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Siddiqi SH, Philip NS, Palm ST, Carreon DM, Arulpragasam AR, Barredo J, Bouchard H, Ferguson MA, Grafman JH, Morey RA, Fox MD. A potential target for noninvasive neuromodulation of PTSD symptoms derived from focal brain lesions in veterans. Nat Neurosci 2024:10.1038/s41593-024-01772-7. [PMID: 39317797 DOI: 10.1038/s41593-024-01772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024]
Abstract
Neuromodulation trials for the treatment of posttraumatic stress disorder (PTSD) have yielded mixed results, and the optimal neuroanatomical target remains unclear. Here we analyzed three datasets to study brain circuitry causally linked to PTSD in military veterans. In veterans with penetrating traumatic brain injury, lesion locations that reduced probability of PTSD were preferentially connected to a circuit including the medial prefrontal cortex, amygdala and anterolateral temporal lobe. In veterans without lesions, PTSD was specifically associated with increased connectivity within this circuit. Reduced functional connectivity within this circuit after transcranial magnetic stimulation correlated with symptom reduction, even though the circuit was not directly targeted. This lesion-based 'PTSD circuit' may serve as a target for clinical trials of neuromodulation in veterans with PTSD.
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Affiliation(s)
- Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
| | - Noah S Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephan T Palm
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Amanda R Arulpragasam
- Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer Barredo
- Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Heather Bouchard
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry, Durham VA Medical Center, Durham, NC, USA
| | - Michael A Ferguson
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, USA
| | - Jordan H Grafman
- Departments of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Rajendra A Morey
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry, Durham VA Medical Center, Durham, NC, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, USA
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Jimenez WP, Zeytonli A, Nabulsi Y, Hu X. (Don't fear) the factors: An item-level meta-analysis of the fear of COVID-19 Scale's factor structure and measurement invariance. Stress Health 2024:e3472. [PMID: 39243275 DOI: 10.1002/smi.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/13/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
The global COVID-19 pandemic saw marked research and clinical interest in evaluating pandemic-related distress, namely fear and anxiety regarding infection and death. The most widely used and earliest developed measure of COVID-19 distress is Ahorsu et al. (2022) seven-item Fear of COVID-19 Scale (FCV-19S). To investigate the factor structure and measurement equivalence of the FCV-19S, we conducted an item-level meta-analysis synthesizing 1155 effect sizes across k = 55 independent samples comprising N = 71,161 individuals. We found that a two-factor measurement model comprising a four-item Emotional factor and a three-item Psychosomatic factor exhibits better fit than the originally proposed single-factor measurement model. Moreover, the bidimensional FCV-19S exhibits partial scalar/strong invariance across the general population, healthcare workers, schoolteachers, and university students as well as partial metric/weak invariance across samples from Bangladesh, China, Japan, Pakistan, Poland, and Portugal. Despite the theoretical and practical implications of these findings, more primary research across a wider range of sample types and countries is undoubtedly needed for further evaluation of the FCV-19S's psychometric properties and generalizability.
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Affiliation(s)
- William P Jimenez
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Asiye Zeytonli
- Department of Management, West Virginia University, Morgantown, West Virginia, USA
| | - Yasmine Nabulsi
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Xiaoxiao Hu
- Department of Management, West Virginia University, Morgantown, West Virginia, USA
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Cocean AM, Vodnar DC. Exploring the gut-brain Axis: Potential therapeutic impact of Psychobiotics on mental health. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111073. [PMID: 38914414 DOI: 10.1016/j.pnpbp.2024.111073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/18/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
One of the most challenging and controversial issues in microbiome research is related to gut microbial metabolism and neuropsychological disorders. Psychobiotics affect human behavior and central nervous system processes via the gut-brain axis, involving neuronal, immune, and metabolic pathways. They have therapeutic potential in the treatment of several neurodegenerative and neurodevelopmental disorders such as depression, anxiety, autism, attention deficit hyperactivity disorder, Alzheimer's disease, Parkinson's disease, schizophrenia, Huntington's disease, anorexia nervosa, and multiple sclerosis. However, the mechanisms underlying the interaction between psychobiotics and the abovementioned diseases need further exploration. This review focuses on the relationship between gut microbiota and its impact on neurological and neurodegenerative disorders, examining the potential of psychobiotics as a preventive and therapeutic approach, summarising recent research on the gut-brain axis and the potential beneficial effects of psychobiotics, highlighting the need for further research and investigation in this area.
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Affiliation(s)
- Ana-Maria Cocean
- Department of Food Science and Technology, Life Science Institute, University of Agricultural Sciences and Veterinary Medicine, Calea Mănăștur 3-5, Cluj-Napoca, Romania.
| | - Dan Cristian Vodnar
- Department of Food Science and Technology, Life Science Institute, University of Agricultural Sciences and Veterinary Medicine, Calea Mănăștur 3-5, Cluj-Napoca, Romania.
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Ramtin S, Ngoue M, Ring D, Teunis T. The Central Sensitization Inventory Measures Thoughts and Emotions. J Patient Exp 2024; 11:23743735241273589. [PMID: 39148748 PMCID: PMC11325304 DOI: 10.1177/23743735241273589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
To determine if the Central Sensitization Inventory questionnaire (CSI) functions as a mental health measure among a cross-section of people seeking musculoskeletal specialty care, we asked: (1) What is the association of CSI total score and item groupings identified in factor analysis with mental health measures? and (2) What is the association between specific CSI items that represent each factor well and specific mental health measures? One hundred and fifty-seven adults seeking specialty care for musculoskeletal symptoms completed the CSI, a measure of catastrophic thinking, and 3 measures of distress (symptoms of health anxiety, general anxiety, and depression). Exploratory factor analysis was used to identify item groupings. Exploratory factor analysis identified 4 item groupings (factors): (1) thoughts and feelings (mental health), accounting for 52% of the variation in the CSI, (2) urinary and visual symptoms (15%) (3) body aches (10%), and (4) jaw pain (8.1%). More than half the variation in both the CSI total score (51%) and the thoughts and feelings factor (57%) were accounted for by variation in measures of catastrophic thinking and distress. Specific items that account for large amounts of the variation in the CSI also had notable correlations with mental health measures. The strong relationship between the CSI and thoughts and emotions suggests that the CSI functions largely as a mental health measure. If the concept of central sensitization is to help people get and stay healthy, it will depend on evidence that central sensitization can be measured and quantified distinct from mental health.
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Affiliation(s)
- Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Marielle Ngoue
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Teun Teunis
- Department of Orthopaedic Surgery, University Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang B, Xiao Q, Gu J, Ma Q, Han L. A qualitative study on the disease coping experiences of pancreatic cancer patients and their spouses. Sci Rep 2024; 14:18626. [PMID: 39128911 PMCID: PMC11317503 DOI: 10.1038/s41598-024-69599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 08/07/2024] [Indexed: 08/13/2024] Open
Abstract
Cancer affects patients as well as their spouses. Patients and their spouses use different strategies to cope with cancer and the associated burden. This study aimed to gain a deeper and more differentiated understanding of support systems for patients and their spouses. This was an exploratory qualitative study conducted in China. The study was based on 20 semistructured face-to-face interviews. Ten pancreatic cancer patients and their spouses were interviewed. The interviews took place at a tertiary hospital from June 2023 to December 2023. The data were analysed using thematic analysis according to Braun and Clarke's methodology. This study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Twenty participants of different ages (patients: range = 49-75 years; spouses: range = 47-73 years) participated. Patients with different cancer stages (e.g., potentially resectable, borderline resectable, locally advanced) and cancer types (initial diagnosis or relapse) participated in the study. Five themes emerged from the data, namely, denial and silence, fear and worry, struggle, coping strategies and cherishing the present. Active dyadic coping is conducive to promoting disease adaptation, and spouses seem to need more psychological support to improve their own well-being. Health care providers should pay attention to pancreatic cancer patients and their spouses in terms of five themes: denial and silence, fear and worry, struggle, coping strategies and cherishing the present. Future studies should use a combination of qualitative and quantitative methods to explore dyadic coping in greater depth.
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Affiliation(s)
- Bo Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Qigui Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jingtao Gu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Qingyong Ma
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Liang Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China.
