good factorial validity, whereas the BSI was found to have poor factorial validity. Due to its uncertain factorial structure, interpretation of the BSI subscales is not advised. In sum, the ISR and BSI have comparable reliability and measurement precision, but ISR has superior validity and better time efficiency and therefore can be considered a valid alternative to the BSI.
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Affiliation(s)
- Annika Bolbeth
- Zentrum für Psychotherapie (ZPHU), Humboldt-Universität zu Berlin
| | | | - Lydia Fehm
- Zentrum für Psychotherapie (ZPHU), Humboldt-Universität zu Berlin
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9
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Berking AC, Thiel C, Schiele MA, Baumann C, Kalisch R, Notzen S, Zwanzger P, Pané-Farré CA, Hamm A, Alpers GW, Fydrich T, Fehm L, Gerlach AL, Straube B, Kircher T, Rief W, Plag J, Ströhle A, Lang T, Wittchen HU, Arolt V, Romanos M, Pauli P, Reif A, Deckert J, Domschke K, Weber H. An investigation of genetic variability of DNA methyltransferases DNMT3A and 3B does not provide evidence for a major role in the pathogenesis of panic disorder and dimensional anxiety phenotypes. J Neural Transm (Vienna) 2020; 127:1527-1537. [PMID: 32468273 DOI: 10.1007/s00702-020-02206-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
While DNA methylation patterns have been studied for a role in the pathogenesis of anxiety disorders, the role of the enzymes establishing DNA methylation-DNA methyltransferases (DNMTs)-has yet to be investigated. In an effort to investigate DNMT genotype-specific effects on dimensional anxiety traits in addition to the categorical phenotype of panic disorder, 506 panic disorder patients and 3112 healthy participants were assessed for anxiety related cognition [Agoraphobic Cognitions Questionnaire (ACQ)], anxiety sensitivity [Anxiety Sensitivity Index (ASI)] as well as pathological worry [Penn State Worry Questionnaire (PSWQ)] and genotyped for five single nucleotide polymorphisms (SNPs) in the DNMT3A (rs11683424, rs1465764, rs1465825) and DNMT3B (rs2424932, rs4911259) genes, which have previously been found associated with clinical and trait-related phenotypes. There was no association with the categorical phenotype panic disorder. However, a significant association was discerned between DNMT3A rs1465764 and PSWQ scores in healthy participants, with the minor allele conveying a protective effect. In addition, a marginally significant association between questionnaire scores (PSWQ, ASI) in healthy participants and DNMT3B rs2424932 was detected, again with the minor allele conveying a protective effect. The present results suggest a possible minor role of DNMT3A and DNMT3B gene variation in conveying resilience towards anxiety disorders. As the observed associations indicated a protective effect of two SNPs particularly with pathological worry, future studies are proposed to explore these variants in generalized anxiety disorder rather than panic disorder.
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Affiliation(s)
- Ann-Cathrine Berking
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Christiane Thiel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian Baumann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Johannes Gutenberg University Medical Center, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
- Catholic University of Applied Science Münster, Münster, Germany
| | - Swantje Notzen
- Catholic University of Applied Science Münster, Münster, Germany
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, District Hospital Gabersee, Wasserburg am Inn, Germany
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry and Psychotherapy LMU, Munich, Germany
| | - Christiane A Pané-Farré
- Institute of Psychology, University of Greifswald, Greifswald, Germany
- Institute of Psychology, Philipps University Marburg, Marburg, Germany
| | - Alfons Hamm
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Thomas Fydrich
- Institute of Psychology, Humboldt University, Berlin, Germany
| | - Lydia Fehm
- Institute of Psychology, Humboldt University, Berlin, Germany
| | - Alexander L Gerlach
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University Hospital of Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University Hospital of Marburg, Marburg, Germany
| | - Winfried Rief
- Institute of Psychology, Philipps University Marburg, Marburg, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Charité Mitte, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Charité Mitte, Berlin, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany
- Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy LMU, Munich, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany.
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10
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Weber H, Wittchen U, Lang T, Heinig I, Arolt A, Gerlach A, Kircher T, Rief W, Fehm L, Fydrich T, Ströhle A, Hamm A, Pané-Farré C, Alpers G, Pauli P, Reif A, Deckert J. Genetic variability of GLRB impact cognitive behavioral therapy response in panic disorder. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3403018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- H Weber
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - U Wittchen
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - T Lang
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - I Heinig
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Arolt
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Gerlach
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - T Kircher
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - W Rief
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - L Fehm
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - T Fydrich
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Ströhle
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Hamm
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - C Pané-Farré
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - G Alpers
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - P Pauli
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Reif
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - J Deckert
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
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11
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Ridderbusch IC, Richter J, Yang Y, Hoefler M, Weber H, Reif A, Hamm A, Pané-Farré CA, Gerlach AL, Stroehle A, Pfleiderer B, Arolt V, Wittchen HU, Gloster A, Lang T, Helbig-Lang S, Fehm L, Pauli P, Kircher T, Lueken U, Straube B. Association of rs7688285 allelic variation coding for GLRB with fear reactivity and exposure-based therapy in patients with panic disorder and agoraphobia. Eur Neuropsychopharmacol 2019; 29:1138-1151. [PMID: 31444036 DOI: 10.1016/j.euroneuro.2019.07.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/20/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Abstract
The gene coding for glycine receptor β subunits (GLRB) has been found to be related to panic disorder and agoraphobia (PD/AG) and to be associated with altered insular BOLD activation during fear conditioning, as an intermediate phenotype of defensive system reactivity in healthy subjects. In a multicenter clinical trial on PD/AG patients we investigated in three sub-samples whether GLRB allelic variation (A/G; A-allele identified as «risk») in the single nucleotide polymorphism rs7688285 was associated with autonomic (behavioral avoidance test BAT; n = 267 patients) and neural (differential fear conditioning; n = 49 patients, n = 38 controls) measures, and furthermore with responding towards exposure-based cognitive behavioral therapy (CBT, n = 184 patients). An interaction of genotype with current PD/AG diagnosis (PD/AG vs. controls; fMRI data only) and their modification after CBT was tested as well. Exploratory fMRI results prior to CBT, revealed A-allele carriers irrespective of diagnostic status to show overall higher BOLD activation in the hippocampus, motor cortex (MC) and insula. Differential activation in the MC, anterior cingulate cortex (ACC) and insula was found in the interaction genotype X diagnosis. Differential activation in ACC and hippocampus was present in differential fear learning. ACC activation was modified after treatment, while no overall rs7688285 dependent effect on clinical outcomes was found. On the behavioral level, A-allele carriers showed pronounced fear reactivity prior to CBT which partially normalized afterwards. In sum, rs7688285 variation interacts in a complex manner with PD/AG on a functional systems level and might be involved in the development of PD/AG but not in their treatment.
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Affiliation(s)
- Isabelle C Ridderbusch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.
| | - Jan Richter
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Michael Hoefler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alfons Hamm
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Christiane A Pané-Farré
- Institute of Psychology, University of Greifswald, Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Alexander L Gerlach
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andreas Stroehle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Pfleiderer
- Medical Faculty, University of Münster and Department Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Andrew Gloster
- Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Thomas Lang
- Christoph-Dornier-Stiftung für Klinische Psychologie, Bremen, Germany; Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Sylvia Helbig-Lang
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Paul Pauli
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
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12
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Rayner C, Coleman JRI, Purves KL, Hodsoll J, Goldsmith K, Alpers GW, Andersson E, Arolt V, Boberg J, Bögels S, Creswell C, Cooper P, Curtis C, Deckert J, Domschke K, El Alaoui S, Fehm L, Fydrich T, Gerlach AL, Grocholewski A, Hahlweg K, Hamm A, Hedman E, Heiervang ER, Hudson JL, Jöhren P, Keers R, Kircher T, Lang T, Lavebratt C, Lee SH, Lester KJ, Lindefors N, Margraf J, Nauta M, Pané-Farré CA, Pauli P, Rapee RM, Reif A, Rief W, Roberts S, Schalling M, Schneider S, Silverman WK, Ströhle A, Teismann T, Thastum M, Wannemüller A, Weber H, Wittchen HU, Wolf C, Rück C, Breen G, Eley TC. A genome-wide association meta-analysis of prognostic outcomes following cognitive behavioural therapy in individuals with anxiety and depressive disorders. Transl Psychiatry 2019; 9:150. [PMID: 31123309 PMCID: PMC6533285 DOI: 10.1038/s41398-019-0481-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 03/01/2019] [Accepted: 03/23/2019] [Indexed: 01/04/2023] Open
Abstract
Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.
