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Hinze J, Röder A, Menzie N, Müller U, Domschke K, Riemenschneider M, Noll-Hussong M. Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy-A Narrative Review. Front Psychiatry 2021; 12:704174. [PMID: 34504447 PMCID: PMC8421596 DOI: 10.3389/fpsyt.2021.704174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Recent fMRI studies on specific animal phobias, particularly spider phobia (arachnophobia), have identified a large variety of specific brain regions involved in normal and disturbed fear processing. Both functional and structural brain abnormalities have been identified among phobic patients. Current research suggests that both conscious and subconscious fear processing play a crucial role in phobic disorders. Cognitive behavioral therapy has been identified as an effective treatment for specific phobias and has been associated with neuroplastic effects which can be evaluated using current neuroimaging techniques. Recent research suggests that new approaches using virtual (VR) or augmented reality (AR) tend to be similarly effective as traditional "in vivo" therapy methods and could expand treatment options for different medical or individual scenarios. This narrative review elaborates on neural structures and particularities of arachnophobia. Current treatment options are discussed and future research questions are highlighted.
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Affiliation(s)
- Jonas Hinze
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Anne Röder
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Nicole Menzie
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Ulf Müller
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Katharina Domschke
- 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
| | - Matthias Riemenschneider
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
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Li SH, Newby J, Graham BM. Day at the museum. A benchmarking and feasibility study for large group, one‐session exposure treatment for spider phobia. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sophie H. Li
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Jill Newby
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Bronwyn M. Graham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia,
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Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, Kishimoto T. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychol Med 2020; 50:2487-2497. [PMID: 33070784 DOI: 10.1017/s0033291720003785] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality exposure therapy (VRET) is currently being used to treat social anxiety disorder (SAD); however, VRET's magnitude of efficacy, duration of efficacy, and impact on treatment discontinuation are still unclear. METHODS We conducted a meta-analysis of studies that investigated the efficacy of VRET for SAD. The search strategy and analysis method are registered at PROSPERO (#CRD42019121097). Inclusion criteria were: (1) studies that targeted patients with SAD or related phobias; (2) studies where VRET was conducted for at least three sessions; (3) studies that included at least 10 participants. The primary outcome was social anxiety evaluation score change. Hedges' g and its 95% confidence intervals were calculated using random-effect models. The secondary outcome was the risk ratio for treatment discontinuation. RESULTS Twenty-two studies (n = 703) met the inclusion criteria and were analyzed. The efficacy of VRET for SAD was significant and continued over a long-term follow-up period: Hedges' g for effect size at post-intervention, -0.86 (-1.04 to -0.68); three months post-intervention, -1.03 (-1.35 to -0.72); 6 months post-intervention, -1.14 (-1.39 to -0.89); and 12 months post-intervention, -0.74 (-1.05 to -0.43). When compared to in vivo exposure, the efficacy of VRET was similar at post-intervention but became inferior at later follow-up points. Participant dropout rates showed no significant difference compared to in vivo exposure. CONCLUSION VRET is an acceptable treatment for SAD patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, VRET efficacy lessens as compared to in vivo exposure.
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Affiliation(s)
- Toshiro Horigome
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shunya Kurokawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Shun Kudo
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Kiko Shiga
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Psychiatry at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
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Jiang MYW, Upton E, Newby JM. A randomised wait-list controlled pilot trial of one-session virtual reality exposure therapy for blood-injection-injury phobias. J Affect Disord 2020; 276:636-645. [PMID: 32871696 DOI: 10.1016/j.jad.2020.07.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/13/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
Virtual reality exposure therapy (VRET) has been recognized as an effective treatment for specific phobias and has the potential to overcome the limitations of traditional in vivo exposure therapy (e.g., acceptability). No past research has evaluated the efficacy of VRET for the treatment of blood-injection-injury (BII) phobia. Therefore, we conducted a randomized controlled trial to examine the acceptability and efficacy of a single-session VRET intervention for BII phobias. Participants who met DSM-5 criteria for BII phobia (N = 43) were randomized to VRET or a waiting list control group, and completed self-report measures of BII severity (Medical Fear Survey [MFS] and Multidimensional Blood Phobia Inventory [MBPI]) and dental anxiety (Modified Dental Anxiety Scale), as well as clinician ratings of BII phobia severity and catastrophic cognitions at baseline, one-week post-treatment, and 3-month follow-up. We found medium to large differences in catastrophic cognitions (probability [g = 0.88] and cost [g = 0.66] ratings), favouring VRET. We found moderate to large differences favouring VRET on the MBPI Injection and Injury fears subscales (g's=0.64-1.14) at one-week post-treatment and 3-month follow-up, and on the MBPI Fainting subscale (g = 0.84) and Injections subscale of the Medical Fear Survey (g = 0.63) at follow-up. There were no other significant group differences. These findings provided some initial evidence to suggest that a single-session VRET may provide some improvements in fears of injections, injury, and fainting. While it may be a useful adjunct or interim step before in vivo exposure therapy, it is not sufficient as a standalone treatment for BII phobia.
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Affiliation(s)
| | - Emily Upton
- School of Psychology, UNSW Sydney, Australia
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55
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Chernyak Y. Improving CPAP Adherence for Obstructive Sleep Apnea: A Practical Application Primer on CPAP Desensitization. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10963. [PMID: 32964119 PMCID: PMC7499811 DOI: 10.15766/mep_2374-8265.10963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a common medical condition with well-established morbidity and mortality. Continuous positive airway pressure (CPAP) is a highly effective treatment prescribed to most individuals with OSA that has documented poor adherence rate for a variety of reasons including claustrophobia and discomfort. CPAP desensitization is an effective, simple, and brief treatment shown to improve adherence rates to CPAP. METHODS A psychologist specializing in behavioral sleep medicine developed this module focused on teaching medical residents the techniques of CPAP desensitization. The educational activity was an interactive 45-minute seminar which included a didactic component followed by a case presentation and interactive role-play. A postseminar survey was used to evaluate the content of the workshop, as well as growth in awareness and perception of knowledge and skills with a pre- to postworkshop evaluation. RESULTS In a survey of 25 primary care and psychiatry residents and sleep medicine fellows, 92% of respondents indicated that the topic of CPAP barriers and CPAP desensitization was important. Ratings of self-reported knowledge and skills improved nearly one-third following the workshop. Qualitative feedback indicated the utility and enthusiasm learners had for this topic. DISCUSSION The workshop on CPAP desensitization was a valuable tool that should be disseminated more widely to improve treatment adherence in the significant portion of the population that suffers from OSA which does not use adherence to positive airway pressure therapy. The workshop is applicable to other health professionals including medical students and nursing, social work, or psychology trainees.