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Jin X, Dong S, Yang Y, Bao G, Ma H. Nominating novel proteins for anxiety via integrating human brain proteomes and genome-wide association study. J Affect Disord 2024; 358:129-137. [PMID: 38697224 DOI: 10.1016/j.jad.2024.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/04/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The underlying pathogenesis of anxiety remain elusive, making the pinpointing of potential therapeutic and diagnostic biomarkers for anxiety paramount to its efficient treatment. METHODS We undertook a proteome-wide association study (PWAS), fusing human brain proteomes from both discovery (ROS/MAP; N = 376) and validation cohorts (Banner; N = 152) with anxiety genome-wide association study (GWAS) summary statistics. Complementing this, we executed transcriptome-wide association studies (TWAS) leveraging human brain transcriptomic data from the Common Mind Consortium (CMC) to discern the confluence of genetic influences spanning both proteomic and transcriptomic levels. We further scrutinized significant genes through a suite of methodologies. RESULTS We discerned 14 genes instrumental in the genesis of anxiety through their specific cis-regulated brain protein abundance. Out of these, 6 were corroborated in the confirmatory PWAS, with 4 also showing associations with anxiety via their cis-regulated brain mRNA levels. A heightened confidence level was attributed to 5 genes (RAB27B, CCDC92, BTN2A1, TMEM106B, and DOC2A), taking into account corroborative evidence from both the confirmatory PWAS and TWAS, coupled with insights from mendelian randomization analysis and colocalization evaluations. A majority of the identified genes manifest in brain regions intricately linked to anxiety and predominantly partake in lysosomal metabolic processes. LIMITATIONS The limited scope of the brain proteome reference datasets, stemming from a relatively modest sample size, potentially curtails our grasp on the entire gamut of genetic effects. CONCLUSION The genes pinpointed in our research present a promising groundwork for crafting therapeutic interventions and diagnostic tools for anxiety.
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Affiliation(s)
- Xing Jin
- Department of Laboratory Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Shuangshuang Dong
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Yang Yang
- Department of Laboratory Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guangyu Bao
- Department of Laboratory Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
| | - Haochuan Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Hospital of Chinese Medicine Postdoctoral Research Workstation, Guangzhou, Guangdong, China.
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Zainal NH, Soh CP, Van Doren N. Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis. J Affect Disord 2024; 358:138-149. [PMID: 38663555 PMCID: PMC11283637 DOI: 10.1016/j.jad.2024.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School, Department of Health Care Policy, United States of America; National University of Singapore, Department of Psychology, Singapore.
| | - Chui Pin Soh
- National University of Singapore, Department of Psychology, Singapore
| | - Natalia Van Doren
- University of California at San Francisco, Department of Psychiatry and Behavioral Sciences, United States of America
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Ebrahimi OV, Asmundson GJG. Scaling up psychological interventions into the daily lives of patients with anxiety and related disorders. J Anxiety Disord 2024; 106:102916. [PMID: 39178811 DOI: 10.1016/j.janxdis.2024.102916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Affiliation(s)
- Omid V Ebrahimi
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
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Reis A, Westhoff M, Quintarelli H, Hofmann SG. Mindfulness as a therapeutic option for obsessive-compulsive disorder. Expert Rev Neurother 2024; 24:735-741. [PMID: 38889066 DOI: 10.1080/14737175.2024.2365945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a prevalent mental health issue characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that can cause significant life impairment. Despite cognitive-behavioral therapy (CBT) being the most effective treatment, some individuals experience insufficient symptom reduction or relapse. AREAS COVERED This special report explores the potential of mindfulness-based interventions as complementary treatments for OCD, examining the specific techniques used and their practical application. In the initial section, the authors examine ten randomized control trial studies included in the meta-analysis conducted by Chien et al. (2022), demonstrating the effectiveness of mindfulness interventions. The authors focus on elucidating the specific mindfulness techniques used in these studies. Then, the authors discuss the integration of these mindfulness strategies into CBT, focusing on enhancing emotional regulation, cognitive flexibility, and acceptance of intrusive thoughts. EXPERT OPINION While mindful based interventions (MBIs) show promise as adjunctive treatments for OCD, variability in OCD symptoms and treatment responses necessitate individualized therapeutic approaches. Further research is required to refine mindfulness-based techniques and optimize their effectiveness. Incorporating MBIs into standard CBT protocols may improve outcomes for patients with persistent OCD symptoms.
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Affiliation(s)
- Andreas Reis
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Marlon Westhoff
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Hicham Quintarelli
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Stefan G Hofmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
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Epe-Jungeblodt F, Pauli P, Schwab F, Andreatta M. Trauma history and course of therapy in a naturalistic cognitive behavior therapy outpatient sample: An archive data study. J Clin Psychol 2024; 80:1937-1948. [PMID: 38747513 DOI: 10.1002/jclp.23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/20/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety and depression disorders. Nonetheless, nearly 50% of all patients do not respond. Besides other factors, nonresponse may be linked to traumatic life events. This study aims to assess the relationship between trauma history, applied therapy interventions, and therapy outcomes. METHODS We analyzed data from 340 CBT outpatients diagnosed with a depression or anxiety disorder and possibly a trauma history treated under naturalistic conditions. Based on their therapy files, we collected information on trauma history, diagnoses, applied interventions, and severity of depression and anxiety symptoms at the start and end of therapy. The relationship between trauma, diagnoses, and intervention use and the development of depression and anxiety symptoms was analyzed using Linear Mixed Models. RESULTS Patients with a trauma history reported higher pre- and posttreatment symptom severity than those without trauma. No differences in applied interventions or decrease in symptom severity were found between patients with and without a trauma history. Specialized interventions were seldom applied. CONCLUSION Although no differences between patients with and without a trauma history were found in therapy response, patients with a trauma history maintained higher levels of symptom severity. These results indicate a need for more personalized interventions and evidence-based guidelines to personalize CBT for patients with a trauma history and high symptom severity.
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Affiliation(s)
- Franziska Epe-Jungeblodt
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Frank Schwab
- Department of Media Psychology, Institute Human-Computer-Media, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Marta Andreatta
- Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Bress JN, Falk A, Schier MM, Jaywant A, Moroney E, Dargis M, Bennett SM, Scult MA, Volpp KG, Asch DA, Balachandran M, Perlis RH, Lee FS, Gunning FM. Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2428372. [PMID: 39163044 PMCID: PMC11337073 DOI: 10.1001/jamanetworkopen.2024.28372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/21/2024] [Indexed: 08/21/2024] Open
Abstract
Importance Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement. Objective To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions. Design, Setting, and Participants This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024. Intervention Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support). Main Outcomes and Measures The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures. Results The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition. Conclusions and Relevance In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions. Trial Registration ClinicalTrials.gov Identifier: NCT05130281.
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Affiliation(s)
- Jennifer N. Bress
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Avital Falk
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Maddy M. Schier
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Elizabeth Moroney
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Monika Dargis
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | | | - Matthew A. Scult
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Kevin G. Volpp
- Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Associate Editor, JAMA Network Open
| | - Francis S. Lee
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
- Associate Editor, JAMA Network Open
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Rosenberg BM, Barnes-Horowitz NM, Zbozinek TD, Craske MG. Reward processes in extinction learning and applications to exposure therapy. J Anxiety Disord 2024; 106:102911. [PMID: 39128178 PMCID: PMC11384290 DOI: 10.1016/j.janxdis.2024.102911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024]
Abstract
Anxiety disorders are common and highly distressing mental health conditions. Exposure therapy is a gold-standard treatment for anxiety disorders. Mechanisms of Pavlovian fear learning, and particularly fear extinction, are central to exposure therapy. A growing body of evidence suggests an important role of reward processes during Pavlovian fear extinction. Nonetheless, predominant models of exposure therapy do not currently incorporate reward processes. Herein, we present a theoretical model of reward processes in relation to Pavlovian mechanisms of exposure therapy, including a focus on dopaminergic prediction error signaling, coinciding positive emotional experiences (i.e., relief), and unexpected positive outcomes. We then highlight avenues for further research and discuss potential strategies to leverage reward processes to maximize exposure therapy response, such as pre-exposure interventions to increase reward sensitivity or post-exposure rehearsal (e.g., savoring, imaginal recounting strategies) to enhance retrieval and retention of learned associations.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Nora M Barnes-Horowitz
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Tomislav D Zbozinek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Matsumoto K, Hamatani S, Shiga K, Iiboshi K, Kasai M, Kimura Y, Yokota S, Watanabe K, Kubo Y, Nakamura M. Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial. JMIR Pediatr Parent 2024; 7:e55786. [PMID: 39037759 DOI: 10.2196/55786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. OBJECTIVE This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. METHODS A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. RESULTS In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. CONCLUSIONS The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. TRIAL REGISTRATION UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035.