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Affiliation(s)
- Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Evelyn Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Julia Boberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Susan Bögels
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Charles Curtis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Katharina Domschke
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
- Center for NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samir El Alaoui
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander L Gerlach
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Anja Grocholewski
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Kurt Hahlweg
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Alfons Hamm
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Erik Hedman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Einar R Heiervang
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Peter Jöhren
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Robert Keers
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Thomas Lang
- Christoph-Dornier-Stiftung für Klinische Psychologie, Institut für Klinische Psychologie und Psychotherapie, Bremen, Germany
| | - Catharina Lavebratt
- Neurogenetics Unit, Center for Molecular Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sang-Hyuck Lee
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Kathryn J Lester
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Maaike Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Christiane A Pané-Farré
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Winfried Rief
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Susanna Roberts
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Schalling
- Neurogenetics Unit, Center for Molecular Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
- Dental Clinic Bochum, Bochum, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christiane Wolf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
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13
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Mumm JLM, Pyrkosch L, Plag J, Nagel P, Petzold MB, Bischoff S, Fehm L, Fydrich T, Ströhle A. Heart rate variability in patients with agoraphobia with or without panic disorder remains stable during CBT but increases following in-vivo exposure. J Anxiety Disord 2019; 64:16-23. [PMID: 30875662 DOI: 10.1016/j.janxdis.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/15/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
Patients with anxiety disorders have a lower heart rate variability (HRV) than healthy controls. Low HRV is associated with cardiovascular disease and dysfunction of the autonomic nervous system (ANS). The aim of the present study was to investigate if HRV in patients with agoraphobia with or without panic disorder can be influenced by cognitive behavioral therapy (CBT). 73 patients with agoraphobia with or without panic disorder were included in the study. Heart rate (HR) and HRV were recorded at rest before and after CBT and during in-vivo exposure. No changes in HR and HRV were observed throughout therapy. During in-vivo exposure HRV increased significantly and HR exhibited a tendency to decrease. Despite clinical improvement of anxiety symptoms, ANS activity at rest did not seem to be influenced by CBT. However, during in-vivo exposure, HRV changed significantly, indicating a higher parasympathetic activity at the end of exposure.
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Affiliation(s)
- Jennifer Lara Maria Mumm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Lena Pyrkosch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Jens Plag
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Patrick Nagel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Cardiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Moritz Bruno Petzold
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Sophie Bischoff
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Lydia Fehm
- Zentrum für Psychotherapie, Institut für Psychologie, Humboldt-Universität zu Berlin, Klosterstr. 64, 10179 Berlin, Germany.
| | - Thomas Fydrich
- Zentrum für Psychotherapie, Institut für Psychologie, Humboldt-Universität zu Berlin, Klosterstr. 64, 10179 Berlin, Germany.
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
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14
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Gottschalk MG, Richter J, Ziegler C, Schiele MA, Mann J, Geiger MJ, Schartner C, Homola GA, Alpers GW, Büchel C, Fehm L, Fydrich T, Gerlach AL, Gloster AT, Helbig-Lang S, Kalisch R, Kircher T, Lang T, Lonsdorf TB, Pané-Farré CA, Ströhle A, Weber H, Zwanzger P, Arolt V, Romanos M, Wittchen HU, Hamm A, Pauli P, Reif A, Deckert J, Neufang S, Höfler M, Domschke K. Orexin in the anxiety spectrum: association of a HCRTR1 polymorphism with panic disorder/agoraphobia, CBT treatment response and fear-related intermediate phenotypes. Transl Psychiatry 2019; 9:75. [PMID: 30718541 PMCID: PMC6361931 DOI: 10.1038/s41398-019-0415-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/06/2019] [Accepted: 01/17/2019] [Indexed: 12/23/2022] Open
Abstract
Preclinical studies point to a pivotal role of the orexin 1 (OX1) receptor in arousal and fear learning and therefore suggest the HCRTR1 gene as a prime candidate in panic disorder (PD) with/without agoraphobia (AG), PD/AG treatment response, and PD/AG-related intermediate phenotypes. Here, a multilevel approach was applied to test the non-synonymous HCRTR1 C/T Ile408Val gene variant (rs2271933) for association with PD/AG in two independent case-control samples (total n = 613 cases, 1839 healthy subjects), as an outcome predictor of a six-weeks exposure-based cognitive behavioral therapy (CBT) in PD/AG patients (n = 189), as well as with respect to agoraphobic cognitions (ACQ) (n = 483 patients, n = 2382 healthy subjects), fMRI alerting network activation in healthy subjects (n = 94), and a behavioral avoidance task in PD/AG pre- and post-CBT (n = 271). The HCRTR1 rs2271933 T allele was associated with PD/AG in both samples independently, and in their meta-analysis (p = 4.2 × 10-7), particularly in the female subsample (p = 9.8 × 10-9). T allele carriers displayed a significantly poorer CBT outcome (e.g., Hamilton anxiety rating scale: p = 7.5 × 10-4). The T allele count was linked to higher ACQ sores in PD/AG and healthy subjects, decreased inferior frontal gyrus and increased locus coeruleus activation in the alerting network. Finally, the T allele count was associated with increased pre-CBT exposure avoidance and autonomic arousal as well as decreased post-CBT improvement. In sum, the present results provide converging evidence for an involvement of HCRTR1 gene variation in the etiology of PD/AG and PD/AG-related traits as well as treatment response to CBT, supporting future therapeutic approaches targeting the orexin-related arousal system.