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Affiliation(s)
- Yelena Chernyak
- Assistant Professor, Department of Psychiatry, Indiana University School of Medicine
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McRae K, Ciesielski BG, Pereira SC, Gross JJ. Case Study: A Quantitative Report of Early Attention, Fear, Disgust, and Avoidance in Specific Phobia for Buttons. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kappelmann N, Suesse M, Steudte-Schmiedgen S, Kaldewaij R, Browning M, Michael T, Rinck M, Reinecke A. D-cycloserine as adjunct to brief computerised CBT for spider fear: Effects on fear, behaviour, and cognitive biases. J Behav Ther Exp Psychiatry 2020; 68:101546. [PMID: 31951819 DOI: 10.1016/j.jbtep.2019.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES In anxiety disorders, cognitive behavioural therapy (CBT) improves information-processing biases such as implicit fear evaluations and avoidance tendencies, which predicts treatment response. Thus, these cognitive biases might constitute important treatment targets. This study investigated (i) whether information-processing biases could be changed following single-session computerised CBT for spider fear, and (ii) whether this effect could be augmented by administration of D-cycloserine (DCS). METHODS Spider-fearful individuals were randomized to receiving either 250 mg of DCS (n = 21) or placebo (n = 17). Three hours after drug administration, they received single-session computerized CBT, characterized by psychoeducation and exposure elements. Spider fear was assessed using self-report, behavioural, and information processing (Extrinsic Affective Simon Task & Approach Avoidance Task) measures at baseline (before drug administration), post-treatment, 1-day, and 1-month follow-up. RESULTS Linear mixed-effects analyses indicated significant improvements on self-report and behavioural spider fear indices following CBT, but not on cognitive bias measures. There was no evidence of an augmentation effect of DCS on any outcome. Cognitive bias measures at 1-day were not predictive of 1-month follow-up spider fear in adjusted linear regression analyses. LIMITATIONS Results might be biased by limited representativeness of the sample (high education and intelligence, largely Caucasian ethnicity, young age). The study was also only powered for detection of medium-sized DCS effects. CONCLUSIONS These findings do not provide evidence for information-processing biases relating to treatment outcome following computerised CBT for spider fear or augmentation with DCS.
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Affiliation(s)
- Nils Kappelmann
- Department of Psychiatry, University of Oxford, Oxford, UK; Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Mareike Suesse
- Oxford Institute of Clinical Psychology Doctorate Training, University of Oxford, Oxford, UK
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Reinoud Kaldewaij
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust, Oxford, UK
| | - Tanja Michael
- Department of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Hemyari C, Dolatshahi B, Sahraian A, Koohi-Hosseinabadi O, Zomorodian K. Evaluation of the Effectiveness of One- and Multi-Session Exposure-Based Treatments in Reducing Biological and Psychological Responses to Rat Phobia Among Students. Psychol Res Behav Manag 2020; 13:665-679. [PMID: 32848483 PMCID: PMC7429405 DOI: 10.2147/prbm.s256781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Animal phobia is one of the most common forms of specific phobias. This anxiety disorder challenges the medical student working with animal models. Regarding this, the present study was conducted to investigate the effectiveness of one- and multi-session cognitive exposure-based treatments in students with rat phobia. METHODS For the purpose of the study, a total of 40 female students with rat phobia were allocated into two groups of one- and multi-session cognitive exposure-based treatments. The data were collected using psychological measures, including state anxiety, rat phobia, and disgust questionnaires, which were completed in three stages, including the baseline, pre-treatment, and post-treatment. The gene expression levels of pro-inflammatory cytokines (ie, interleukin-1 [IL-1], nuclear factor-kappaB [NF-κB], and tumor necrosis factor-alpha [TNFα]) associated with acute stress, as well as the serum levels of IL-6 and cortisol, were determined using reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) methods. This study was registered at the Iranian Registry of Clinical Trials (IRCT20171123037602N1). RESULTS According to the results, both treatments yielded a significant reduction in almost all psychological measures and biological variables, except for IL-6. Rat phobia was the only variable that showed a statistically greater reduction in the multi-session treatment group. Furthermore, rat phobia and disgust reduction were maintained in both groups to the same extent during follow-up. CONCLUSION The findings of the present study were indicative of the incidence of habituation in psychological and biological factors following exposure therapy. Both one- and multi-session treatments reduced the factors associated with rat phobia almost to the same degree. As a result of the high levels of disgust, anxiety-related biological factors remained high in four students despite observing a significant reduction in their fear. This led to passive avoidance in this group. The OST enabled the students to handle rats in less than half a day. Accordingly, it could be applied as a half-day workshop for students in medical universities to avoid the incidence of associated anxiety-related disorders in this group.
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Affiliation(s)
- Camellia Hemyari
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Sahraian
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Kamiar Zomorodian
- Center of Basic Research in Infectious Diseases, Shiraz University of Medical Sciences, Shiraz, Iran
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Li SH, Graham BM. Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia. J Affect Disord 2020; 270:1-8. [PMID: 32275214 DOI: 10.1016/j.jad.2020.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian hormones have been implicated as a potential source of variability in the effectiveness of exposure therapy for anxiety disorders in women. Additionally, preclinical studies in healthy women indicate that ovarian hormones are related to cognitive modes of emotion regulation, like cognitive restructuring. The purpose of the current study was to determine whether a relationship exists between endogenous ovarian hormones and the outcomes of cognitive restructuring in clinically anxious women. METHODS Ninety women with spider phobia received training in cognitive restructuring or a control task and provided a blood sample for the measurement of serum estradiol and progesterone levels. Behavioral avoidance, using a behavioral approach task with a live spider, and self-reported fear of spiders were measured at baseline and 1-week post-treatment. RESULTS The results indicated that heightened levels of progesterone, but not estradiol, at the time of cognitive restructuring predicted greater post-treatment reductions in behavioral avoidance, but not self-reported fear, amongst women who received cognitive restructuring but not those in the control group. LIMITATIONS As menstrual cycle phase was not assessed; the present study provides information regarding how the benefits of cognitive therapy are predicted by between-person individual differences in absolute hormone levels, but does not examine the relationship between within-person fluctuations in hormone levels and outcomes. CONCLUSIONS These results suggest the effectiveness of cognitive therapy for anxiety disorders in women may differ depending on endogenous levels of progesterone, and raise the possibility that progesterone could be a useful pharmacological adjunct to cognitive therapy.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia.
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia
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Patel K, Stummer L, Patel K. Stiff-person syndrome in a patient with comorbid bipolar and panic disorders: A case report and literature review. Ment Health Clin 2020; 10:95-99. [PMID: 32420007 PMCID: PMC7213949 DOI: 10.9740/mhc.2020.05.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stiff-person syndrome (SPS) is a neurologic disorder characterized by muscle stiffness, rigidity, and muscle spasms, and it can increase a patient's risk for falls. It is recognized as a rare disease with limited clinical guidelines to manage the condition and its symptoms. Currently, there is even less clinical guidance for the management of common comorbid conditions in these patients. This patient case report aims to evaluate the efficacy of various medications for symptom management in a patient with SPS and comorbid psychiatric disorders, specifically bipolar I and panic disorder. Throughout the patient's course of treatment, various medications were trialed, including fluoxetine, hydroxyzine, valproic acid, propranolol, and clonazepam. Ultimately, fluoxetine, hydroxyzine, and propranolol were discontinued due to adverse drug reactions and incomplete symptom resolution. The patient's bipolar I disorder was adequately managed with valproic acid. Once the clonazepam was changed from as-needed to scheduled dosing, the patient's panic disorder and anxiety-triggered spasms were well controlled. The efficacy of benzodiazepines, specifically high doses of diazepam, in alleviating muscle spasms and anxiety in SPS has been demonstrated in the literature. Case reports including patients with SPS that are prescribed selective serotonin reuptake inhibitors provide controversial evidence as some studies report exacerbation of SPS symptoms with prolonged use. As this case report and literature review suggest, patients with SPS and comorbid panic disorder and anxiety-triggered spasms may benefit from the use of benzodiazepines. The use of other medication classes for the treatment of other comorbid psychiatric disorders in a patient with SPS is lacking evidence.