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Affiliation(s)
- Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Hospital, Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Kiko Shiga
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Kiyoko Iiboshi
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Makiko Kasai
- Clinical Psychology Course, Naruto University of Education, Tokushima, Japan
| | - Yasuhiro Kimura
- Department of Welfare Psychology, Faculty of Welfare, Fukushima College, Fukushima, Japan
| | | | | | - Yoko Kubo
- Graduate School of Clinical Psychology, Kagoshima University, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Wang Z, Cao Z, Min J, Duan T, Xu C. Associations between device-measured and self-reported physical activity and common mental disorders: Findings from a large-scale prospective cohort study. BMJ Evid Based Med 2024:bmjebm-2024-112933. [PMID: 38997150 DOI: 10.1136/bmjebm-2024-112933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES To investigate the associations between device-measured and self-reported physical activity (PA) and incident common mental disorders in the general population. DESIGN AND SETTING Large-scale prospective cohort study. PARTICIPANTS Using the UK Biobank data, a validated PA questionnaire was used to estimate self-reported weekly PA in 365 656 participants between 2006 and 2010 while 91 800 participants wore wrist-worn accelerometers for 7 days in 2013-2015 to derive objectively measured PA. All the participants were followed up until 2021. MAIN OUTCOME MEASURES Incidences of depression and anxiety were ascertained from hospital inpatient records. Cox proportional hazards models and restricted cubic splines were used to assess the associations between subjectively and objectively measured PA and common mental disorders. RESULTS During a median follow-up of 12.6 years, 16 589 cases of depression, 13 905 cases of anxiety and 5408 cases of comorbid depression and anxiety were documented in the questionnaire-based cohort. We found J-shaped associations of self-reported PA with incident risk of depression and anxiety, irrespective of PA intensities. The lowest risk for depression occurred at 550, 390, 180 and 560 min/week of light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) and moderate-to-vigorous PA (MVPA), respectively. During a median follow-up of 6.9 years, a total of 2258 cases of depression, 2166 cases of anxiety and 729 cases of comorbid depression and anxiety were documented in the accelerometer-based cohort. We found L-shaped associations of device-measured MPA and VPA with incident depression and anxiety. MPA was adversely associated with incident depression and anxiety until 660 min/week, after which the associations plateaued. The point of inflection for VPA occurred at 50 min/week, beyond which there was a diminished but continued reduction in the risks of depression and anxiety. CONCLUSION Different patterns of associations between self-reported and device-measured PA and mental health were observed. Future PA guidelines should fully recognise this inconsistency and increasingly employ objectively measured PA standards.
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Affiliation(s)
- Zhe Wang
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Zhi Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahao Min
- School of Public Health, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Tingshan Duan
- School of Public Health, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Chenjie Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, People's Republic of China
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Gruner NG, Cullen JM, Crosby JM, DeCross SN, Mathes B, Garner L, Gironda C, Hu Y, Krompinger JW, Elias JA, Twohig MP. Investigating an Acceptance and Commitment Therapy-Based Exposure Therapy Intervention in Treatment-Refractory OCD and Related Disorders: Changes in Psychological Flexibility, Treatment Engagement, and Treatment Perceptions. J Cogn Psychother 2024; 38:255-272. [PMID: 38991743 DOI: 10.1891/jcp-2022-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
While exposure therapy is the most effective psychological treatment for obsessive-compulsive disorder (OCD), anxiety, and traumatic stress-related disorders, it is not universally effective, indicating a need for further treatment optimization. This study investigated a shift in approach to exposure therapy with 29 treatment-refractory adults in an OCD clinic not responding to standard treatment, comprising habituation-based exposure therapy. Participants completed standard exposure as a continuation of standard clinic treatment, followed by an acceptance and commitment therapy (ACT) consultation session to assess psychological inflexibility processes interfering with treatment progress, and then an ACT-based exposure targeting behavior change through increasing psychological flexibility. After each exposure, participants and independent raters reported levels of psychological flexibility, rituals, distress, treatment engagement, and treatment perceptions. We observed that the shift to ACT-based exposure was associated with greater psychological flexibility, treatment engagement, treatment acceptability, and treatment preference. These findings suggest that there may be situations where ACT-based exposure has particular utility.
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Affiliation(s)
- Nate G Gruner
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jenifer M Cullen
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jesse M Crosby
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | | | - Brittany Mathes
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Lauryn Garner
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Christina Gironda
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Yuanjun Hu
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jason W Krompinger
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jason A Elias
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Hauck A, Michael T, Issler TC, Klein S, Lass-Hennemann J, Ferreira de Sá DS. Can glucose facilitate fear exposure? Randomized, placebo-controlled trials on the effects of glucose administration on fear extinction processes. Behav Res Ther 2024; 178:104553. [PMID: 38728832 DOI: 10.1016/j.brat.2024.104553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
Previous studies showed that glucose has beneficial effects on memory function and can enhance contextual fear learning. To derive potential therapeutic interventions, further research is needed regarding the effects of glucose on fear extinction. In two experimental studies with healthy participants (Study 1: N = 68, 39 females; Study 2: N = 89, 67 females), we investigated the effects of glucose on fear extinction learning and its consolidation. Participants completed a differential fear conditioning paradigm consisting of acquisition, extinction, and return of fear tests: reinstatement, and extinction recall. US-expectancy ratings, skin conductance response (SCR), and fear potentiated startle (FPS) were collected. Participants were pseudorandomized and double-blinded to one of two groups: They received either a drink containing glucose or saccharine 20 min before (Study 1) or immediately after extinction (Study 2). The glucose group showed a significantly stronger decrease in differential FPS during extinction (Study 1) and extinction recall (Study 2). Additionally, the glucose group showed a significantly lower contextual anxiety at test of reinstatement (Study 2). Our findings provide first evidence that glucose supports the process of fear extinction, and in particular the consolidation of fear extinction memory, and thus has potential as a beneficial adjuvant to extinction-based treatments. Registered through the German Clinical Trials Registry (https://www.bfarm.de/EN/BfArM/Tasks/German-Clinical-Trials-Register/_node.html; Study 1: DRKS00010550; Study 2: DRKS00018933).
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Affiliation(s)
- Alexander Hauck
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tobias C Issler
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Steven Klein
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Diana S Ferreira de Sá
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
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Gu J, Wang H, Pei J, Meng J, Song Y. The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study. Nurs Crit Care 2024; 29:672-681. [PMID: 37922250 DOI: 10.1111/nicc.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND The patient's spouse, in their role as the primary caregiver, assumes responsibility for the patient's care during the recovery process and provides the most robust social support. Previous research has primarily focused on the coping experiences and thoughts of individual intensive care unit (ICU) patients or caregivers, with limited attention afforded to the relationship between patients and their spouses. AIMS This study aims to explore the dyadic coping experiences of ICU transfer patients and their spouses, with the goal of providing evidence to support the subsequent development of an individualized intervention program. STUDY DESIGN A qualitative study using a phenomenological research approach was undertaken. Purposive sampling was employed to select participants for face-to-face semi-structured in-depth interviews. The interviews took place at a tertiary general hospital in Nanjing from January 2023 to February 2023.Twelve ICU transfer patients and their twelve spouses were interviewed. The data were then summarized, and themes were derived using the Colaizzi 7-step analysis method. FINDINGS A total of four themes and eleven sub-themes emerged from the analysis. The identified themes include positive coping (actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (a lack of information, high physical and psychological stress, and significant financial burden), and needs and suggestions (strengthening transition care, fostering increased intimacy, and reducing negative emotions). CONCLUSION Both patients and spouses experience physical and psychological stress during the transfer from the ICU to the ward. Therefore, any intervention developed for caregivers should be designed in a dyadic manner. Increasing dyadic coping skills may represent an important area for future research and intervention. RELEVANCE TO CLINICAL PRACTICE This study provides valuable evidence to inform the formulation of a comprehensive dual disease management plan for ICU transfer patients and their spouses.
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Affiliation(s)
- Jiayi Gu
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - He Wang
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jiaqin Pei
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jingyu Meng
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Yan Song
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Depatment of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medcine, Nanjing, China
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Levy HC, Mullins J, Tolin DF. An investigation of the role of estradiol in fear reduction during a single session of exposure therapy. Cogn Behav Ther 2024; 53:364-376. [PMID: 38299480 DOI: 10.1080/16506073.2024.2313743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
Research suggests that estradiol may moderate fear extinction. It is unclear whether these results generalize to exposure therapy. The aim of the current study was to determine whether estradiol moderates outcomes in exposure therapy among women with anxiety disorders. Participants were 35 women with a primary diagnosis of an anxiety disorder who participated in the study as part of routine care at an anxiety specialty clinic. Endogenous estradiol was assessed via saliva. They provided subjective distress ratings before (pre) and after (post) an exposure session, as well as after a brief delay (recall). Contrary to predictions, there were no significant differences in exposure outcomes between the high and low estradiol groups. However, among participants with primary obsessive-compulsive disorder (OCD), results were partially consistent with the hypotheses. Women with lower estradiol initially demonstrated more improvement in subjective distress from pre- to post-exposure, but after the delay, significantly greater distress (attenuated extinction recall). Results suggest that women with lower estradiol may respond less favorably to exposure therapy for OCD relative to women with higher estradiol. These findings await replication in larger samples with longer recall delays. Should replication occur, these results may inform the use of estradiol to augment exposure therapy.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT 06106, USA
| | - Jessica Mullins
- Department of Obstetrics and Gynecology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06106, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT 06106, USA
- Yale University School of Medicine, 333 Cedar Street New, Haven, CT 06510, USA
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Malivoire BL, Stewart KE, Cameron D, Rowa K, McCabe RE. Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting. Behav Cogn Psychother 2024; 52:440-455. [PMID: 38291658 DOI: 10.1017/s1352465823000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an empirically supported treatment for generalized anxiety disorder (GAD). Little is known about the effectiveness of CBT for GAD in real-world treatment settings. AIM This study investigated the effectiveness of group CBT and predictors of treatment response in an out-patient hospital clinic. METHOD Participants (n = 386) with GAD participated in 12 sessions of group CBT at an out-patient clinic. Of those who provided at least partial data (n = 326), 84.5% completed treatment. Most questionnaires were completed at pre- and post-treatment; worry severity was assessed weekly. RESULTS Group CBT led to improvements in chronic worry (d = -0.91, n = 118), depressive symptoms (d = -1.22, n = 172), GAD symptom severity (d = -0.65, n = 171), intolerance of uncertainty (IU; d = -0.46, n = 174) and level of functional impairment (d = -0.35, n = 169). Greater pre-treatment GAD symptom severity (d = -0.17, n = 293), chronic worry (d = -0.20, n = 185), functional impairment (d = -0.12, n = 292), and number of comorbid diagnoses (d = -0.13, n = 299) predicted greater improvement in past week worry over treatment. Biological sex, age, depression symptom severity, number of treatment sessions attended, and IU did not predict change in past week worry over time. DISCUSSION These findings provide support for the effectiveness of group CBT for GAD and suggest the outcomes are robust and are either not impacted or are slightly positively impacted by several demographic and clinical factors.