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Affiliation(s)
- Michael G. Gottschalk
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany ,0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Jan Richter
- grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Christiane Ziegler
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam A. Schiele
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Mann
- 0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Maximilian J. Geiger
- 0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany ,grid.5963.9Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Schartner
- 0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany ,0000 0001 2297 6811grid.266102.1Department of Physiology, University of California San Francisco, San Francisco, CA USA
| | - György A. Homola
- 0000 0001 1958 8658grid.8379.5Department of Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Georg W. Alpers
- 0000 0001 0943 599Xgrid.5601.2Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christian Büchel
- 0000 0001 2180 3484grid.13648.38Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Fehm
- 0000 0001 2248 7639grid.7468.dDepartment of Psychology, Humboldt University, Berlin, Germany
| | - Thomas Fydrich
- 0000 0001 2248 7639grid.7468.dDepartment of Psychology, Humboldt University, Berlin, Germany
| | - Alexander L. Gerlach
- 0000 0000 8580 3777grid.6190.eDepartment of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andrew T. Gloster
- 0000 0001 2111 7257grid.4488.0Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany ,0000 0004 1937 0642grid.6612.3Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Sylvia Helbig-Lang
- 0000 0001 2111 7257grid.4488.0Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany ,0000 0001 2287 2617grid.9026.dDepartment of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Raffael Kalisch
- grid.410607.4Neuroimaging Center (NIC) und Deutsches Resilienz-Zentrum (DRZ), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Tilo Kircher
- 0000 0004 1936 9756grid.10253.35Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Thomas Lang
- 0000 0001 2111 7257grid.4488.0Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany ,0000 0001 2287 2617grid.9026.dDepartment of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany ,Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany
| | - Tina B. Lonsdorf
- 0000 0001 2180 3484grid.13648.38Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane A. Pané-Farré
- grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heike Weber
- 0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany ,0000 0004 0578 8220grid.411088.4Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Peter Zwanzger
- 0000 0004 0551 4246grid.16149.3bDepartment of Psychiatry and Psychotherapy, University Hospital of Münster, Münster, Germany ,kbo-Inn-Salzach-Hospital, Wasserburg, Germany ,0000 0004 1936 973Xgrid.5252.0Department of Psychiatry und Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Volker Arolt
- 0000 0004 0551 4246grid.16149.3bDepartment of Psychiatry and Psychotherapy, University Hospital of Münster, Münster, Germany
| | - Marcel Romanos
- 0000 0001 1378 7891grid.411760.5Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Hans-Ulrich Wittchen
- 0000 0001 2111 7257grid.4488.0Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany ,0000 0004 1936 973Xgrid.5252.0Department of Psychiatry und Psychotherapy, Ludwig Maximilians University, Munich, Germany
| | - Alfons Hamm
- grid.5603.0Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Paul Pauli
- 0000 0001 1958 8658grid.8379.5Department of Psychology, Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Andreas Reif
- 0000 0004 0578 8220grid.411088.4Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Jürgen Deckert
- 0000 0001 1378 7891grid.411760.5Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Susanne Neufang
- 0000 0001 1378 7891grid.411760.5Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany ,0000 0001 2176 9917grid.411327.2Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Duesseldorf, Germany
| | - Michael Höfler
- 0000 0001 2111 7257grid.4488.0Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Center for NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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16
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Pyrkosch L, Mumm J, Alt I, Fehm L, Fydrich T, Plag J, Ströhle A. Learn to forget: Does post-exposure administration of d-cycloserine enhance fear extinction in agoraphobia? J Psychiatr Res 2018; 105:153-163. [PMID: 30237105 DOI: 10.1016/j.jpsychires.2018.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 12/23/2022]
Abstract
The use of d-cycloserine (DCS) to augment exposure based therapy for anxiety disorders has shown mixed, although overall positive effects. Aim of the present study was to examine post-exposure administration of DCS in patients with agoraphobia with or without panic disorder. 73 patients with agoraphobia (with or without panic disorder) were treated with 12 sessions of cognitive behavioral therapy (CBT) including 3 exposures. Following successful exposure patients were given double blind either placebo or 50 mg of DCS. Primary outcome criterion was change in the Panic and Agoraphobia Scale (PAS) between CBT session t1, t4 (+∼2 months), t10 (+∼3 months) und t11 (+∼4 months). During the course of CBT the patients' symptomatology decreased significantly as measured by primary and secondary outcome criteria, however, without an additional benefit for DCS treated patients. Exploratory sub-group analyses for severely ill patients and patients with high anxiety and strong habituation during exposure showed that DCS administration was associated with increased improvement during the 1-month follow-up period (t10 - t11) with medium to large effect sizes (range in effect size η2p from .06 to .25). Our study results are consistent with recent research on DCS, indicating a beneficial augmentative effect for sub-groups of anxiety patients. The lack of an overall DCS effect for the whole patient sample might be explained by a dual mechanism in fear conditioning and extinction with different cognitive processes being involved during exposure depending on the degree of anxiety experienced by the patient.
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Affiliation(s)
- L Pyrkosch
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Germany.
| | - J Mumm
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Germany.
| | - I Alt
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Germany.
| | - L Fehm
- Centre of Psychotherapy at the Department of Psychology, Humboldt-Universität zu Berlin, Germany.
| | - T Fydrich
- Centre of Psychotherapy at the Department of Psychology, Humboldt-Universität zu Berlin, Germany.
| | - J Plag
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Germany.
| | - A Ströhle
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Germany.
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Velten J, Bräscher AK, Fehm L, Fladung AK, Fydrich T, Heider J, Hentschel S, Limberg-Thiesen A, Lutz W, Margraf J, Schöttke H, Witthöft M, Hoyer J. Behandlungsdiagnosen in universitären Ambulanzen für psychologische Psychotherapie im Jahr 2016. Zeitschrift für Klinische Psychologie und Psychotherapie 2018. [DOI: 10.1026/1616-3443/a000490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Im Jahr 2013 entstand die Initiative, Daten der universitären Psychotherapieambulanzen zusammenzuführen, um so eine deutschlandweite Forschungsdatenplattform zu schaffen. Der Forschungsverbund KODAP (Koordination der Datenerhebung und -auswertung an Forschungs-, Lehr- und Ausbildungsambulanzen für psychologische Psychotherapie) organisiert dieses komplexe Vorhaben. Fragestellung / Methode: In der vorliegenden Studie wird die technische und organisatorische Machbarkeit einer solchen Forschungskooperation im Hinblick auf die Übermittlung und Zusammenführung der Daten dargestellt. Gleichzeitig wird die im Jahr 2016 in den Ambulanzen behandelte Patient_innenpopulation beschrieben und es werden erste Vergleichsdaten zur Häufigkeit ICD-10-basierter Diagnosen in diesem Versorgungssegment generiert. Ergebnisse: Insgesamt stellten 16 Ambulanzen Daten von 4504 Patientinnen und Patienten (MAlter = 37.87; SD = 13.47; Range = 15 bis 86; 65.3 % weiblich) aus dem Jahr 2016 zur Verfügung. Trotz der unterschiedlichen Systeme und Formate, in denen Patient_innen- und therapiebezogene Forschungsdaten verwaltet werden, erwies sich die Übermittlung und Zusammenführung der Datensätze als machbar. Affektive Störungen (F3) und Neurotische, Belastungs- und Somatoforme Störungen (F4) machten den Großteil der vergebenen Diagnosen aus. Bei mehr als der Hälfte der Patient_innen lag mehr als eine Störungsdiagnose vor (M = 1.84; SD = 0.99; Range = 0 bis 7). Schlussfolgerungen: Diese Studie konnte zeigen, dass die Aufbereitung, Zusammenführung und Auswertung von Forschungsdaten über Ambulanzen hinweg möglich ist. Der Forderung nach einer stärkeren Ausrichtung der Psychologie in Richtung kumulativer und kooperativer Forschungsprojekte kommt das KODAP-Projekt in besonderem Maße nach.
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Affiliation(s)
- Julia Velten
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | - Anne-Kathrin Bräscher
- Johannes Gutenberg-Universität Mainz, Abteilung für Klinische Psychologie, Psychotherapie und Experimentelle Psychopathologie
| | - Lydia Fehm
- Humboldt-Universität zu Berlin, Institut für Psychologie, Zentrum für Psychotherapie
| | | | - Thomas Fydrich
- Humboldt-Universität zu Berlin, Institut für Psychologie, Zentrum für Psychotherapie
| | - Jens Heider
- Universität Koblenz-Landau, Psychotherapeutische Universitätsambulanz
| | - Sophie Hentschel
- Freie Universität Berlin, Klinische Psychologie und Psychotherapie
| | - Anke Limberg-Thiesen
- Universität Greifswald, Physiologische und Klinische Psychologie / Psychotherapie
| | - Wolfgang Lutz
- Universität Trier, Klinische Psychologie und Psychotherapie
| | - Jürgen Margraf
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | | | - Michael Witthöft
- Johannes Gutenberg-Universität Mainz, Abteilung für Klinische Psychologie, Psychotherapie und Experimentelle Psychopathologie
| | - Jürgen Hoyer
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie
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Laurin-Barantke L, Hoyer J, Fehm L, Knappe S. Oral but not written test anxiety is related to social anxiety. World J Psychiatry 2016; 6:351-357. [PMID: 27679775 PMCID: PMC5031936 DOI: 10.5498/wjp.v6.i3.351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/15/2016] [Accepted: 08/01/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the associations of test anxiety (TA) in written vs oral exam situations with social anxiety (SA).