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Bagley LR, Bandarian-Balooch S. Attenuation of renewal of fear using context similarity with spider fearful individuals. LEARNING AND MOTIVATION 2020. [DOI: 10.1016/j.lmot.2020.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Groat LL, Shane MS. A Motivational Framework for Psychopathy: Toward a Reconceptualization of the Disorder. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Abstract. The link between psychopathy and violence has been well documented. Estimates suggest psychopathic offenders are responsible for as much as 40% of violence-related crime, and that they show rates of violent recidivism up to five times higher than non-psychopathic offenders. Existing theories of the disorder argue that this violence stems from a core insensitivity to emotional/aversive information, or from a core inability to optimally allocate processing resources in complex environments. However, some newer findings have been difficult for existing theories to assimilate; moreover, successful treatment programs based off current conceptualizations have been slow to develop. With this in mind, the current paper proposes a new motivational framework for psychopathy, within which the disorder is conceptualized as stemming from more strategic, motivated processes. The paper begins by reviewing traditional theories of psychopathy and highlighting their explanatory strengths and limitations. The proposed motivational framework is then outlined, and a supportive rationale for the framework provided. Next, the paper undertakes a selective review of some of the most empirically supported features of the disorder, to highlight how these features may be productively reformulated within a motivational framework. Finally, the paper suggests several methods through which an empirical evaluation of the proposed ideas may be undertaken, and explores potential implications of a motivational framework for next-generation rehabilitation and treatment opportunities.
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Affiliation(s)
- Lindsay L. Groat
- The University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Matthew S. Shane
- The University of Ontario Institute of Technology, Oshawa, ON, Canada
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Thng CEW, Lim-Ashworth NSJ, Poh BZQ, Lim CG. Recent developments in the intervention of specific phobia among adults: a rapid review. F1000Res 2020; 9. [PMID: 32226611 PMCID: PMC7096216 DOI: 10.12688/f1000research.20082.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 12/03/2022] Open
Abstract
Specific phobia is highly prevalent worldwide. Although the body of intervention studies is expanding, there is a lack of reviews that summarise recent progress and discuss the challenges and direction of research in this area. Hence, this rapid review seeks to systematically evaluate the available evidence in the last five years in the treatment of specific phobias in adults. Studies published between January 2014 to December 2019 were identified through searches on the electronic databases of Medline and PsychINFO. In total, 33 studies were included. Evidence indicates that psychotherapy, and in particular cognitive behaviour therapy, when implemented independently or as an adjunctive, is a superior intervention with large effect sizes. Technology-assisted therapies seem to have a beneficial effect on alleviating fears and are described to be more tolerable than
in vivo exposure therapy. Pharmacological agents are investigated solely as adjuncts to exposure therapy, but the effects are inconsistent; propranolol and glucocorticoid may be promising. A handful of cognitive-based therapies designed to alter fear arousal and activation pathways of phobias have presented preliminary, positive outcomes. Challenges remain with the inherent heterogeneity of specific phobia as a disorder and the accompanying variability in outcome measures and intervention approaches to warrant a clear conclusion on efficacy.
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Affiliation(s)
- Christabel E W Thng
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Nikki S J Lim-Ashworth
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Brian Z Q Poh
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Scheveneels S, Boddez Y, Van Daele T, Hermans D. Virtually Unexpected: No Role for Expectancy Violation in Virtual Reality Exposure for Public Speaking Anxiety. Front Psychol 2019; 10:2849. [PMID: 31920878 PMCID: PMC6928118 DOI: 10.3389/fpsyg.2019.02849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
In the current study, we examined the role of expectancy violation and retrospective reasoning about the absence of feared outcomes in virtual reality exposure therapy (VRET). Participants fearful of public speaking were asked to give speeches in virtual reality. We asked each participant individually to report their expectancies about feared outcomes in public speaking situations and which of these could be tested in VRET. Each of the expectancies was categorized as being related to: (1) participants’ own reactions, (2) (overt) reactions of the audience, or (3) (covert) negative evaluation. We examined whether the proportion of testable expectancies could predict treatment outcome and which type of expectancies were evaluated as being more testable in VRET. Additionally, we experimentally manipulated retrospective reasoning about whether or not expectancies related to the overt reactions of the audience could be violated by providing verbal information after VRET about whether or not the virtual audience was interactive. A reduction in public speaking anxiety was observed from pre- to post-VRET. Treatment effects were, however, not predicted by the individually reported proportions of testable expectancies. Participants evaluated expectancies about their own reactions as being more testable in VRET compared to expectancies about reactions of the audience or about being negatively evaluated. In addition, we did not find evidence that the experimental manipulation regarding whether or not the audience was interactive influenced treatment effects. In conclusion, the results of the current study suggest that the effects of VRET are not univocally explained by the mechanism of expectancy violation.
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Affiliation(s)
- Sara Scheveneels
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Yannick Boddez
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Dirk Hermans
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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Wechsler TF, Kümpers F, Mühlberger A. Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Front Psychol 2019; 10:1758. [PMID: 31551840 PMCID: PMC6746888 DOI: 10.3389/fpsyg.2019.01758] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is in vivo exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and in vivo exposure in studies applying an equivalent amount of exposure in both treatments is necessary. Methods: We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and in vivo. We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' g effect sizes for the treatment effects of VR exposure, in vivo exposure, and the comparison of VR to in vivo exposure in all studies and separately for studies on each diagnosis. Results: Nine studies (n = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and in vivo exposure both showed large, significant effect sizes. The comparison of VR to in vivo exposure revealed a small, but non-significant effect size favoring in vivo (g = -0.20). Specifically, effect sizes for Specific Phobia (g = -0.15) and Agoraphobia (g = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring in vivo (g = -0.50). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring in vivo exposure. Conclusions: We found no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
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Affiliation(s)
- Theresa F. Wechsler
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
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Scheveneels S, Boddez Y, Vervliet B, Hermans D. Modeling Hierarchical Versus Random Exposure Schedules in Pavlovian Fear Extinction: No Evidence for Differential Fear Outcomes. Behav Ther 2019; 50:967-977. [PMID: 31422851 DOI: 10.1016/j.beth.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 02/08/2023]
Abstract
In exposure therapy, the client can either be confronted with the fear-eliciting situations in a hierarchical way or in a random way. In the current study we developed a procedure to investigate the effects of hierarchical versus random exposure on long-term fear responding in the laboratory. Using a fear conditioning procedure, one stimulus (CS+) was paired with an electric shock (US), whereas another stimulus was not paired with the shock (CS-). The next day, participants underwent extinction training including presentations of the CS-, CS+ and a series of morphed stimuli between the CS- and CS+. In the hierarchical extinction condition (HE; N = 32), participants were first presented with the CS-, subsequently with the morph most similar to the CS-, then with the morph most similar to that one, and so forth, until reaching the CS+. In the random extinction condition (RE; N = 32), the same stimuli were presented but in a random order. Fear responding to the CS+, CS- and a new generalization stimulus (GS) was measured on the third day. Higher expectancy violation, t(62) = -2.67, p = .01, physiological arousal, t(62) = -2.08, p = .04, and variability in US-expectancy ratings, t(62) = -2.25, p = .03, were observed in the RE condition compared to the HE condition, suggesting the validity of this novel procedure. However, no differences between the RE and HE condition were found in fear responding as tested one day later, F(1, 62) < 1. In conclusion, we did not find evidence for differential long-term fear responding in modeling hierarchical versus random exposure in Pavlovian fear extinction.