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Affiliation(s)
- B L Malivoire
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - K E Stewart
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - D Cameron
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - K Rowa
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - R E McCabe
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Zhong W, Luo J, Zhang H. The therapeutic effectiveness of artificial intelligence-based chatbots in alleviation of depressive and anxiety symptoms in short-course treatments: A systematic review and meta-analysis. J Affect Disord 2024; 356:459-469. [PMID: 38631422 DOI: 10.1016/j.jad.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The emergence of artificial intelligence-based chatbot has revolutionized the field of clinical psychology and psychotherapy, granting individuals unprecedented access to professional assistance, overcoming time constraints and geographical limitations with cost-effective convenience. However, despite its potential, there has been a noticeable gap in the literature regarding their effectiveness in addressing common mental health issues like depression and anxiety. This meta-analysis aims to evaluate the efficacy of AI-based chatbots in treating these conditions. METHODS A systematic search was executed across multiple databases, including PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase on April 4th, 2024. The effect size of treatment efficacy was calculated using the standardized mean difference (Hedge's g). Quality assessment measures were implemented to ensure trial's quality. RESULTS In our analysis of 18 randomized controlled trials involving 3477 participants, we observed noteworthy improvements in depression (g = -0.26, 95 % CI = -0.34, -0.17) and anxiety (g = -0.19, 95 % CI = -0.29, -0.09) symptoms. The most significant benefits were evident after 8 weeks of treatment. However, at the three-month follow-up, no substantial effects were detected for either condition. LIMITATIONS Several limitations should be considered. These include the lack of diversity in the study populations, variations in chatbot design, and the use of different psychotherapeutic approaches. These factors may limit the generalizability of our findings. CONCLUSION This meta-analysis highlights the promising role of AI-based chatbot interventions in alleviating depressive and anxiety symptoms among adults. Our results indicate that these interventions can yield substantial improvements over a relatively brief treatment period.
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Affiliation(s)
- Wenjun Zhong
- Center for Studies of Education and Psychology of Ethnic Minorities in Southwest China, Southwest University, Chongqing, China
| | - Jianghua Luo
- Center for Studies of Education and Psychology of Ethnic Minorities in Southwest China, Southwest University, Chongqing, China.
| | - Hong Zhang
- Center for Psychological Health Education, Xinjiang University of Finance & Economics, Urumqi, Xinjiang, China
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22
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Ortiz C, Fastman M. A novel independence intervention to treat child anxiety: A nonconcurrent multiple baseline evaluation. J Anxiety Disord 2024; 105:102893. [PMID: 38901131 DOI: 10.1016/j.janxdis.2024.102893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge, 2023). Exposure-based cognitive-behavioral therapy is the gold standard in the treatment of anxious children (Hofmann et al. (2012)). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child anxiety composed of independence activities (IAs), which are child-directed, fun, unstructured, developmentally challenging tasks performed without parents' help. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy. Despite this dissimilarity, IAs target putative mechanisms involved in the development and maintenance of child anxiety (e.g., parental accommodation and overinvolvement, child avoidance, unhelpful thinking styles). Using a nonconcurrent multiple baseline design, this five-session treatment provided preliminary evidence of high treatment acceptability from children and parents. Medium to large improvements were reported in child anxiety and avoidance, parent and child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness. Results may suggest a new treatment paradigm, which is desperately needed, given unabated increases in child and adolescent anxiety despite vast resources being directed toward the problem.
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Affiliation(s)
- Camilo Ortiz
- Department of Psychology, Long Island University-Post, USA.
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23
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Fennig M, Agali U, Looby M, Gilbert K. Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study. Am J Psychother 2024; 77:46-54. [PMID: 38507336 PMCID: PMC11325626 DOI: 10.1176/appi.psychotherapy.20230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Disorders related to overcontrol frequently first appear during adolescence, are highly comorbid, and show limited treatment response, necessitating the adaptation of radically open dialectical behavior therapy (RO DBT; a transdiagnostic treatment targeting overcontrol) for adolescents (RO DBT-A). This study tested the preliminary efficacy of telehealth-delivered RO DBT-A in a heterogeneous clinical sample of youths. METHODS The sample consisted of 20 female participants ages 13-21 with elevated overcontrol; most were White (75%) and non-Hispanic/Latino (80%). RO DBT-A was provided over 20 weeks via skills group and individual sessions (N=13 participants). Participants seeking other treatment or no treatment formed the control group (N=7). Outcomes included self-reported symptoms and overcontrol. Follow-up interviews were analyzed by using inductive, contextualist thematic analysis to examine participant perceptions and reasons for dropout. RESULTS The RO DBT-A group showed significant improvements in depression (t=-1.78, df=10, p=0.011) and quality of life (QOL; Wilcoxon W=75, p=0.021) compared with the control group. From baseline to posttreatment, youths receiving RO DBT-A demonstrated significant improvements in maladaptive overcontrol (t=2.76, df=12, p=0.043), anxiety (t=2.91, df=12, p=0.043), depression (Wilcoxon signed rank V=82.5, p=0.043), and QOL (t=-3.01, df=12, p=0.043). Qualitative analysis revealed themes related to treatment barriers, facilitators, and timing. CONCLUSIONS The findings provide preliminary evidence supporting telehealth-delivered RO DBT-A in targeting overcontrol, decreasing symptomatology, and improving QOL in a heterogeneous clinical sample of youths. Qualitative follow-ups highlighted that dropout was driven by barriers related to therapy (e.g., structure- and therapist-related issues) and the timing of RO DBT-A compared with other treatments.
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Affiliation(s)
- Molly Fennig
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Uchechukwu Agali
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Melinda Looby
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Kirsten Gilbert
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
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24
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Chin P, Gorman F, Beck F, Russell BR, Stephan KE, Harrison OK. A systematic review of brief respiratory, embodiment, cognitive, and mindfulness interventions to reduce state anxiety. Front Psychol 2024; 15:1412928. [PMID: 38933581 PMCID: PMC11203600 DOI: 10.3389/fpsyg.2024.1412928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Anxiety is one of the most prevalent mental health conditions worldwide, and psychotherapeutic techniques can be employed to help manage and mitigate symptoms. While the available therapies are numerous, key strategies often involve cognitive and/or embodiment techniques. Within body-centered methods, breathing-oriented approaches are particularly prevalent, using either attention towards or active control of breathing. As the perception of body states (i.e., interoception) is thought to be an integral component of emotion generation, these embodiment and breathing techniques may be key in addressing the miscommunication between the brain and body that is thought to exist with anxiety. Therefore, we conducted a systematic review and meta-analysis to assess the effects of acute administration of psychological interventions for state anxiety. Results This systematic review was conducted in accordance with the PRISMA statement and registered prospectively in PROSPERO. A literature search for randomized controlled trials was conducted in PubMed, PsycINFO, and Scopus. We considered interventions that focused on cognitive, embodiment or breathing strategies, or a combination of these techniques. Twelve studies met our inclusion criteria, and study characteristics, quality and effect sizes were assessed. A single cognitive study was found to produce a moderate reduction in state anxiety, while moderate to large effects were found across studies assessing embodiment practices. In contrast, studies which utilized breathing-based interventions alone produced inconsistent results, with both attention towards and active control of breathing producing large to no effects depending on the technique employed. Finally, consistent moderate effects were found with combination techniques that involved passive attention (e.g., towards cognitions, body and/or breathing), with active combination techniques producing inconsistent results. Discussion While study numbers are limited regarding brief interventions, cognitive and embodiment techniques are consistently helpful for reducing state anxiety, while breathing-based exercises need to consider the specific technique employed, and how successful this may be for each individual. Furthermore, combined practices such as mindfulness can also be successful, although care must be taken when introducing an active change to one or more elements. PROSPERO Systematic Review Registration Number CRD42024507585 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024507585.