METHODS A convenience sample of 204 students was recruited at the Technische Universität Dresden (TU Dresden, Germany) and contacted via e-mail asking to complete a cross-sectional online survey based on established questionnaires. The study protocol was approved by the ethics committee of the TU Dresden. Full data of n = 96 students were available for dependent t-tests and correlation analyses on the associations of SA and TA respectively with trigger events, cognitions, safety behaviors, physical symptoms and depersonalization. Analyses were run using SPSS.
RESULTS Levels of TA were higher for fear in oral exams than for fear in written exams (M = 48.1, SD = 11.5 vs M = 43.7, SD = 10.1 P < 0.001). Oral TA and SA were positively correlated (Spearman’s r = 0.343, P < 0.001; Pearson’s r = 0.38, P < 0.001) contrasting written TA and SA (Spearman’s r = 0.17, P > 0.05; Pearson’s r = 0.223, P > 0.05). Compared to written TA, trigger events were more often reported for oral TA (18.2% vs 30.3%, P = 0.007); which was also accompanied more often by test-anxious cognitions (7.9% vs 8.5%, P = 0.001), safety behavior (8.9% vs 10.3%, P < 0.001) and physical symptoms (for all, P < 0.001).
CONCLUSION Written, but not oral TA emerged being unrelated to SA and may rather not be considered as a typical facet of SA disorder.
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Liebscher C, Wittmann A, Gechter J, Schlagenhauf F, Lueken U, Plag J, Straube B, Pfleiderer B, Fehm L, Gerlach AL, Kircher T, Fydrich T, Deckert J, Wittchen HU, Heinz A, Arolt V, Ströhle A. Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. Eur Neuropsychopharmacol 2016; 26:431-44. [PMID: 26837851 DOI: 10.1016/j.euroneuro.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 11/13/2015] [Accepted: 01/15/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates. EXPERIMENTAL PROCEDURES We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29). RESULTS Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups. DISCUSSION This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala's involvement in the fear system's sensitivity to treatment.
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Affiliation(s)
- Carolin Liebscher
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - André Wittmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Gechter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Max Planck Institute for Human Cognitive and Brain Science, Leipzig, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Lydia Fehm
- Institute of Psychology, Psychotherapy and Somatopsychology - Humboldt University at Berlin, Berlin, Germany
| | | | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Thomas Fydrich
- Institute of Psychology, Psychotherapy and Somatopsychology - Humboldt University at Berlin, Berlin, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Schumacher S, Miller R, Fehm L, Kirschbaum C, Fydrich T, Ströhle A. Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study. Psychiatry Res 2015; 230:668-75. [PMID: 26545614 DOI: 10.1016/j.psychres.2015.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 12/22/2022]
Abstract
Exposure therapy is considered an effective treatment strategy for phobic anxiety, however, it is rarely applied in clinical practice. The under-usage might be due to various factors of which heightened stress levels not only in patients but also in therapists are presumed to be of particular relevance. The present study aimed to investigate whether different forms of exposure might lead to varying physiological and psychological stress responses in therapists and phobic patients. 25 patients with specific phobia underwent individual cognitive behavioural therapy, performed by 25 psychotherapist trainees, applying exposure sessions in graduated form or the flooding technique. Patients and therapists provided subjective evaluations of stress and five saliva samples for analysis of salivary cortisol and alpha-amylase either during two graduated exposure sessions or during one flooding session, while a regular therapy session served as control condition. Therapists displayed heightened salivary alpha-amylase release during exposure of the flooding, but not the graduated, type. Patients showed elevated salivary cortisol during flooding exposure numerically, however, not on a statistically significant level. Therapists reported more pronounced subjective stress during flooding compared to graduated exposure. Elevated stress levels should be addressed in clinical training in order to improve application of exposure in routine practice.
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Affiliation(s)
- Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; Department of Psychology, Humboldt-University at Berlin, Berlin, Germany.
| | - Robert Miller
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-University at Berlin, Berlin, Germany
| | - Clemens Kirschbaum
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-University at Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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21
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Drenckhan I, Glöckner-Rist A, Rist F, Richter J, Gloster AT, Fehm L, Lang T, Alpers GW, Hamm AO, Fydrich T, Kircher T, Arolt V, Deckert J, Ströhle A, Wittchen HU, Gerlach AL. Dimensional structure of bodily panic attack symptoms and their specific connections to panic cognitions, anxiety sensitivity and claustrophobic fears. Psychol Med 2015; 45:1675-1685. [PMID: 25482960 DOI: 10.1017/s0033291714002803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. METHOD In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). RESULTS CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. CONCLUSIONS Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.
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Affiliation(s)
- I Drenckhan
- Clinical Psychology and Psychotherapy,Institute of Psychology,University of Münster,Fliednerstraße 21,Münster,Germany
| | - A Glöckner-Rist
- Department Survey Design and Methodology,GESIS Leibniz Institute for Social Science,Mannheim,Germany
| | - F Rist
- Clinical Psychology and Psychotherapy,Institute of Psychology,University of Münster,Fliednerstraße 21,Münster,Germany
| | - J Richter
- Department of Biological and Clinical Psychology,University of Greifswald,Greifswald,Germany
| | - A T Gloster
- Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany
| | - L Fehm
- Department of Psychology,Humboldt University of Berlin,Berlin,Germany
| | - T Lang
- Christoph-Dornier Foundation for Clinical Psychology,Bremen,Germany
| | - G W Alpers
- Department of Clinical and Biological Psychology,University of Mannheim,Mannheim,Germany
| | - A O Hamm
- Department of Biological and Clinical Psychology,University of Greifswald,Greifswald,Germany
| | - T Fydrich
- Department of Psychology,Humboldt University of Berlin,Berlin,Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy,Philipps-University Marburg,Marburg,Germany
| | - V Arolt
- Department of Psychiatry,University of Münster,Germany
| | - J Deckert
- Department of Psychiatry,Psychosomatics and Psychotherapy,University of Würzburg,Würzburg,Germany
| | - A Ströhle
- Department of Psychiatry and Psychotherapy,Charité-UniversitätsmedizinBerlin,Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany
| | - A L Gerlach
- Clinical Psychology and Psychotherapy,Institute of Psychology,University of Münster,Fliednerstraße 21,Münster,Germany
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Hohoff C, Weber H, Richter J, Domschke K, Zwanzger PM, Ohrmann P, Bauer J, Suslow T, Kugel H, Baumann C, Klauke B, Jacob CP, Fritze J, Bandelow B, Gloster AT, Gerlach AL, Kircher T, Lang T, Alpers GW, Ströhle A, Fehm L, Wittchen HU, Arolt V, Pauli P, Hamm A, Reif A, Deckert J. RGS2 ggenetic variation: association analysis with panic disorder and dimensional as well as intermediate phenotypes of anxiety. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:211-22. [PMID: 25740197 DOI: 10.1002/ajmg.b.32299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
Abstract
Accumulating evidence from mouse models points to the G protein-coupled receptor RGS2 (regulator of G-protein signaling 2) as a promising candidate gene for anxiety in humans. Recently, RGS2 polymorphisms were found to be associated with various anxiety disorders, e.g., rs4606 with panic disorder (PD), but other findings have been negative or inconsistent concerning the respective risk allele. To further examine the role of RGS2 polymorphisms in the pathogenesis of PD, we genotyped rs4606 and five additional RGS2 tag single nucleotide polymorphisms (SNPs; rs16834831, rs10801153, rs16829458, rs1342809, rs1890397) in two independent PD samples, comprising 531 matched case/control pairs. The functional SNP rs4606 was nominally associated with PD when both samples were combined. The upstream SNP rs10801153 displayed a Bonferroni-resistant significant association with PD in the second and the combined sample (P = 0.006 and P = 0.017). We furthermore investigated the effect of rs10801153 on dimensional anxiety traits, a behavioral avoidance test (BAT), and an index for emotional processing in the respective subsets of the total sample. In line with categorical results, homozygous risk (G) allele carriers displayed higher scores on the Agoraphobic Cognitions Questionnaire (ACQ; P = 0.015) and showed significantly more defensive behavior during fear provoking situations (P = 0.001). Furthermore, significant effects on brain activation in response to angry (P = 0.013), happy (P = 0.042) and neutral faces (P = 0.032) were detected. Taken together, these findings provide further evidence for the potential role of RGS2 as a candidate gene for PD.