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Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial. Behav Res Ther 2019; 118:130-140. [DOI: 10.1016/j.brat.2019.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/23/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023]
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Abstract
Abstract. In the current investigation, we classified participants as inhibitors or non-inhibitors depending on the extent to which they showed conditioned inhibition in a context that had been used for extinction of a conditioned response. This classification enabled us to predict participant responses in a second experiment which used a different design and a different experimental task. In the second experiment a feature-negative discrimination survived reversal training of the feature to a greater extent in the non-inhibitors than in the inhibitors and this result was supported by Bayesian analyses. We propose that the fundamental distinction between inhibitors and non-inhibitors is based on a tendency to utilize first-order (direct associations) or second-order (occasion-setting) strategies when faced with ambiguous information and that this classification is a stable individual differences attribute.
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Affiliation(s)
- Steven Glautier
- School of Psychology, Southampton University, Southampton, UK
| | - Ovidiu Brudan
- School of Psychology, Southampton University, Southampton, UK
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Scheveneels S, Boddez Y, De Ceulaer T, Hermans D. Ruining the surprise: The effect of safety information before extinction on return of fear. J Behav Ther Exp Psychiatry 2019; 63:73-78. [PMID: 30446162 DOI: 10.1016/j.jbtep.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In psychoeducation before exposure treatment patients are sometimes provided with information about the (low) probability that the feared outcome would occur. Since it has been proposed in the literature that this might have adverse effects, the current study investigated the effect of providing participants with this type of safety information on return of fear. METHOD In an ABA-renewal paradigm, participants in the experimental group were instructed between acquisition and extinction that the probability of US-occurrence would be extremely small in the remainder of the experiment. Participants in the control group did not receive this information. RESULTS Less return of fear in US-expectancy ratings was observed in participants who received the safety information. LIMITATIONS We failed to find successful acquisition in the skin-conductance data, which prevented us from interpreting the results of this outcome measure. CONCLUSIONS These results suggest that providing safety information is not deleterious for the effects of exposure and can even be beneficial for its effects. However, further clinical research is needed.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.
| | - Yannick Boddez
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Toon De Ceulaer
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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de Vries YA, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Cia AH, De Girolamo G, Dinolova RV, Esan O, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Karam A, Kawakami N, Kiejna A, Kovess-Masfety V, Lee S, Mneimneh Z, Navarro-Mateu F, Piazza M, Scott K, ten Have M, Torres Y, Viana MC, Kessler RC, de Jonge P. Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys. BMC Med 2019; 17:101. [PMID: 31122269 PMCID: PMC6533738 DOI: 10.1186/s12916-019-1328-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. METHODS We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. RESULTS Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). CONCLUSIONS This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
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Affiliation(s)
- Ymkje Anna de Vries
- Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | | | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo H. Cia
- Anxiety Clinic and Research Center, Buenos Aires, Argentina
| | | | | | - Oluyomi Esan
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Aimee Karam
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Andrzej Kiejna
- Wroclaw Medical University, Wrocław, Poland
- University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, Murcia, Spain
- Centro de Investigación Biomédica en ERed en Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
| | - Marina Piazza
- Instituto Nacional de Salud, Lima, Peru
- Universidad Cayetano Heredia, Lima, Peru
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Margreet ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Peter de Jonge
- Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Gujjar KR, van Wijk A, Kumar R, de Jongh A. Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review. J Evid Based Dent Pract 2019; 19:140-155. [PMID: 31326046 DOI: 10.1016/j.jebdp.2019.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/25/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. DATA SOURCES A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. INCLUSION CRITERIA Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. RESULTS A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. CONCLUSIONS A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. CLINICAL SIGNIFICANCE The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. PROSPERO REGISTRATION NUMBER CRD42017064810.
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Affiliation(s)
- Kumar Raghav Gujjar
- Faculty of Dentistry, SEGi University, Petaling Jaya, Selangor, Malaysia; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Arjen van Wijk
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ratika Kumar
- School of Public Health, The University of Queensland, Public Health Building, Brisbane, Australia
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, Worcester, United Kingdom; School of Psychology, Queen's University, Belfast, Northern Ireland
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73
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Frank B, McKay D. The Suitability of an Inhibitory Learning Approach in Exposure When Habituation Fails: A Clinical Application to Misophonia. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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74
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Gain through pain: Augmenting in vivo exposure with enhanced attention to internal experience leads to increased resilience to distress. Behav Res Ther 2019; 113:9-17. [DOI: 10.1016/j.brat.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/09/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
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Knowles KA, Olatunji BO. Enhancing Inhibitory Learning: The Utility of Variability in Exposure. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 26:186-200. [PMID: 31787834 PMCID: PMC6884337 DOI: 10.1016/j.cbpra.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered.
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The Effect of Augmented Reality and Virtual Reality on Inducing Anxiety for Exposure Therapy: A Comparison Using Heart Rate Variability. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2018:6357351. [PMID: 30595830 PMCID: PMC6286749 DOI: 10.1155/2018/6357351] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/01/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022]
Abstract
Claustrophobia is an anxiety disorder characterized by the fear of enclosed spaces. Although medication treatment can effectively control symptoms, the effects quickly disappear once medication is discontinued. Many studies have shown that combining psychotherapy and medication is more efficacious than solely using medication. However, the weaknesses of the traditional psychotherapy are that it is time-consuming and expensive. Alternatively, vivo exposure therapy is proposed in which anxiety is gradually triggered with stimuli. Targeting claustrophobia is diagnosed using the traditional method, and this study established virtual reality (VR) and augmented reality (AR) environments consistent with claustrophobic characteristics, comparing the two using an experimental process to examine whether VR and AR environments are equally capable of triggering anxiety in participants. This study further analysed the efficacies of VR and AR by measuring changes in participant's heart rates variability (HRV) and examining data from survey questionnaires. HRV results indicated that the proposed VR system and AR system were both able to trigger anxiety. Furthermore, the AR environment produced a stronger experience for the participants and caused physiological reactions more evident than those caused by the VR environment. Regarding the anxiety questionnaire, the participants suggested that their anxiety was significantly higher in the VR environment than in the AR environment.