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Affiliation(s)
- Phoebe Chin
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Faye Gorman
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Ngāpuhi, New Zealand
- Ngāti Kahu, New Zealand
| | - Fraser Beck
- Ngāi Tahu, New Zealand
- Optimal Health Model Ltd., Glenorchy, New Zealand
| | | | - Klaas E. Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
| | - Olivia K. Harrison
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
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25
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Trenoska Basile V, Newton-John T, McDonald S, Wootton BM. Internet videoconferencing delivered cognitive behaviour therapy for generalized anxiety disorder: A randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 38860620 DOI: 10.1111/bjc.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual and societal burden. Cognitive-behaviour therapy (CBT) therapy is an effective treatment for GAD, however, many individuals experience logistical barriers when accessing evidence-based care. Remote treatments may help to reduce these barriers, however, currently, there are few studies examining the efficacy of high-intensity remote methods for GAD treatment. The current study aims to examine the efficacy of CBT delivered via videoconferencing (VCBT) for GAD using a randomized controlled trial design comparing an immediate treatment group to a waitlist control. METHOD Seventy-eight adults (Mage = 36.92; SD = 12.92; 84.4% female) with GAD were enrolled in the study. RESULTS Those in the treatment group demonstrated a statistically significant reduction in GAD symptoms from pre-treatment to post-treatment (d = 1.03) and pre-treatment to 3-month follow-up (d = 1.50). Large between-group effect sizes were also observed at post-treatment (d = .80). Twenty-five participants (64.10%) in the VCBT group no longer met diagnostic criteria for GAD at post-treatment, and 26/39 (66.67%) no longer met criteria at 3-month follow-up. Ninety-six per cent of participants were satisfied with the treatment. CONCLUSION The results contribute towards advancing our knowledge on the efficacy and acceptability of VCBT for patients with GAD.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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26
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Racz JI, Bialocerkowski A, Calteaux I, Farrell LJ. Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review. Clin Child Fam Psychol Rev 2024; 27:317-341. [PMID: 38630196 PMCID: PMC11222222 DOI: 10.1007/s10567-024-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.
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Affiliation(s)
- J I Racz
- School of Applied Psychology, Griffith University, Southport, QLD, Australia.
| | | | - I Calteaux
- School of Applied Psychology, Griffith University, Southport, QLD, Australia
| | - L J Farrell
- School of Applied Psychology, Griffith University, Southport, QLD, Australia
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27
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Smits JAJ, Abramowitz JS, Arch JJ, Papini S, Anderson RA, Dixon LJ, Graham BM, Hofmann SG, Hoyer J, Huppert JD, Jacquart J, Johnson D, McEvoy PM, McKay D, Newby J, Otto MW, Pittig A, Rief W, Rosenfield D, Timpano KR, Wannemüller A. Improving Exposure Therapy: Rationale and Design of an International Consortium. Psychiatr Clin North Am 2024; 47:433-444. [PMID: 38724129 PMCID: PMC11082449 DOI: 10.1016/j.psc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, this article describes the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team science and larger-scale collaborative research in this area. Clinical working groups have begun to identify opportunities to enhance access to helpful resources for implementing exposure therapy effectively. This article discusses directions for expanding the consortium's activities and its impact on a global scale.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, 1 University Station, Mail Code A8000, Austin, TX 78712, USA.
| | - Jonathan S Abramowitz
- Department of Psychology, The University of North Carolina at Chapel Hill, Campus Box 3270, Chapel Hill, NC 27599, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96822, USA
| | - Rebecca A Anderson
- School of Population Health and enAble Institute, Curtin University, Bentley, Western Australia, 6102 Australia
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS 38677, USA
| | - Bronwyn M Graham
- School of Psychology, UNSW Sydney, New South Wales 2052 Australia
| | - Stefan G Hofmann
- Department of Psychology, University of Marburg, Marburg 35032, Germany
| | | | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905 Israel
| | - Jolene Jacquart
- Department of Psychology, The University of Arizona, 1503 E. University Boulevard, Tucson, AZ 85721, USA
| | - David Johnson
- Department of Psychological & Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia 6000, Australia
| | - Dean McKay
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458-5198, USA
| | - Jill Newby
- School of Psychology, UNSW Sydney at the Black Dog Institute, Hospital Road, Randwick, New South Wales 2031, Australia
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA 02215, USA
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Germany
| | - Winfried Rief
- Department of Psychology, University of Marburg, 35032 Marburg, Germany
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6425 Boaz Lane, Dallas TX 75205, USA
| | - Kiara R Timpano
- Department of Psychology, The University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr University Bochum, Massenbergstr. 9-13, Bochum 44787, Germany
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Morrison AS, Goldin PR, Gross JJ. Fear of negative and positive evaluation as mediators and moderators of treatment outcome in social anxiety disorder. J Anxiety Disord 2024; 104:102874. [PMID: 38754336 DOI: 10.1016/j.janxdis.2024.102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/29/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Elevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined. METHODS This sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up. RESULTS CBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist - higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT. DISCUSSION FNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.
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Affiliation(s)
- Amanda S Morrison
- Department of Psychology, California State University, East Bay, Hayward, CA 94542, USA.
| | - Philippe R Goldin
- UC Davis Medical Center, University of California, Davis, Davis, CA, 95616, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
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Luyten L, Chalkia A, Schnell AE, Özcan B, Leng L, Schroyens N, Van Oudenhove L, Vanpaemel W, Beckers T. No harmful effect of propranolol administered prior to fear memory extinction in rats and humans. J Anxiety Disord 2024; 104:102870. [PMID: 38733644 PMCID: PMC7615999 DOI: 10.1016/j.janxdis.2024.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Exposure therapy is an evidence-based treatment option for anxiety-related disorders. Many patients also take medication that could, in principle, affect exposure therapy efficacy. Clinical and laboratory evidence indeed suggests that benzodiazepines may have detrimental effects. Large clinical trials with propranolol, a common beta-blocker, are currently lacking, but several preclinical studies do indicate impaired establishment of safety memories. Here, we investigated the effects of propranolol given prior to extinction training in 9 rat studies (N = 215) and one human study (N = 72). A Bayesian meta-analysis of our rat studies provided strong evidence against propranolol-induced extinction memory impairment during a drug-free test, and the human study found no significant difference with placebo. Two of the rat studies actually suggested a small beneficial effect of propranolol. Lastly, two rat studies with a benzodiazepine (midazolam) group provided some evidence for a harmful effect on extinction memory, i.e., impaired extinction retention. In conclusion, our midazolam findings are in line with prior literature (i.e., an extinction retention impairment), but this is not the case for the 10 studies with propranolol. Our data thus support caution regarding the use of benzodiazepines during exposure therapy, but argue against a harmful effect of propranolol on extinction learning.
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Affiliation(s)
- Laura Luyten
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Anastasia Chalkia
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Anna Elisabeth Schnell
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Burcu Özcan
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lu Leng
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Natalie Schroyens
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Translational Research in Gastro-Intestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Wolf Vanpaemel
- Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Tom Beckers
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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Kühne F, Hobrecker LK, Heinze PE, Meißner C, Weck F. Exposure therapy tailored to inhibitory learning principles in a naturalistic setting: an open pilot trial in obsessive-compulsive outpatient care. Front Psychol 2024; 15:1328850. [PMID: 38803836 PMCID: PMC11129681 DOI: 10.3389/fpsyg.2024.1328850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps < 0.01). However, individual patients reported some negative effects of therapy. The results underline the value of thorough investigations of novel therapeutic interventions in naturalistic settings.
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Affiliation(s)
- Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
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31
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Masella G, Silva F, Corti E, Azkona G, Madeira MF, Tomé ÂR, Ferreira SG, Cunha RA, Duarte CB, Santos M. The amygdala NT3-TrkC pathway underlies inter-individual differences in fear extinction and related synaptic plasticity. Mol Psychiatry 2024; 29:1322-1337. [PMID: 38233468 PMCID: PMC11189811 DOI: 10.1038/s41380-024-02412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
Fear-related pathologies are among the most prevalent psychiatric conditions, having inappropriate learned fear and resistance to extinction as cardinal features. Exposure therapy represents a promising therapeutic approach, the efficiency of which depends on inter-individual variation in fear extinction learning, which neurobiological basis is unknown. We characterized a model of extinction learning, whereby fear-conditioned mice were categorized as extinction (EXT)-success or EXT-failure, according to their inherent ability to extinguish fear. In the lateral amygdala, GluN2A-containing NMDAR are required for LTP and stabilization of fear memories, while GluN2B-containing NMDAR are required for LTD and fear extinction. EXT-success mice showed attenuated LTP, strong LTD and higher levels of synaptic GluN2B, while EXT-failure mice showed strong LTP, no LTD and higher levels of synaptic GluN2A. Neurotrophin 3 (NT3) infusion in the lateral amygdala was sufficient to rescue extinction deficits in EXT-failure mice. Mechanistically, activation of tropomyosin receptor kinase C (TrkC) with NT3 in EXT-failure slices attenuated lateral amygdala LTP, in a GluN2B-dependent manner. Conversely, blocking endogenous NT3-TrkC signaling with TrkC-Fc chimera in EXT-success slices strengthened lateral amygdala LTP. Our data support a key role for the NT3-TrkC system in inter-individual differences in fear extinction in rodents, through modulation of amygdalar NMDAR composition and synaptic plasticity.