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Affiliation(s)
- Christa Hohoff
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
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23
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Hauke C, Gloster AT, Gerlach A, Richter J, Kircher T, Fehm L, Stoy M, Lang T, Klotsche J, Einsle F, Deckert J, Wittchen HU. Standardized treatment manuals: Does adherence matter? ACTA ACUST UNITED AC 2014. [DOI: 10.7790/sa.v0i0.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Schumacher S, Gaudlitz K, Plag J, Miller R, Kirschbaum C, Fehm L, Fydrich T, Ströhle A. Who is stressed? A pilot study of salivary cortisol and alpha-amylase concentrations in agoraphobic patients and their novice therapists undergoing in vivo exposure. Psychoneuroendocrinology 2014; 49:280-9. [PMID: 25127086 DOI: 10.1016/j.psyneuen.2014.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/26/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
In cognitive behavioural therapy of phobic anxiety, in vivo exposure is considered as an effective treatment strategy. Apparently, it involves the experience of stress and anxiety in patients. Given the therapist's role during exposure sessions, it is conceivable that the performance is also accompanied with the experience of stress in therapists, especially when unversed in conducting psychotherapy. Studies confirmed that cognitive behavioural therapists tend to avoid therapist-guided in vivo exposure. The objective of this study was the simultaneous investigation of therapist's and patient's stress response during in vivo exposure. Therefore, 23 agoraphobic patients and their 23 treating therapists in training provided five saliva samples during an in vivo exposure and five samples during an ordinary therapy session. Before and during exposure session, subjective evaluations of stress and anxiety were assessed. Results suggested that therapists reported similar levels of perceived stress as patients before exposure. Both groups displayed significantly elevated salivary cortisol (sC) levels during exposure compared to the control session and a trend for alterations in salivary alpha-amylase (sAA) activity was found. Therapists reached peak concentrations of sC before start of the intervention followed by a decline during exposure, while patients displayed peak levels of cortisol secretion after 60 min of exposure. In vivo exposure seems to be a demanding intervention not only for the patient, but also for therapists in training. However, it was also demonstrated that physiological and subjective stress rather decrease during the intervention and that both groups rated exposure to be substantially successful. Based on the presented results, another potential factor contributing to the under-usage of exposure treatment is conceivable and needs to be addressed in future research.
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Affiliation(s)
- Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; Department of Psychology, Humboldt University of Berlin, Berlin, Germany.
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Robert Miller
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Department of Biopsychology, Technical University Dresden, Dresden, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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25
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Quast C, Reif A, Brückl T, Pfister H, Weber H, Mattheisen M, Cichon S, Lang T, Hamm A, Fehm L, Ströhle A, Arolt V, Domschke K, Kircher T, Wittchen HU, Pauli P, Gerlach AL, Alpers GW, Deckert J, Rupprecht R, Binder EB, Erhardt A. Gender-specific association of variants in the AKR1C1 gene with dimensional anxiety in patients with panic disorder: additional evidence for the importance of neurosteroids in anxiety? Depress Anxiety 2014; 31:843-50. [PMID: 24390875 DOI: 10.1002/da.22229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/14/2013] [Accepted: 11/29/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neurosteroids are synthesized both in brain and peripheral steroidogenic tissue from cholesterol or steroidal precursors. Neurosteroids have been shown to be implicated in neural proliferation, differentiation, and activity. Preclinical and clinical studies also suggest a modulatory role of neurosteroids in anxiety-related phenotypes. However, little is known about the contribution of genetic variants in genes relevant for the neurosteroidogenesis to anxiety disorders. METHODS We performed an association analysis of single nucleotide polymorphisms (SNPs) in five genes related to the neurosteroidal pathway with emphasis on progesterone and allopregnanolone biosynthesis (steroid-5-alpha-reductase 1A (SRD5A1), aldo-keto reductase family 1 C1-C3 (AKR1C1-AKR1C3) and translocator protein 18 kDA (TSPO) with panic disorder (PD) and dimensional anxiety in two German PD samples (cases N = 522, controls N = 1,115). RESULTS Case-control analysis for PD and SNPs in the five selected genes was negative in the combined sample. However, we detected a significant association of anticipatory anxiety with two intronic SNPs (rs3930965, rs41314625) located in the gene AKR1C1 surviving correction for multiple testing in PD patients. Stratification analysis for gender revealed a female-specific effect of the associations of both SNPs. CONCLUSIONS These results suggest a modulatory effect of AKR1C1 activity on anxiety levels, most likely through changes in progesterone and allopregnanolone levels within and outside the brain. In summary, this is the first evidence for the gender-specific implication of the AKR1C1 gene in the expression of anticipatory anxiety in PD. Further analyses to unravel the functional role of the SNPs detected here and replication analyses are needed to validate our results.
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Affiliation(s)
- Carina Quast
- Max Planck Institute of Psychiatry, Munich, Germany
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26
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Cammin-Nowak S, Helbig-Lang S, Lang T, Gloster AT, Fehm L, Gerlach AL, Ströhle A, Deckert J, Kircher T, Hamm AO, Alpers GW, Arolt V, Wittchen HU. Specificity of homework compliance effects on treatment outcome in CBT: evidence from a controlled trial on panic disorder and agoraphobia. J Clin Psychol 2013; 69:616-29. [PMID: 23504641 DOI: 10.1002/jclp.21975] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Although homework assignments are an integral component of cognitive-behavioral therapy (CBT) and relate to positive therapy outcomes, it is unclear whether specific homework types and their completion have specific effects on outcome. METHOD Data from N = 292 patients (75% female, mean age 36 years) with panic disorder and agoraphobia and treated with standardized CBT were analyzed with homework compliance quality and quantity for different types of homework serving as predictors for different outcome variables. RESULTS Quality ratings of homework completion were stronger outcome predictors than quantitative compliance ratings. Exposure homework was a better outcome predictor than homework relating to psychoeducation and self-monitoring. CONCLUSION Different aspects of homework compliance and specific homework types might differentially relate to CBT outcome.
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Affiliation(s)
- Sandra Cammin-Nowak
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.