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77
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Blakey SM, Abramowitz JS, Buchholz JL, Jessup SC, Jacoby RJ, Reuman L, Pentel KZ. A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behav Res Ther 2019; 112:28-35. [DOI: 10.1016/j.brat.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Miller-Matero LR, Eshelman A. The development and treatment of a food phobia after bariatric surgery. Eat Weight Disord 2018; 23:903-905. [PMID: 29022228 DOI: 10.1007/s40519-017-0446-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Renee Miller-Matero
- Department of Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA. .,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Anne Eshelman
- Department of Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA
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Abstract
Several studies have revealed that fear recovery is prevented when extinction training is conducted after retrieval of a fear memory. Postretrieval extinction training is related to modification of memory during reconsolidation. Providing new information during reconsolidation can modify the original memory. We propose that avoidance behavior is a relevant factor that prevents subjects from obtaining new safety information during reconsolidation. Postretrieval extinction training without avoidance behavior reduced the fear response to conditioned stimulus and prevented spontaneous recovery in the current study, which corresponded with previous studies. Under the condition of postretrieval extinction training with avoidance behavior, the fear response was not reduced as much as it was in the condition without avoidance. It is possible that avoidance behavior prevents receiving new safety information during postretrieval extinction training.
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80
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Landowska A, Roberts D, Eachus P, Barrett A. Within- and Between-Session Prefrontal Cortex Response to Virtual Reality Exposure Therapy for Acrophobia. Front Hum Neurosci 2018; 12:362. [PMID: 30443209 PMCID: PMC6221970 DOI: 10.3389/fnhum.2018.00362] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/23/2018] [Indexed: 01/30/2023] Open
Abstract
Exposure Therapy (ET) has demonstrated its efficacy in the treatment of phobias, anxiety and Post-traumatic Stress Disorder (PTSD), however, it suffers a high drop-out rate because of too low or too high patient engagement in treatment. Virtual Reality Exposure Therapy (VRET) is comparably effective regarding symptom reduction and offers an alternative tool to facilitate engagement for avoidant participants. Neuroimaging studies have demonstrated that both ET and VRET normalize brain activity within a fear circuit. However, previous studies have employed brain imaging technology which restricts people's movement and hides their body, surroundings and therapist from view. This is at odds with the way engagement is typically controlled. We used a novel combination of neural imaging and VR technology-Functional Near-Infrared Spectroscopy (fNIRS) and Immersive Projection Technology (IPT), to avoid these limitations. Although there are a few studies that have investigated the effect of VRET on a brain function after the treatment, the present study utilized technologies which promote ecological validity to measure brain changes after VRET treatment. Furthermore, there are no studies that have measured brain activity within VRET session. In this study brain activity within the prefrontal cortex (PFC) was measured during three consecutive exposure sessions. N = 13 acrophobic volunteers were asked to walk on a virtual plank with a 6 m drop below. Changes in oxygenated (HbO) hemoglobin concentrations in the PFC were measured in three blocks using fNIRS. Consistent with previous functional magnetic resonance imaging (fMRI) studies, the analysis showed decreased activity in the DLPFC and MPFC during first exposure. The activity increased toward normal across three sessions. The study demonstrates potential efficacy of a method for measuring within-session neural response to virtual stimuli that could be replicated within clinics and research institutes, with equipment better suited to an ET session and at fraction of the cost, when compared to fMRI. This has application in widening access to, and increasing ecological validity of, immersive neuroimaging across understanding, diagnosis, assessment and treatment of, a range of mental disorders such as phobia, anxiety and PTSD or addictions.
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Affiliation(s)
- Aleksandra Landowska
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - David Roberts
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Peter Eachus
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Alan Barrett
- Military Veterans’ Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
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Yuan J, Yan M, Xu Y, Chen W, Wang X. Social Company Disrupts Fear Memory Renewal: Evidence From Two Rodent Studies. Front Neurosci 2018; 12:565. [PMID: 30174582 PMCID: PMC6107706 DOI: 10.3389/fnins.2018.00565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/27/2018] [Indexed: 11/13/2022] Open
Abstract
Renewal of fear outside treatment context is a challenge for behavioral therapies. Prior studies suggest a social buffering effect that fear response is attenuated in the presence of social company. However, few studies have examined the role of social company in reducing fear renewal. Here, we used a Pavlovian fear conditioning procedure including acquisition, extinction and test stages to examine social buffering effect on fear memory renewal in male rats. The test context was manipulated to be either different from the extinction one in ABC model, or same as that in ACC model. All conditioned subjects underwent extinction individually in Experiment 1 but with a partner in Experiment 2. In test, both experiments manipulated social company (alone vs. accompanied) and context (ABC vs. ACC). Experiment 1 showed more freezing in ABC than in ACC model during the test-alone condition, indicating a fear renewal effect which, however, was absent during the test-accompanied condition. Also, accompanied subjects showed less freezing compared to alone subjects in the ABC model. In Experiment 2, animals showed a similar freezing in ABC and ACC models despite being tested alone, implying that social company offered at extinction disrupted fear renewal. Again, we observed reduced freezing in accompanied relative to alone subjects in the test. These results suggest that social company is effective in disrupting fear renewal after leaving treatment context.
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Affiliation(s)
- Jiajin Yuan
- College of Education Science, Chengdu University, Chengdu, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Minmin Yan
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Yin Xu
- School of Sociology, China University of Political Science and Law, Beijing, China
| | - Weihai Chen
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Xiaqing Wang
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
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82
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Heart rate variability biofeedback and other psychophysiological procedures as important elements in psychotherapy. Int J Psychophysiol 2018; 131:89-95. [DOI: 10.1016/j.ijpsycho.2017.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022]
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83
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Ishii D, Matsuzawa D, Matsuda S, Tomizawa-Shinohara H, Sutoh C, Shimizu E. Spontaneous recovery of fear differs among early - late adolescent and adult male mice. Int J Neurosci 2018; 129:1-9. [PMID: 30010457 DOI: 10.1080/00207454.2018.1501049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adolescence is a vulnerable period for developing anxiety-related mental disorders such as post-traumatic stress disorder (PTSD), which requires a long-term course of therapy when a traumatic event has been experienced during childhood. However, the biological mechanism underlying these age-dependent characteristics remains unclear. In the present study, we used early adolescent, late adolescent and adult (4-, 8-, and 15-week old) male mice to examine age differences in fear memory, fear extinction, and spontaneous recovery of fear. We also measured the activation of extracellular signal-regulated kinase (ERK) 2 in the dorsal hippocampus (dHip) and the basolateral amygdala (BLA) following a spontaneous recovery test. Our major findings were as follows: (1) early adolescent and adult mice did not recover the fear response; only late adolescent mice recovered the fear response. (2) The ERK2 in the dHip was more activated after the spontaneous recovery test in late adolescent mice than in adult mice, and the ERK2 in the BLA was more activated after the spontaneous recovery test in adult mice than in late adolescent mice. These results suggest that there exists a unique period in which spontaneous recovery occurs and that these late adolescent behavioral signatures may be related to alteration in the ERK2 phosphorylation in the dHip and BLA.