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Affiliation(s)
- Gianluca Masella
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal
| | - Francisca Silva
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal
| | - Elisa Corti
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal
| | - Garikoitz Azkona
- Department of Basic Psychological Processes and Their Development, School of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Maria Francisca Madeira
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal
| | - Ângelo R Tomé
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Samira G Ferreira
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal
| | - Rodrigo A Cunha
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos B Duarte
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Mónica Santos
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.
- Institute of Interdisciplinary Research, University of Coimbra (iiiUC), Coimbra, Portugal.
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.
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Kong Q, Han B. Pharmacotherapy and cognitive bias modification for the treatment of anxiety disorders. Expert Rev Neurother 2024; 24:517-525. [PMID: 38557434 DOI: 10.1080/14737175.2024.2334847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Anxiety disorders are characterized by widespread and persistent anxiety or recurrent panic attacks. As a result of their high prevalence, chronicity, and comorbidity, patients' quality of life and functioning are severely compromised. However, several patients do not receive treatment. AREAS COVERED This review discusses the effectiveness, safety, and limitations of major medications and cognitive bias modification (CBM) for treating anxiety disorders. The possibility of combined treatment is also discussed in the literature. Furthermore, drawing on Chinese cultural perspectives, the authors suggest that anxiety can be recognized, measured, and coped with at three levels of skill (), vision (), and Tao (). EXPERT OPINION The combination of pharmacotherapy and CBM is possibly more effective in treating anxiety disorders than either treatment alone. However, clinicians and patients should participate in the joint decision-making process and consider comprehensive factors. Moderate anxiety has adaptive significance. In the coming years, by combining the downward analytical system of western culture with the upward integrative system of Chinese culture, a comprehensive understanding of anxiety and anxiety disorders should be established, rather than focusing only on their treatment.
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Affiliation(s)
- Qingyan Kong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Buxin Han
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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McHugh RK, Fitzmaurice GM, Votaw VR, Geyer RB, Ragnini K, Greenfield SF, Weiss RD. Cognitive behavioral therapy for anxiety and opioid use disorder: Development and pilot testing. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209296. [PMID: 38272120 PMCID: PMC11060910 DOI: 10.1016/j.josat.2024.209296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/25/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Anxiety disorders are highly prevalent among people with opioid use disorder (OUD), and they have a negative impact on disorder course and treatment outcomes. The objective of this Stage 1 A/1B behavioral treatment development trial was to develop a novel cognitive-behavioral therapy (CBT) protocol for co-occurring anxiety disorders and OUD. METHODS Following a period of iterative manual development involving patient interviews and feedback from content experts, we tested a 12-session individual CBT protocol in a small, open pilot trial (N = 5). This was followed by a small, randomized controlled trial (N = 32), comparing the new protocol to 12 sessions of manualized Individual Drug Counseling. All participants also received medication for OUD. RESULTS Overall, support for feasibility and acceptability was strong, based on recruitment and retention rates and patient satisfaction ratings. Within-subjects results identified 11-point reductions in anxiety symptom severity (on a 0-56 point scale); these gains were sustained through 3 months of follow-up. However, these changes did not differ between randomized conditions. With respect to opioid outcomes, 85 % of participants were abstinent in the prior month at the end of treatment. Opioid use outcomes also did not differ by treatment condition. CONCLUSIONS These results support the feasibility and acceptability of a CBT protocol for co-occurring anxiety and OUD. However, in this small pilot trial results do not show an initial benefit over an evidence-based psychosocial treatment targeted to OUD alone, in combination with medication for OUD.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA.
| | - Garrett M Fitzmaurice
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
| | - Victoria R Votaw
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
| | - Rachel B Geyer
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
| | - Kael Ragnini
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
| | - Shelly F Greenfield
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shuttuck Street, Boston, MA 02115, USA
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Meinke C, Lueken U, Walter H, Hilbert K. Predicting treatment outcome based on resting-state functional connectivity in internalizing mental disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 160:105640. [PMID: 38548002 DOI: 10.1016/j.neubiorev.2024.105640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
Predicting treatment outcome in internalizing mental disorders prior to treatment initiation is pivotal for precision mental healthcare. In this regard, resting-state functional connectivity (rs-FC) and machine learning have often shown promising prediction accuracies. This systematic review and meta-analysis evaluates these studies, considering their risk of bias through the Prediction Model Study Risk of Bias Assessment Tool (PROBAST). We examined the predictive performance of features derived from rs-FC, identified features with the highest predictive value, and assessed the employed machine learning pipelines. We searched the electronic databases Scopus, PubMed and PsycINFO on the 12th of December 2022, which resulted in 13 included studies. The mean balanced accuracy for predicting treatment outcome was 77% (95% CI: [72%- 83%]). rs-FC of the dorsolateral prefrontal cortex had high predictive value in most studies. However, a high risk of bias was identified in all studies, compromising interpretability. Methodological recommendations are provided based on a comprehensive exploration of the studies' machine learning pipelines, and potential fruitful developments are discussed.
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Affiliation(s)
- Charlotte Meinke
- Department of Psychology, Humboldt-Universität zu Berlin, Germany.
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Germany.
| | - Henrik Walter
- Charité Universtätsmedizin Berlin, corporate member of FU Berlin and Humboldt Universität zu Berlin, Department of Psychiatrie and Psychotherapy, CCM, Germany.
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Germany; Department of Psychology, Health and Medical University Erfurt, Germany.
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Schmalbach I, Witthöft M, Strauß B, Joraschky P, Petrowski K. The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder: Extended results of the SOPHONET-Study. Transl Psychiatry 2024; 14:188. [PMID: 38605013 PMCID: PMC11009385 DOI: 10.1038/s41398-024-02882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken -1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts.
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Affiliation(s)
- Ileana Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bernhard Strauß
- Institute for Psychosocial Medicine, Psychotherapy & Psychooncology, University Hospital Jena, Jena, Germany
| | - Peter Joraschky
- University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Dresden University of Technology, Carl Gustav Carus Medical Faculty, Department of General Medicine/MK3, Dresden, Germany
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Tu EN, Manley H, Saunders KEA, Creswell C. Systematic Review and Meta-Analysis: Risks of Anxiety Disorders in Offspring of Parents With Mood Disorders. J Am Acad Child Adolesc Psychiatry 2024; 63:407-421. [PMID: 37453607 DOI: 10.1016/j.jaac.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To examine the risk of anxiety disorders in offspring of parents with mood disorders. METHOD We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors. RESULTS A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders. CONCLUSION Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. STUDY PREREGISTRATION INFORMATION Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.
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Affiliation(s)
- En-Nien Tu
- University of Oxford, United Kingdom; Chang Gung Memorial Hospital, Keelung, Taiwan, and Chang Gung University, Taiwan
| | | | - Kate E A Saunders
- University of Oxford, United Kingdom; Queen's University, Kingston, Canada, and Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Drzewiecki CM, Fox AS. Understanding the heterogeneity of anxiety using a translational neuroscience approach. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:228-245. [PMID: 38356013 PMCID: PMC11039504 DOI: 10.3758/s13415-024-01162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
Anxiety disorders affect millions of people worldwide and present a challenge in neuroscience research because of their substantial heterogeneity in clinical presentation. While a great deal of progress has been made in understanding the neurobiology of fear and anxiety, these insights have not led to effective treatments. Understanding the relationship between phenotypic heterogeneity and the underlying biology is a critical first step in solving this problem. We show translation, reverse translation, and computational modeling can contribute to a refined, cross-species understanding of fear and anxiety as well as anxiety disorders. More specifically, we outline how animal models can be leveraged to develop testable hypotheses in humans by using targeted, cross-species approaches and ethologically informed behavioral paradigms. We discuss reverse translational approaches that can guide and prioritize animal research in nontraditional research species. Finally, we advocate for the use of computational models to harmonize cross-species and cross-methodology research into anxiety. Together, this translational neuroscience approach will help to bridge the widening gap between how we currently conceptualize and diagnose anxiety disorders, as well as aid in the discovery of better treatments for these conditions.
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Affiliation(s)
- Carly M Drzewiecki
- California National Primate Research Center, University of California, Davis, CA, USA.
| | - Andrew S Fox
- California National Primate Research Center, University of California, Davis, CA, USA.
- Department of Psychology, University of California, Davis, CA, USA.