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27
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Beesdo-Baum K, Knappe S, Fehm L, Höfler M, Lieb R, Hofmann SG, Wittchen HU. The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatr Scand 2012; 126:411-25. [PMID: 22632172 DOI: 10.1111/j.1600-0447.2012.01886.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the natural course of social anxiety disorder (SAD) in the community and to explore predictors for adverse long-term outcomes. METHOD A community sample of N = 3021 subjects aged 14-24 was followed-up over 10 years using the DSM-IV/M-CIDI. Persistence of SAD is based on a composite score reflecting the proportion of years affected since onset. Diagnostic stability is the proportion of SAD subjects still affected at follow-up. RESULTS SAD reveals considerable persistence with more than half of the years observed since onset spent with symptoms. 56.7% of SAD cases revealed stability with at least symptomatic expressions at follow-up; 15.5% met SAD threshold criteria again. 15.1% were completely remitted (no SAD symptoms and no other mental disorders during follow-up). Several clinical features (early onset, generalized subtype, more anxiety cognitions, severe avoidance and impairment, co-occurring panic) and vulnerability characteristics (parental SAD and depression, behavioural inhibition, harm avoidance) predicted higher SAD persistence and - less impressively - diagnostic stability. CONCLUSION A persistent course with a considerable degree of fluctuations in symptom severity is characteristic for SAD. Both consistently meeting full threshold diagnostic criteria and complete remissions are rare. Vulnerability and clinical severity indicators predict poor prognosis and might be helpful markers for intervention needs.
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Affiliation(s)
- K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
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Richter J, Hamm AO, 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. Dynamics of defensive reactivity in patients with panic disorder and agoraphobia: implications for the etiology of panic disorder. Biol Psychiatry 2012; 72:512-20. [PMID: 22621998 DOI: 10.1016/j.biopsych.2012.03.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 02/22/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG). METHODS Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test. RESULTS Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks. CONCLUSIONS We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
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Affiliation(s)
- Jan Richter
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
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Weber H, Scholz CJ, Domschke K, Baumann C, Klauke B, Jacob CP, Maier W, Fritze J, Bandelow B, Zwanzger PM, Lang T, Fehm L, Ströhle A, Hamm A, Gerlach AL, Alpers GW, Kircher T, Wittchen HU, Arolt V, Pauli P, Deckert J, Reif A. Gender differences in associations of glutamate decarboxylase 1 gene (GAD1) variants with panic disorder. PLoS One 2012; 7:e37651. [PMID: 22662185 PMCID: PMC3360757 DOI: 10.1371/journal.pone.0037651] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/23/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Panic disorder is common (5% prevalence) and females are twice as likely to be affected as males. The heritable component of panic disorder is estimated at 48%. Glutamic acid dehydrogenase GAD1, the key enzyme for the synthesis of the inhibitory and anxiolytic neurotransmitter GABA, is supposed to influence various mental disorders, including mood and anxiety disorders. In a recent association study in depression, which is highly comorbid with panic disorder, GAD1 risk allele associations were restricted to females. METHODOLOGY/PRINCIPAL FINDINGS Nineteen single nucleotide polymorphisms (SNPs) tagging the common variation in GAD1 were genotyped in two independent gender and age matched case-control samples (discovery sample n = 478; replication sample n = 584). Thirteen SNPs passed quality control and were examined for gender-specific enrichment of risk alleles associated with panic disorder by using logistic regression including a genotype×gender interaction term. The latter was found to be nominally significant for four SNPs (rs1978340, rs3762555, rs3749034, rs2241165) in the discovery sample; of note, the respective minor/risk alleles were associated with panic disorder only in females. These findings were not confirmed in the replication sample; however, the genotype×gender interaction of rs3749034 remained significant in the combined sample. Furthermore, this polymorphism showed a nominally significant association with the Agoraphobic Cognitions Questionnaire sum score. CONCLUSIONS/SIGNIFICANCE The present study represents the first systematic evaluation of gender-specific enrichment of risk alleles of the common SNP variation in the panic disorder candidate gene GAD1. Our tentative results provide a possible explanation for the higher susceptibility of females to panic disorder.
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Affiliation(s)
- Heike Weber
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.
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Lang T, Helbig-Lang S, Gloster AT, Richter J, Hamm AO, Fehm L, Fydrich T, Gerlach AL, Ströhle A, Alpers GW, Gauggel S, Kircher T, Deckert J, Höfler M, Arolt V, Wittchen HU. Effekte therapeutenbegleiteter versus patientengeleiteter Exposition bei Panikstörung mit Agoraphobie. Zeitschrift für Klinische Psychologie und Psychotherapie 2012. [DOI: 10.1026/1616-3443/a000139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Rolle der Therapeutenbegleitung während Expositionsübungen bei Panikstörung mit Agoraphobie (P/A) ist bislang ungeklärt. Eine kürzlich durchgeführte klinische Studie (MAC-Studie) lieferte Hinweise auf ein günstigeres Behandlungsergebnis bei Therapeutenbegleitung. Fragestellung: Wie lassen sich Effekte therapeutenbegleiteter Exposition (T+) im Vergleich zu Exposition ohne Therapeutenbegleitung (T–) erklären? Methode: Daten von 301 Patienten, die eine expositionsbasierte KVT mit bzw. ohne Therapeutenbegleitung erhalten hatten, wurden analysiert. Untersucht wurden der Einfluss der initialen Störungsschwere, des Sicherheitsverhaltens sowie differenzielle Effekte der Bedingungen auf die Angst vor der Angst. Zusätzlich wurde überprüft, inwieweit die Übungshäufigkeit in den Behandlungsbedingungen variiert und einen Mediator des Behandlungserfolgs darstellt. Ergebnisse: Störungsschwere und Sicherheitsverhalten zeigten keine differenziellen Effekte zwischen den Bedingungen; die T+ Bedingung führte jedoch zu stärkeren Reduktionen der Angst vor der Angst im Angstsensitivitätsindex. Patienten der T+ Bedingung führten häufiger selbständig Expositionsübungen durch, während Patienten in T– im Durchschnitt länger übten. Die Übungshäufigkeit stellte dabei einen Mediator des Behandlungserfolgs dar. Schlussfolgerungen: Günstigere Effekte einer therapeutenbegleiteten Exposition gehen auf stärkere Reduktionen der Angst vor der Angst sowie auf eine höhere Übungshäufigkeit im Selbstmanagement zurück.
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Affiliation(s)
- Thomas Lang
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen Christoph-Dornier-Stiftung für Klinische Psychologie, Bremen
| | - Sylvia Helbig-Lang
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen Klinische Psychologie und Psychotherapie, Universität Hamburg
| | - Andrew T. Gloster
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Jan Richter
- Institut für Psychologie, Ernst-Moritz-Arndt Universität Greifswald
| | - Alfons O. Hamm
- Institut für Psychologie, Ernst-Moritz-Arndt Universität Greifswald
| | - Lydia Fehm
- Institut für Psychologie, Humboldt Universität Berlin
| | | | | | - Andreas Ströhle
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin
| | - Georg W. Alpers
- Lehrstuhl Klinische und Biologische Psychologie, Universität Mannheim Institut für Psychologie, Universität Würzburg
| | - Siegried Gauggel
- Institut für Medizinische Psychologie, Universitätsklinikum der RWTH Aachen
| | - Tilo Kircher
- Universitätsklinik für Psychiatrie und Psychotherapie, Marburg
| | - Jürgen Deckert
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität Würzburg
| | - Michael Höfler
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | | | - Hans-Ulrich Wittchen
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
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Wittmann A, Schlagenhauf F, John T, Guhn A, Rehbein H, Siegmund A, Stoy M, Held D, Schulz I, Fehm L, Fydrich T, Heinz A, Bruhn H, Ströhle A. A new paradigm (Westphal-Paradigm) to study the neural correlates of panic disorder with agoraphobia. Eur Arch Psychiatry Clin Neurosci 2011; 261:185-94. [PMID: 21113608 DOI: 10.1007/s00406-010-0167-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 10/28/2010] [Indexed: 11/24/2022]
Abstract
Agoraphobia (with and without panic disorder) is a highly prevalent and disabling anxiety disorder. Its neural complexity can be characterized by specific cues in fMRI studies. Therefore, we developed a fMRI paradigm with agoraphobia-specific stimuli. Pictures of potential agoraphobic situations were generated. Twenty-six patients, suffering from panic disorder and agoraphobia, and 22 healthy controls rated the pictures with respect to arousal, valence, and agoraphobia-related anxiety. The 96 pictures, which discriminated best between groups were chosen, split into two parallel sets and supplemented with matched neutral pictures from the International Affective Picture System. Reliability, criterion, and construct validity of the picture set were determined in a second sample (44 patients, 28 controls). The resulting event-related "Westphal-Paradigm" with cued and uncued pictures was tested in a fMRI pilot study with 16 patients. Internal consistency of the sets was very high; parallelism was given. Positive correlations of picture ratings with Mobility Inventory and Hamilton anxiety scores support construct validity. FMRI data revealed activations in areas associated with the fear circuit including amygdala, insula, and hippocampal areas. Psychometric properties of the Westphal-Paradigm meet necessary quality requirements for further scientific use. The paradigm reliably produces behavioral and fMRI patterns in response to agoraphobia-specific stimuli. To our knowledge, it is the first fMRI paradigm with these properties. This paradigm can be used to further characterize the functional neuroanatomy of panic disorder and agoraphobia and might be useful to contribute data to the differentiation of panic disorder and agoraphobia as related, but conceptually different clinical disorders.