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Affiliation(s)
- Daisuke Ishii
- a Center for Medical Sciences , Ibaraki Prefectural University of Health Sciences , Ibaraki , Japan.,b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan
| | - Daisuke Matsuzawa
- b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan.,c Research Center for Child Mental Development , Chiba University Graduate School of Medicine , Chiba , Japan
| | - Shingo Matsuda
- b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan.,d Department of Pharmacotherapeutics , Showa Pharmaceutical University , Tokyo , Japan.,e Department of Ultrastructural Research , National Institute of Neuroscience, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Haruna Tomizawa-Shinohara
- b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan
| | - Chihiro Sutoh
- b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan
| | - Eiji Shimizu
- b Department of Cognitive Behavioral Physiology , Chiba University Graduate School of Medicine , Chiba , Japan.,c Research Center for Child Mental Development , Chiba University Graduate School of Medicine , Chiba , Japan
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84
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Successful Treatment of Halitophobia with Cognitive Behavioural Therapy: A Case Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018. [DOI: 10.1007/s10879-018-9398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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85
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Eaton WW, Bienvenu OJ, Miloyan B. Specific phobias. Lancet Psychiatry 2018; 5:678-686. [PMID: 30060873 PMCID: PMC7233312 DOI: 10.1016/s2215-0366(18)30169-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022]
Abstract
Anxiety disorders are among the most prevalent mental disorders, but the subcategory of specific phobias has not been well studied. Phobias involve both fear and avoidance. For people who have specific phobias, avoidance can reduce the constancy and severity of distress and impairment. However, these phobias are important because of their early onset and strong persistence over time. Studies indicate that the lifetime prevalence of specific phobias around the world ranges from 3% to 15%, with fears and phobias concerning heights and animals being the most common. The developmental course of phobias, which progress from fear to avoidance and then to diagnosis, suggests the possibility that interrupting the course of phobias could reduce their prevalence. Although specific phobias often begin in childhood, their incidence peaks during midlife and old age. Phobias persist for several years or even decades in 10-30% of cases, and are strongly predictive of onset of other anxiety, mood, and substance-use disorders. Their high comorbidity with other mental disorders, especially after onset of the phobia, suggests that early treatment of phobias could also alter the risk of other disorders. Exposure therapy remains the treatment of choice, although this approach might be less effective in the long term than previously believed. This Review discusses the literature regarding the prevalence, incidence, course, risk factors, and treatment of specific phobias, and presents epidemiological data from several population-based surveys.
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Affiliation(s)
- William W Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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86
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Abstract
This study describes treatment of an adult woman, referred to as “Carla,” who was referred for psychological intervention following bariatric surgery due to recurrent nausea and vomiting along with food avoidance. Carla evinced symptoms including dietary range restriction, failure to progress to recommended caloric intake, fear of vomiting, and body dissatisfaction. She was diagnosed with generalized anxiety disorder, along with comorbidities including dysthymia, body dysmorphia, and subsyndromal specific phobia of vomiting (SPOV). Treatment included 20 weekly sessions utilizing a transdiagnostic approach to treatment, which has been shown to be efficacious in management of multiple comorbidities. The limited body of research and results of this case suggest expansion of the criteria for avoidant restrictive food intake disorder (ARFID) to allow for inclusion of this constellation of symptoms within bariatric patients.
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87
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Guillén V, Baños RM, Botella C. Users' Opinion About a Virtual Reality System as an Adjunct to Psychological Treatment for Stress-Related Disorders: A Quantitative and Qualitative Mixed-Methods Study. Front Psychol 2018; 9:1038. [PMID: 29988491 PMCID: PMC6024567 DOI: 10.3389/fpsyg.2018.01038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/01/2018] [Indexed: 11/13/2022] Open
Abstract
This study aims to explore patients' and therapists' attitudes about the psychological treatment they received (patients) or applied (therapists). The treatments were standard CBT protocols for post-traumatic stress disorder (PTSD), complicated grief (CG), or adjustment disorders (ADs), depending on each patient diagnosis. The treatments were delivered following a traditional format or supported by a virtual reality (VR) system "EMMA's WORLD" designed for the treatment of stress-related disorders. "EMMA's WORLD" is a VR application in which patients can explore negative experiences using different virtual elements that can be customized to make them more meaningful to the user. The sample was composed of two groups: the "professionals" (N = 10) were all clinical psychologists who applied the same psychological treatment in both the traditional format ("traditional condition") and using the VR system ("EMMA" condition). The second group consisted of a sample of patients (N = 50) who met the criteria for at least one of three different diagnoses: PTSD (N = 15), CG (N = 15), or AD (N = 20). 25 patients received treatment in the traditional format and 25 supported by the VR system. The patients were asked about their expectations (before treatment) and satisfaction (after treatment) with the treatment they received. All the therapists were asked their opinions about both treatment conditions. A mixed-methods approach using quantitative and qualitative methodologies was used. In both conditions, high scores were observed, and the patient's opinions were even better when they have already received the treatments. A more pronounced pre-test-post-test change in the EMMA therapy group than in the traditional group was observed. EMMA's World was well-accepted by both patients and therapists, and it helped to foster motivation in patients, while helping the therapist to apply the treatment. Thus, VR can be useful as an adjunct tool to enhance the treatment.
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Affiliation(s)
- Verónica Guillén
- Department of Personality Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Rosa M. Baños
- Department of Personality Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Cristina Botella
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón de la Plana, Spain
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88
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Abstract
AbstractSocial anxiety is a common, debilitating psychological problem. In the present study, two meta-analyses examined the efficacy of virtual reality exposure therapy for social anxiety. The first meta-analysis tested whether virtual reality exposure therapy reduces social anxiety more than a waitlist control condition. The results of the first meta-analysis, consisting of six studies and 233 participants, showed a significant overall effect size, indicating that virtual reality exposure therapy was effective in reducing social anxiety. The second meta-analysis tested whether the standard treatment for social anxiety, which includes in vivo or imaginal exposure, leads to greater effects than virtual reality exposure therapy. The second meta-analysis, consisting of seven studies and 340 total participants, showed essentially no difference in effect sizes between virtual reality exposure and in vivo or imaginal exposure. The results of the two meta-analyses support the use of virtual reality in the treatment of social anxiety.