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Chu YC, Wang HH, Chou FH, Hsu YF, Liao KL. Outcomes of trauma-informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2024; 31:203-214. [PMID: 37697899 DOI: 10.1111/jpm.12976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Women are more likely to experience intimate partner violence (IPV) than men; 19.2%-69.0% of women have experienced IPV, and the percentage is increasing. Survivors of IPV suffer from physical, psychological, social and reproductive health problems and numerous adverse health consequences such as post-traumatic stress disorder, depression and anxiety. These are considered IPV comorbidities, especially among women. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study reviews and reinforces existing scientific knowledge regarding the application of trauma-informed care (TIC), including intervention content or type, frequency, duration of session and length. This study focused on the effects of TIC. Furthermore, it examines short-term (3 months) and medium-term (6 months) outcome effects, which are more significant for clinical practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Development of a standardized protocol to address specific needs for TIC in IPV care settings. Among multidisciplinary teams, nurses are the ideal professionals to support women experiencing IPV. They can understand their traumatic experiences better, improve their therapeutic relationships and engage patients in collaborative care. ABSTRACT INTRODUCTION: Post-traumatic stress disorder (PTSD), depression and anxiety are considered intimate partner violence (IPV) comorbidities, especially among women. Trauma-informed care (TIC) is the most common element of IPV care. AIM This study analysed the short-term (3 months) and medium-term (6 months) outcomes of TIC on PTSD, depression and anxiety in women experiencing IPV. METHOD The Preferred Items for Systematic Reviews and Meta-Analysis guidelines were followed, and databases were searched from their inception to September 2022. RESULTS Thirteen randomized controlled trials included 850 women randomly assigned to the TIC and usual care groups. Overall, TIC showed a superior psychological health-improving effect. Depression and anxiety significantly improved after treatment and at three and 6 months. No difference was observed in PTSD between the two groups at 3 and 6 months. DISCUSSION The growing evidence demonstrates that the lack of IPV intervention effects reported by reviews may be due to the attributes of PTSD, heterogeneity of TIC intervention design and components of TIC. Therefore, its clinical efficacy remains inconclusive. IMPLICATIONS FOR PRACTICE We analysed studies by stratifying intervention frequencies of once or twice a week. Regardless of the intervention frequency, length and design, PTSD decreased immediately after the TIC intervention. However, a significant difference in depression was observed after a TIC intervention of above 9 weeks.
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Affiliation(s)
- Yi-Chin Chu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Lin Liao
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Baranoff JA, Clubb B, Coates JM, Elphinston RA, Loveday W, Connor JP. The contribution of pain catastrophizing, depression and anxiety symptoms among patients with persistent pain and opioid misuse behaviours. J Behav Med 2024; 47:342-347. [PMID: 37803191 DOI: 10.1007/s10865-023-00452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Anxiety, depression and pain catastrophizing are independently associated with risk of opioid misuse in patients with persistent pain but their relationship to current opioid misuse, when considered together, is poorly understood. This study will assess the relative contribution of these modifiable, and distinct psychological constructs to current opioid misuse in patients with persistent pain. METHODS One hundred and twenty-seven patients referred to a specialized opioid management clinic for prescription opioid misuse within a tertiary pain service were recruited for this study. The Pain Catastrophizing Scale, Depression, Anxiety and Stress Scales and the Current Opioid Misuse Measure were administered pre-treatment. Pain severity and morphine equivalent dose based on independent registry data were also recorded. RESULTS Higher levels of pain catastrophizing, depression, and anxiety were significantly associated with higher current opioid misuse (r = .475, 0.599, and 0.516 respectively, p < .01). Pain severity was significantly associated with pain catastrophizing (r = .301, p < .01). Catastrophizing, depression, and anxiety explained an additional 11.56% of the variance (R2 change = 0.34, p < .01) over and above age, gender, pain severity and morphine equivalent dose. Depression was the only significant variable at Step 2 (β = 0.62, p < .01). CONCLUSION Findings show that in a sample of people with persistent pain referred for treatment for opioid misuse, depression contributes over and above that of anxiety and pain catastrophizing. Theoretical and clinical practice implications are presented.
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Affiliation(s)
- John A Baranoff
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Bryce Clubb
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- The Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jason M Coates
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Rachel A Elphinston
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - William Loveday
- Monitored Medicines Unit, Queensland Department of Health, Chief Medical Officer and Healthcare Regulation, Brisbane, Australia
| | - Jason P Connor
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Siddiqi S, Philip NS, Palm S, Arulpragasam A, Barredo J, Bouchard H, Ferguson M, Grafman J, Morey R, Fox M, Carreon D. A potential neuromodulation target for PTSD in Veterans derived from focal brain lesions. RESEARCH SQUARE 2024:rs.3.rs-3132332. [PMID: 38562753 PMCID: PMC10984085 DOI: 10.21203/rs.3.rs-3132332/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Neuromodulation trials for PTSD have yielded mixed results, and the optimal neuroanatomical target remains unclear. We analyzed three datasets to study brain circuitry causally linked to PTSD in military Veterans. After penetrating traumatic brain injury (n=193), lesions that reduced probability of PTSD were preferentially connected to a circuit including the medial prefrontal cortex (mPFC), amygdala, and anterolateral temporal lobe (cross-validation p=0.01). In Veterans without lesions (n=180), PTSD was specifically associated with connectivity within this circuit (p<0.01). Connectivity change within this circuit correlated with PTSD improvement after transcranial magnetic stimulation (TMS) (n=20) (p<0.01), even though the circuit was not directly targeted. Finally, we directly targeted this circuit with fMRI-guided accelerated TMS, leading to rapid resolution of symptoms in a patient with severe lifelong PTSD. All results were independent of depression severity. This lesion-based PTSD circuit may serve as a neuromodulation target for Veterans with PTSD.
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Affiliation(s)
- Shan Siddiqi
- Harvard Medical School, Brigham & Women's Hospital
| | - Noah S Philip
- Alpert Medical School of Brown University, Center for Neurorestoration and Neurotechnology, Providence VA Medical Center
| | | | | | | | | | | | | | | | - Michael Fox
- Brigham and Women's Hospital, Harvard Medical School
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Eriksson-Liebon M, Westas M, Johansson P, Mourad G. Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial. BMC Psychiatry 2024; 24:216. [PMID: 38504157 PMCID: PMC10953164 DOI: 10.1186/s12888-024-05661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain. AIMS To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress. METHODS A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety. RESULTS A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up. CONCLUSIONS Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high tendency to avoid activities or situations that they believe could trigger cardiac symptoms may benefit more from psychological interventions targeting cardiac anxiety. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov NCT03336112 on 08/11/2017.
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Affiliation(s)
- Magda Eriksson-Liebon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Emergency Medicine in Norrköping, and, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine in Norrköping, and, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Kutzer Y, Whitehead L, Quigley E, Stanley M. Changes in sleep effort mediate insomnia severity in older adults following online cognitive behavioural therapy. Psychogeriatrics 2024; 24:303-311. [PMID: 38168883 DOI: 10.1111/psyg.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND To examine treatment mechanisms of digitally delivered cognitive behavioural therapy for insomnia (CBT-I), this study assessed the mediating effects of dysfunctional beliefs, hyperarousal, locus of control, self-efficacy, sleep effort, and safety behaviours on self-reported insomnia severity in older adults before and following the completion of a self-guided, online CBT-I program. METHODS The baseline and follow-up measurements were completed by 62 older adults (55 female, 89%). This was a two-condition within-participant design. Mediation analysis using a parallel mediation model was conducted using the MEMORE macro for repeated measure designs. RESULTS Out of all the included mediator variables, only a reduction in sleep effort scores (0.88; SE 0.51; 95% CI 0.001-2.00) significantly mediated changes in insomnia severity scores following the intervention. Insomnia severity scores significantly reduced following the intervention (Mpre = 9.84, SD = 5.89, Mpost = 6.87, SD = 4.90); t(61) = 5.19, P = <0.001; d = 0.55 95% CI 0.38-0.93. CONCLUSIONS Sleep in older adults improved following digitally delivered CBT-I, and these changes were influenced by a reduction in sleep control efforts exerted by participants. These findings highlight possible treatment pathways of CBT-I. Further investigation of CBT-I as a strategy to prevent sleep problems is warranted. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451.
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Affiliation(s)
- Yvonne Kutzer
- Edith Cowan University, Perth, Western Australia, Australia
| | - Lisa Whitehead
- Edith Cowan University, Perth, Western Australia, Australia
| | - Eimear Quigley
- Edith Cowan University, Perth, Western Australia, Australia
- ORS Group, Perth, Western Australia, Australia
| | - Mandy Stanley
- Edith Cowan University, Perth, Western Australia, Australia
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Shinno S, Matsumoto K, Hamatani S, Inaba Y, Ozawa Y, Kawasaki Y, Ikai T, Sutoh C, Hayashi H, Shimizu E. Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial. JMIR Form Res 2024; 8:e53659. [PMID: 38421717 PMCID: PMC10940979 DOI: 10.2196/53659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. OBJECTIVE The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. METHODS In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Working Alliance Inventory-Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. RESULTS Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI -22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI -28.4 to -3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI -50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI -59.7 to -4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. CONCLUSIONS Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439.