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Affiliation(s)
- A Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Knappe S, Beesdo-Baum K, Fehm L, Stein MB, Lieb R, Wittchen HU. Social fear and social phobia types among community youth: differential clinical features and vulnerability factors. J Psychiatr Res 2011; 45:111-20. [PMID: 20684833 DOI: 10.1016/j.jpsychires.2010.05.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/30/2010] [Accepted: 05/05/2010] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare different social fears and social phobia subtypes with regard to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability factors (behavioural inhibition (BI), parental psychopathology and parental rearing) among community youth. METHODS Fears of 6 social situations and Social Phobia (SP), along with their clinical features, were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N = 3021 14-24 year olds that were followed up for 10 years. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings' family history reports. RESULTS In the total sample, 20.0%, 11.6%, 11.7% reported fear of 1, 2, 3 or more social situations, respectively; rates were 24.2%, 18.7%, and 57.1% in SP-cases (6.6% of the total sample). Exploring the factorial structure indicated rather unidimensionality of social fears than mutual distinction of social fears by interaction vs. performance situations. Except for fear of taking tests and public speaking, social fears rarely occurred in isolation. Social fears of both interaction and performance situations were associated with severe avoidance (vs. fear of either situation; Odds Ratios, OR = 1.5, 95%CI: 1.1-1.9) and impairment (OR = 3.6, 95%CI: 2.6-4.9), and more comorbid anxiety and depressive disorders (OR range 3.2-5.8, p > .001). Fear of interaction situations was associated with higher BI (vs. performance-related fears, OR range 1.2-2.1, p < .05). Associations with parental psychopathology and unfavourable parental rearing were less consistent, albeit stronger for fear of interaction situations (vs. performance-related fears). Interactions with time indicated an earlier onset of SP for higher BI, but not for parental psychopathology or unfavourable parental rearing. CONCLUSIONS Interaction-related social fears differ in their clinical and vulnerability factors from performance-related social fears. The current DSM-IV specifier of "generalized" SP may fall short of adequately denoting these differences. Fear of taking tests appears to be conceptually and, possibly, etiologically distinct from other social fears, and may be better placed in another category (e.g., as a type of specific phobia).
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
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Gloster AT, Wittchen HU, Einsle F, Höfler M, Lang T, Helbig-Lang S, Fydrich T, Fehm L, Hamm AO, Richter J, Alpers GW, Gerlach AL, Ströhle A, Kircher T, Deckert J, Zwanzger P, Arolt V. Mechanism of action in CBT (MAC): methods of a multi-center randomized controlled trial in 369 patients with panic disorder and agoraphobia. Eur Arch Psychiatry Clin Neurosci 2009; 259 Suppl 2:S155-66. [PMID: 19876674 DOI: 10.1007/s00406-009-0065-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.
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Affiliation(s)
- A T Gloster
- Dresden University of Technology, Dresden, Germany
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Weidmann A, Conradi A, Gröger K, Fehm L, Fydrich T. Using stressful films to analyze risk factors for PTSD in analogue experimental studies – which film works best? Anxiety, Stress & Coping 2009; 22:549-69. [DOI: 10.1080/10615800802541986] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Knappe S, Lieb R, Beesdo K, Fehm L, Low NCP, Gloster AT, Wittchen HU. The role of parental psychopathology and family environment for social phobia in the first three decades of life. Depress Anxiety 2009; 26:363-70. [PMID: 18839408 DOI: 10.1002/da.20527] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To examine the role of parental psychopathology and family environment for the risk of social phobia (SP) in offspring from childhood to early adulthood, encompassing the high risk period for SP. METHODS A community sample of 1,395 adolescents was prospectively followed-up over 10 years. Offspring and parental psychopathology were assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) using the Munich Composite International Diagnostic Interview (M-CIDI), and direct diagnostic interviews in parents were supplemented by family history reports. Parental rearing was assessed by the Questionnaire of Recalled Rearing Behavior administered to offspring. Family functioning was assessed by the McMaster Family Assessment Device administered to parents. RESULTS Parental SP was associated with offspring's risk to develop SP (OR=3.3, 95%CI:1.4-8.0). Other parental anxiety disorders (OR=2.9, 95%CI:1.4-6.1), depression (OR=2.6, 95%CI:1.2-5.4), and alcohol use disorders (OR=2.8, 95%CI:1.3-6.1) were also associated with offspring SP. Parental rearing styles of overprotection, rejection, and lack of emotional warmth were associated with offspring SP. Family functioning measures were not associated with offspring SP. Analyses of interaction of parental psychopathology and parental rearing indicated combined effects on the risk for offspring SP. CONCLUSIONS Parental psychopathology and rearing were associated with offspring SP, independently as well as in their interaction. Further delineation of these associations is warranted as malleable components of these risk factors may provide potential targets for prevention programs. In addition, parent-to-offspring transmission of other internalizing disorders should be considered to examine the degree of diagnostic specificity.
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
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Knappe S, Beesdo K, Fehm L, Lieb R, Wittchen HU. Associations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder? J Neural Transm (Vienna) 2008; 116:639-48. [PMID: 18982243 PMCID: PMC2694921 DOI: 10.1007/s00702-008-0118-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 08/20/2008] [Indexed: 11/29/2022]
Abstract
We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIA-X/M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-to-offspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.
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Affiliation(s)
- Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
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Fehm L, Hoyer J, Schneider G, Lindemann C, Klusmann U. Assessing post-event processing after social situations: a measure based on the cognitive model for social phobia. Anxiety, Stress & Coping 2008; 21:129-42. [DOI: 10.1080/10615800701424672] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York, London: The Guilford Press] introduced a process called "post-event processing" (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.
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Affiliation(s)
- Lydia Fehm
- Psychotherapy and Somatopsychology, Humboldt University Berlin, Rudower Chaussee 18, D-12489 Berlin, Germany.
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Abstract
Among professional musicians as well as among music students, performance anxiety occurs frequently and can cause considerable distress. As the professional development starts early among future musicians, younger samples are of great interest, but to date, few studies have examined adolescents. The present survey explored performance anxiety in a sample of 15-19-year-old pupils who attended a German special music school. Of those pupils, 74 participated in the study (93% response rate). In addition to frequency and expression of performance anxiety, coping strategies were assessed. Results pointed to the high frequency of performance anxiety in this sample; about one third of the group were distinctly handicapped by their anxiety. Unfavorable coping strategies, such as drug or alcohol abuse were rarely reported. Most pupils called for more support either from their teachers or from outside of school to cope with their anxiety.