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89
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Azoum M, Clark GI, Rock AJ. The impact of affect labelling on responses to aversive flying-cues. PLoS One 2018; 13:e0194519. [PMID: 29672519 PMCID: PMC5908089 DOI: 10.1371/journal.pone.0194519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022] Open
Abstract
Individuals with flying phobia experience increases in subjective anxiety in response to flying-related cues. However, the cognitive processes that contribute to cue-reactive anxiety in individuals with flying-related anxiety remain poorly understood. Preliminary research suggests that changes in visual imagery and volitional control may contribute to this cue-reactive anxiety. Engaging in affect labelling during exposure therapy has been shown to reduce cue-reactive anxiety in individuals with fears relating to a variety of stimuli but has not been investigated in the fear of flying. The present study recruited 110 participants with a range of flying-related anxiety scores to complete an online cue-reactivity experiment. The study sought to evaluate whether an aversive flying cue triggered changes in imagery, volitional control and anxiety, and whether changes in imagery and volitional control predicted level of cue-reactive anxiety. Participants were randomly allocated to an affect labelling or non-affect labelling condition to additionally assess whether engaging in labelling one's emotion following exposure to an aversive flying cue would attenuate cue-reactive changes in anxiety relative to a group who did not. Significant cue-reactive changes in anxiety, and volitional control were observed from neutral to aversive flying cue were observed. After accounting for the effects of flying anxiety severity, only volitional control significantly improved the prediction of cue-reactive anxiety. Participants in the affect labelling condition reported significantly smaller increases in anxiety than the non-affect labelling group following exposure to the aversive flight cue. This is the first study to indicate affect labelling may help to regulate aspects of cue-reactive anxiety in response to aversive flying stimuli.
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Affiliation(s)
- Michelle Azoum
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Gavin I. Clark
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Adam J. Rock
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
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90
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Tams S, Legoux R, Léger PM. Smartphone withdrawal creates stress: A moderated mediation model of nomophobia, social threat, and phone withdrawal context. COMPUTERS IN HUMAN BEHAVIOR 2018. [DOI: 10.1016/j.chb.2017.11.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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91
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Levinson CA, Sala M, Fewell L, Brosof LC, Fournier L, Lenze EJ. Meal and snack-time eating disorder cognitions predict eating disorder behaviors and vice versa in a treatment seeking sample: A mobile technology based ecological momentary assessment study. Behav Res Ther 2018; 105:36-42. [PMID: 29614379 DOI: 10.1016/j.brat.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 01/01/2023]
Abstract
Individuals with eating disorders experience high anxiety when eating, which may contribute to the high relapse rates seen in the eating disorders. However, it is unknown if specific cognitions associated with such anxiety (e.g., fears of gaining weight) may lead to engagement in eating disorder behaviors (e.g., weighing oneself). Participants (N = 66) recently treated at a residential eating disorder facility and diagnosed with an eating disorder (primarily anorexia nervosa; n = 40; 60.6%) utilized a mobile application to answer questions about mealtime cognitions, anxiety, and eating disorder behaviors four times a day for one week. Hierarchical linear models using cross-lag analyses identified that there were quasi-causal (and sometimes reciprocal) within-person relationships between specific eating disorder cognitions and subsequent eating disorder behaviors. These cognitions predicted higher anxiety during the next meal and eating disorder pathology at one-month follow-up. Interventions personalized to target these specific cognitions in real time might reduce eating disorder relapse.
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Affiliation(s)
- Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, USA.
| | - Margarita Sala
- Southern Methodist University, Department of Psychology, USA
| | - Laura Fewell
- University of Louisville, Department of Psychological & Brain Sciences, USA
| | - Leigh C Brosof
- University of Louisville, Department of Psychological & Brain Sciences, USA
| | - Lauren Fournier
- Washington University in St. Louis, Department of Psychological & Brain Sciences, USA
| | - Eric J Lenze
- Washington University in St. Louis, Department of Psychiatry, USA
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92
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Schäfer SK, Ihmig FR, Lara H KA, Neurohr F, Kiefer S, Staginnus M, Lass-Hennemann J, Michael T. Effects of heart rate variability biofeedback during exposure to fear-provoking stimuli within spider-fearful individuals: study protocol for a randomized controlled trial. Trials 2018; 19:184. [PMID: 29548298 PMCID: PMC5857097 DOI: 10.1186/s13063-018-2554-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/15/2018] [Indexed: 02/24/2023] Open
Abstract
Background Specific phobias are among the most common anxiety disorders. Exposure therapy is the treatment of choice for specific phobias. However, not all patients respond equally well to it. Hence, current research focuses on therapeutic add-ons to increase and consolidate the effects of exposure therapy. One potential therapeutic add-on is biofeedback to increase heart rate variability (HRV). A recent meta-analysis shows beneficial effects of HRV biofeedback interventions on stress and anxiety symptoms. Therefore, the purpose of the current trial is to evaluate the effects of HRV biofeedback, which is practiced before and utilized during exposure, in spider-fearful individuals. Further, this trial is the first to differentiate between the effects of a HRV biofeedback intervention and those of a low-load working memory (WM) task. Methods Eighty spider-fearful individuals participate in the study. All participants receive a training session in which they practice two tasks (HRV biofeedback and a motor pseudo-biofeedback task or two motor pseudo-biofeedback tasks). Afterwards, they train both tasks at home for 6 days. One week later, during the exposure session, they watch 16 1-min spider video clips. Participants are divided into four groups: group 1 practices the HRV biofeedback and one motor pseudo-task before exposure and utilizes HRV biofeedback during exposure. Group 2 receives the same training, but continues the pseudo-biofeedback task during exposure. Group 3 practices two pseudo-biofeedback tasks and continues one of them during exposure. Group 4 trains in two pseudo-biofeedback tasks and has no additional task during exposure. The primary outcome is fear of spiders (measured by the Fear of Spiders Questionnaire and the Behavioral Approach Test). Secondary outcomes are physiological measures based on electrodermal activity, electrocardiogram and respiration. Discussion This RCT is the first one to investigate the effects of using a pre-trained HRV biofeedback during exposure in spider-fearful individuals. The study critically contrasts the effects of the biofeedback intervention with those of pseudo-tasks, which also require WM capacity, but which do not have a physiological base. If HRV biofeedback is effective in reducing fear of spiders, it would represent an easy-to-use tool to improve exposure-therapy outcomes. Trial registration Deutsches Register Klinischer Studien, DRKS00012278. Registered on 23 May 2017, amendment on 5 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2554-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Frank R Ihmig
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Karen A Lara H
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Frank Neurohr
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Stephan Kiefer
- Department of Biomedical Microsystems, Fraunhofer-Institut fuer Biomedizinische Technik (IBMT), Sulzbach, Saar, Germany
| | - Marlene Staginnus
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Building A 1.3, 66123, Saarbrücken, Germany.