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Affiliation(s)
- Lydia Fehm
- Clinical Psychology and Psychotherapy, Technical University of Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany.
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Abstract
This paper provides a critical review of the prevalence of social phobia in European countries, a description of associated disability and burden and of clinical correlates and risk factors associated with social phobia. On the basis of a comprehensive literature search we identified 21 community studies and two primary care studies. The median lifetime and 12-month prevalence rates of social phobia in community samples referring to DSM-III-R and DSM-IV criteria were 6.65% and 2.0%, respectively. Younger individuals showed the highest rates, and women were more frequently affected than men. Social phobia was shown to be a persistent condition with a remarkably high degree of comorbid conditions, associated impairment and disability. Research deficits lie in a lack of data for most EU countries and in a lack of studies in children and the elderly. No data are available addressing met and unmet needs for intervention and costs, and data for vulnerability and risk factors of malignant course are scarce.
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Affiliation(s)
- Lydia Fehm
- Department of Psychology, Humboldt-University Berlin, Rudower Chaussee 18, D-12489 Berlin, Germany.
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Fehm L, Kazantzis N. Attitudes and use of homework assignments in therapy: a survey of German psychotherapists. Clin Psychol Psychother 2004. [DOI: 10.1002/cpp.419] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Maercker A, Michael T, Fehm L, Becker ES, Margraf J. Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women. Br J Psychiatry 2004; 184:482-7. [PMID: 15172941 DOI: 10.1192/bjp.184.6.482] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Findings in developmental psychopathology suggest that traumatisation in childhood may increase the risk of both post-traumatic stress disorder (PTSD) and major depressive disorder, whereas traumatisation in adolescence is more likely to lead to elevated PTSD risk. AIMS To estimate the impact of traumatisation in childhood or adolescence in a community sample. METHOD A representative sample of 1966 young women from Dresden aged 18-45 years were interviewed for occurrence of traumatic events and the onset of PTSD and major depression. The sample was subdivided into a childhood trauma group (trauma up to age 12 years) and an adolescent trauma group (trauma from age 13 years). RESULTS A quarter of all participants reported traumatic events meeting the DSM AI criterion. In the childhood group conditional risks for PTSD and major depressive disorder were 17.0% and 23.3%, respectively, compared with risks of 13.3% and 6.5%, respectively, in the adolescent group. In 29% of those with PTSD, major depression was also present. CONCLUSIONS The risk of developing major depressive disorder after traumatisation in childhood is approximately equal to the risk of developing PTSD. After age 13 years, the risk of PTSD is greater than the risk of major depression after traumatisation.
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Affiliation(s)
- Andreas Maercker
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Switzerland.
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Abstract
OBJECTIVE To summarize epidemiological studies providing data on prevalence, incidence, comorbidity, natural course, risk factors and consequences of social phobia (SP). METHOD Data from cross-sectional studies and prospective longitudinal studies in particular are considered. RESULTS These studies portray SP as a frequent mental disorder, which begins typically in early adolescence, and is highly comorbid with other anxiety disorders, as well as secondary depression and substance abuse disorders. Several possible risk factors have already been identified for the onset and unfavorable course of SP; some of them have been tested in prospective longitudinal studies. SP is a chronic disorder when compared with other mental disorders and when subclinical symptomatic levels are considered. Impairment caused by SP is considerable and increases over a patient's life span. The negative impact of SP is not only reflected in subjective well-being and reduced quality of life but also in social role functioning, and it impacts negatively on career progression. CONCLUSION Prospective longitudinal studies in representative samples drawn from the general population provide information that allows the overall direct and indirect costs of the disorder (treatment costs, disability, social welfare) to be determined, and enables an improvement in long-term care strategies as well as preventive efforts to be established.
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Affiliation(s)
- H-U Wittchen
- Department of Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzer Str. 46, Dresden, Germany.
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Abstract
The paradoxical effects of intended thought suppression have been linked to psychological disorders, specifically anxiety disorders. So far, the evidence for thought suppression playing a major role in the disorder is mixed. One important issue is whether thought suppression is impaired only for thoughts related to the disorder, or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with a healthy control group. All subjects were asked to suppress two topics related to the respective central fear of the two disorders and one nonspecific topic. We found a rather specific deficit in thought suppression for the agoraphobics; that is, when compared with the control group, we found the biggest differences for the agoraphobic fear. The social phobics seem to be characterized by a general impairment of mental control, affecting specific and nonspecific stimuli. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that generally impaired thought suppression may be an important feature of social phobia.
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Affiliation(s)
- Lydia Fehm
- Department of Clinical Psychology, Technical University of Dresden, Germany.
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Abstract
Social phobia is a common condition, with current prevalence estimates in the range of 4% to 6% and a lifetime risk of 7% to 13%. It has an early onset and, without appropriate intervention, it has a disproportionately higher risk for persistence compared with other anxiety disorders. Presentation differs between age groups; the disorder in teenagers and in those in their early 20s tends to look different in terms of types of problems and the associated distress to that expected in the 30s and 40s age groups, when these individuals have already endured 20 years of suffering and disability. There is an increased risk for depression and substance abuse disorders even in adolescence, in addition to an increased risk for psychosocial impairment and disability resembling that experienced by depressed outpatients. This finding is particularly true in cases affected by generalized SP, which might have slightly different etiologic pathways than the nongeneralized type. Social phobia is in itself a disabling disorder, and individuals who develop comorbid conditions have a more severe level of disability. Early recognition, diagnosis, and treatment of SP could minimize sufferers' problems throughout their subsequent lives, preventing the development of comorbidity and a worsened prognosis. Developing models for early recognition and treatment should improve the outcome for the patient, as well as reduce future demand on health care resources. Epidemiologic studies, with their methodologic strengths and unique methods, can be instrumental in this respect. They may, for example, provide time-efficient, simple screening tools for use by physicians or even patients, based on the existing diagnostic instruments used in epidemiologic surveys. They may provide further guidance in making treatment decisions and developing treatment algorithms by offering criteria, which with additional vulnerability and risk factors, will lead to more severe, chronic, and comorbid course in a given case.
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Affiliation(s)
- H U Wittchen
- Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
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Fehm L, Dilcher K, Margraf J. Die Unterdrückung unerwünschter Gedanken: Vergleich zweier Varianten eines experimentellen Paradigmas. Zeitschrift für Klinische Psychologie und Psychotherapie 2001. [DOI: 10.1026/0084-5345.30.3.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Rolle von Gedankenunterdrückung bei der Entstehung und Aufrechterhaltung psychischer Störungen wird immer häufiger auch experimentell untersucht. Dabei unterscheiden sich die Studien darin, ob die Versuchspersonen während der Unterdrückungsphasen laut oder leise denken sollen. Fragestellung: Untersuchung des Effekts dieser Variation auf die Prozesse und den Erfolg der Gedankenunterdrückung sowie auf das Erleben der Versuchspersonen. Methode: 108 Personen wurden einer der beiden experimentellen Bedingungen (lautes/leises Denken) zugeordnet. Ergebnisse: Zwischen den Gruppen zeigten sich nur geringe Unterschiede beim Erfolg der Unterdrückung und den verwendeten Strategien. Hinsichtlich der Befindlichkeit und der Präferenz der Versuchspersonen fiel das leise Denken deutlich positiver aus. Schlußfolgerung: Für die Arbeit mit Patientenstichproben ist das leise Denken zu empfehlen.
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Lang R, Voigt KH, Fehm L, Pfeiffer EF. Isolated pituitary cells: ACTH secretion and synthesis. Acta Endocrinol Suppl (Copenh) 1973; 173:29. [PMID: 4353568 DOI: 10.1530/acta.0.072s029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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