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93
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Agogo D, Hess TJ. “How does tech make you feel?” a review and examination of negative affective responses to technology use. EUR J INFORM SYST 2018. [DOI: 10.1080/0960085x.2018.1435230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- David Agogo
- Information Systems and Business Analytics, College of Business, Florida International University , Miami, FL, USA
| | - Traci J. Hess
- Isenberg School of Management, University of Massachusetts Amherst , Amherst MA USA
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94
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Effects of prediction error on post-retrieval extinction of fear to compound stimuli. ACTA PSYCHOLOGICA SINICA 2018. [DOI: 10.3724/sp.j.1041.2018.00739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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Trost Z, Jones A, Guck A, Vervoort T, Kowalsky JM, France CR. Initial validation of a virtual blood draw exposure paradigm for fear of blood and needles. J Anxiety Disord 2017; 51:65-71. [PMID: 28780134 DOI: 10.1016/j.janxdis.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022]
Abstract
Fear of blood, injections, and needles commonly prevents or delays individuals' receipt of health care, such as vaccines or blood draws. Innovative methods are needed to overcome these fears and reduce anxiety related to activities of this nature. The present study describes initial testing of an arm illusion paradigm that may prove useful during early phases of graded exposure for people with blood and needle fear. Seventy-four undergraduate students aged 18-29 years were tested. In line with study aims, results indicated that the virtual blood draw paradigm promoted strong perceptions of arm ownership and elicited significant changes in physiological indices (blood pressure, heart rate, electrodermal activity, respiratory rate) in response to key procedure elements (e.g., needle insertion). Further, bivariate correlations indicated that individual differences in self-reported blood and needle fear collected prior to the illusion paradigm were significantly associated with presyncopal symptoms reported following the procedure. In regression analyses, self-reported measures of blood and needle fear explained unique variance in presyncopal symptoms even after controlling for general state anxiety. These findings provide initial support for the virtual blood draw paradigm as a promising tool to help provide graded exposure to medical procedures involving needles and blood draw.
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Affiliation(s)
- Z Trost
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd., Room 415, Birmingham, AL 35294, USA.
| | - A Jones
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave S., Birmingham, AL 35294, USA
| | - A Guck
- Department of Psychology, University of North Texas, 611 W. Mulberry St., Denton, TX 76201, USA
| | - T Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - J M Kowalsky
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA
| | - C R France
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA
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96
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Abstract
PURPOSE OF REVIEW This review provides an overview of the current evidence base for and clinical applications of the use of virtual reality (VR) in psychiatric practice, in context of recent technological developments. RECENT FINDINGS The use of VR in psychiatric practice shows promise with much of the research demonstrating clinical effectiveness for conditions including post-traumatic stress disorder, anxiety and phobias, chronic pain, rehabilitation, and addictions. However, more research is needed before the use of VR is considered a clinical standard of practice in some areas. The recent release of first generation consumer VR products signals a change in the viability of further developing VR systems and applications. As applications increase so will the need for good quality research to best understand what makes VR effective, and when VR is not appropriate for clinical services. As the field progresses, it is hopeful that the flexibility afforded by this technology will yield superior outcomes and a better understanding of the underlying mechanisms impacting those outcomes.
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97
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Rudaz M, Ledermann T, Margraf J, Becker ES, Craske MG. The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia? PLoS One 2017; 12:e0180298. [PMID: 28671977 PMCID: PMC5495400 DOI: 10.1371/journal.pone.0180298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/13/2017] [Indexed: 01/04/2023] Open
Abstract
Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.
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Affiliation(s)
- Myriam Rudaz
- Department of Psychology, Utah State University, Logan, Utah, United States of America
- * E-mail:
| | - Thomas Ledermann
- Department of Psychology, Utah State University, Logan, Utah, United States of America
| | - Jürgen Margraf
- Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Eni S. Becker
- Behavioural Science Institute, Radboud University of Nijmegen, Nijmegen, Netherlands
| | - Michelle G. Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
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98
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Maples-Keller JL, Yasinski C, Manjin N, Rothbaum BO. Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress. Neurotherapeutics 2017; 14:554-563. [PMID: 28512692 PMCID: PMC5509629 DOI: 10.1007/s13311-017-0534-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Virtual reality (VR) refers to an advanced technological communication interface in which the user is actively participating in a computer-generated 3-dimensional virtual world that includes computer sensory input devices used to simulate real-world interactive experiences. VR has been used within psychiatric treatment for anxiety disorders, particularly specific phobias and post-traumatic stress disorder, given several advantages that VR provides for use within treatment for these disorders. Exposure therapy for anxiety disorder is grounded in fear-conditioning models, in which extinction learning involves the process through which conditioned fear responses decrease or are inhibited. The present review will provide an overview of extinction training and anxiety disorder treatment, advantages for using VR within extinction training, a review of the literature regarding the effectiveness of VR within exposure therapy for specific phobias and post-traumatic stress disorder, and limitations and future directions of the extant empirical literature.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Carly Yasinski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole Manjin
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara Olasov Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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99
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Wardenaar KJ, Lim CC, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C, Bunting B, de Girolamo G, Demyttenaere K, Florescu SE, Gureje O, Hisateru T, Hu C, Huang Y, Karam E, Kiejna A, Lepine JP, Navarro-Mateu F, Browne MO, Piazza M, Posada-Villa J, ten Have ML, Torres Y, Xavier M, Zarkov Z, Kessler RC, Scott KM, de Jonge P. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychol Med 2017; 47:1744-1760. [PMID: 28222820 PMCID: PMC5674525 DOI: 10.1017/s0033291717000174] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. METHOD Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. RESULTS The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. CONCLUSIONS Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
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Affiliation(s)
- Klaas J. Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Carmen C.W. Lim
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jordi Alonso
- Health Services Research Unit, Instituto Hospital del Mar de Investigaciones Médicas, Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Laura H. Andrade
- Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Brendan Bunting
- Psychology Research Institute, Ulster University, Londonderry, United Kingdom
| | | | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia E. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Tachi Hisateru
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Japan
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - Elie Karam
- St George Hospital University Medical Center, Balamand University, Institute for Development, Research, Advocacy, Beirut, Lebanon
| | - Andrzej Kiejna
- Department of Psychiatry Wroclaw Medical University, Wroclaw, Poland
| | - Jean Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes Paris, France
| | - Fernando Navarro-Mateu
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca. Centro de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP)-Murcia. Subdirección General de Salud Mental y Asistencia Psiquiátrica. Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | | | - Maria Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, St Martin de Porres, Peru
| | | | - Margreet L. ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Miguel Xavier
- Nova faculdade ciencias medicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Zahari Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | | | - Kate M. Scott
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
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Matsuoka H, Chiba I, Sakano Y, Toyofuku A, Abiko Y. Cognitive behavioral therapy for psychosomatic problems in dental settings. Biopsychosoc Med 2017. [PMID: 28630646 PMCID: PMC5470220 DOI: 10.1186/s13030-017-0102-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cognitive behavioral therapy (CBT) has been applied for various problems, including psychiatric diseases such as depression and anxiety, and for physical symptoms such as pain. It has also been applied for dental problems. Although the effect of CBTs on temporomandibular disorders and dental anxiety are well documented, its effectiveness on other types of oral symptoms remain unclear. Little information comparing the different types of CBTs in the dental setting is currently available. Because dental professionals are often expected to conduct CBTs in the dental setting, it is important to develop proper training programs for dental professionals. In this review article, we demonstrate and discuss the application of CBTs for psychosomatic problems, including temporomandibular disorders, dental anxiety, burning mouth syndrome, and other oral complaints in dental settings.
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Affiliation(s)
- Hirofumi Matsuoka
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Itsuo Chiba
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Yuji Sakano
- School of Psychological Science, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
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