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Affiliation(s)
- Seina Shinno
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
| | - Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Yosuke Inaba
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoki Ikai
- Faculty of Medical Sciences, Division of Medicine Primary Health Care, University of Fukui, Fukui, Japan
| | - Chihiro Sutoh
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hiroyuki Hayashi
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
- Department of Emergency and General Medicine, Fukui University Hospital, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Shahid S, Kelson J, Saliba A. Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review. JMIR Ment Health 2024; 11:e48916. [PMID: 38329804 PMCID: PMC10884902 DOI: 10.2196/48916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD. OBJECTIVE The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD. METHODS The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items. RESULTS The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria. CONCLUSIONS The findings showed that VR exposure therapy-based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues. TRIAL REGISTRATION PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891.
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Affiliation(s)
- Simon Shahid
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Joshua Kelson
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Anthony Saliba
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
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Malipeddi S, Mehrotra S, John JP, Kutty BM. Practice and proficiency of Isha Yoga for better mental health outcomes: insights from a COVID-19 survey. Front Public Health 2024; 12:1280859. [PMID: 38371236 PMCID: PMC10869487 DOI: 10.3389/fpubh.2024.1280859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction The COVID-19 pandemic has brought about unparalleled suffering on a global scale, affecting both physical and mental well-being. In such challenging times, it becomes crucial to identify interventions that can alleviate negative mental health outcomes, such as stress, while promoting positive mental health outcomes, like well-being. We report the effectiveness of a mind-body practise, Isha Yoga, in promoting well-being. Methods We conducted an online survey, during the COVID-19 pandemic, with Yoga practitioners (n = 1,352) from the Isha Yoga tradition in Karnataka, India. We evaluated stress and well-being attributes using conventional psychometric questionnaires. Subsequently, we requested the Isha Yoga practitioners to share another survey with their friends and family members, assessing similar outcomes. From the respondents of this shared survey (n = 221), we identified individuals who currently did not engage in any form of Yoga or meditation, constituting the non-Yoga control group (n = 110). To enhance the reliability and validity of our study and minimize the limitations commonly associated with online surveys, we adhered to the CHERRIES guidelines for reporting survey studies. Results Isha Yoga practitioners had significantly lower levels of stress (p < 0.001, gHedges = 0.94) and mental distress (p < 0.001, gHedges = 0.75) while reporting significantly higher levels of well-being (p < 0.001, gHedges = 0.78) and affective balance (p < 0.001, gHedges = 0.80) compared to the control group. Furthermore, expertise-related improvements were observed in these outcomes, and a dose-response relationship was found between regularity of Isha Yoga practice and outcome changes. A minimum 3-4 days of weekly practice showed significant differences with the control group. In addition, we investigated the effect of Isha Yoga on stress and well-being among the healthcare workers (HCWs) in our sample and observed better mental health outcomes. Discussion These findings collectively underscore the benefits of Mind and Body practices like Isha Yoga on various aspects of mental health and well-being, emphasizing its potential as an effective and holistic approach for promoting a healthy lifestyle among diverse populations, including healthcare workers, even in difficult circumstances such as the COVID-19 pandemic.
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Affiliation(s)
- Saketh Malipeddi
- Centre for Consciousness Studies, Department of Neurophysiology, NIMHANS, Bengaluru, Karnataka, India
| | - Seema Mehrotra
- Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - John P. John
- Multi-modal Brain Image Analysis Laboratory, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Bindu M. Kutty
- Centre for Consciousness Studies, Department of Neurophysiology, NIMHANS, Bengaluru, Karnataka, India
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Öst LG, Brattmyr M, Finnes A, Ghaderi A, Havnen A, Hedman-Lagerlöf M, Parling T, Welch E, Wergeland GJ. Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis. Int J Eat Disord 2024; 57:249-264. [PMID: 38098336 DOI: 10.1002/eat.24104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. METHOD Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. RESULTS Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). CONCLUSION CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. PUBLIC SIGNIFICANCE Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Elisabeth Welch
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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47
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Herring MP, Rasmussen CL, McDowell CP, Gordon BR, Kenny RA, Laird E. Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing. Psychiatry Res 2024; 332:115723. [PMID: 38211471 DOI: 10.1016/j.psychres.2024.115723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
The lowest moderate-to-vigorous physical activity (MVPA) dose that conveys protection for Generalized Anxiety Disorder (GAD) and worry is unknown. This study quantified associations of weekly accumulated MVPA doses with GAD and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA). Continuous MVPA (metabolic equivalent of task [MET] minutes per week [MET.min.week-1]; e.g., moderate-intensity brisk walking = 4METs), three-dose and, more precise, five-dose MVPA categories were examined. Worry symptoms and GAD status were measured using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview. Multivariable negative random effect binomial regression and logistic models adjusted for relevant covariates quantified associations across time. Among the 7,650 participants, compared to no MVPA (0 MET.min.week-1), 18 % (OR: 0.82; 95 %CI: [0.69-0.98]), 22 % (OR: 0.78; [ 0.64-0.95]) and 31 % (OR: 0.69; [0.59-0.79]) lower odds of GAD were found for the doses of 1-<600, 600-<1,200 and ≥2,400 MET.min.week-1 respectively. Post-hoc analysis demonstrated 47 % lower odds (OR: 0.53; (0.36-0.78) of GAD for 1-<200 MET.min.week1 compared to inactivity. Compared to no activity, engaging in even minimal physical activity equivalent of 10 min/day for five days/week of moderate-intensity activity (e.g., brisk walking), may lower the risk of GAD over time among older adults.
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Affiliation(s)
- Matthew P Herring
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland.
| | | | | | - Brett R Gordon
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
| | - Eamon Laird
- Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences, University of Limerick, Ireland
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Jacoby RJ, Brown ML, Wieman ST, Rosenfield D, Hoeppner SS, Bui E, Hoge EA, Khalsa SBS, Hofmann SG, Simon NM. Effect of cognitive behavioural therapy and yoga for generalised anxiety disorder on sleep quality in a randomised controlled trial: the role of worry, mindfulness, and perceived stress as mediators. J Sleep Res 2024; 33:e13992. [PMID: 37577773 PMCID: PMC10840983 DOI: 10.1111/jsr.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
Abstract
Sleep disturbances are present in ~65% of individuals with generalised anxiety disorder (GAD). Although both Kundalini yoga (KY) and cognitive behavioural therapy (CBT) are effective treatment options for GAD, little is known about how these treatments compare in improving sleep for GAD and what drives these changes. Accordingly, we examined the effects of CBT, KY, and stress education (SEdu; an attention control condition) on subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity Index [ISI]) in a randomised controlled trial of 226 adults with GAD (mean age 33.37 years; 70% female; 79% White). We hypothesised that both CBT and KY would outperform SEdu in improving sleep disturbances. Three potential mediators of sleep improvement (worry, mindfulness, perceived stress) were also examined. In line with hypotheses, PSQI and ISI scores significantly improved from pre- to post-treatment for all three treatment groups (all p < 0.001, all d > 0.97). However, contrary to predictions, sleep changes were not significantly greater for CBT or KY compared to SEdu. In mediation analyses, within-person deviations in worry, mindfulness, and stress each significantly mediated the effect of time on sleep outcomes. Degree of change in sleep attributable to worry (CBT > KY > SEdu) and perceived stress (CBT, KY > SEdu) was moderated by treatment group. Personalised medicine as well as combined treatment approaches should be studied to help reduce sleep difficulties for patients with GAD who do not respond.
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Affiliation(s)
- Ryan J. Jacoby
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Mackenzie L. Brown
- University of Louisville, Department of Psychology, 2301 S 3rd St, Louisville, KY 40292, USA
| | - Sarah T. Wieman
- Suffolk University, Department of Psychology, 73 Tremont St., Boston, MA 02108, USA
| | - David Rosenfield
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX 75275, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Eric Bui
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France & Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Elizabeth A. Hoge
- Georgetown University Medical Center, Department of Psychiatry, 2115 Wisconsin Ave, NW, Suite 200, Washington, DC, 20007, USA
| | - Sat Bir S. Khalsa
- Brigham and Women’s Hospital / Harvard Medical School, Division of Sleep and Circadian Disorders, Department of Medicine, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Stefan G. Hofmann
- Philipps-University Marburg, Department of Clinical Psychology, Schulstrasse 12, 35037 Marburg/Lahn, Germany
| | - Naomi M. Simon
- New York University Grossman School of Medicine, Department of Psychiatry, One Park Avenue, 8th Floor, New York NY 10016, USA
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Pettitt AK, Nelson BW, Forman-Hoffman VL, Goldin PR, Peiper NC. Longitudinal outcomes of a therapist-supported digital mental health intervention for depression and anxiety symptoms: A retrospective cohort study. Psychol Psychother 2024. [PMID: 38270220 DOI: 10.1111/papt.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study examined treatment outcomes (depression and anxiety symptoms) up to 24 months after completion of a therapist-supported digital mental health intervention (DMHI). METHODS The sample consisted of 380 participants who participated in an eight-week DMHI from February 6, 2017 to May 20, 2019. Participants reported depression and anxiety symptoms at eight timepoints from baseline to 24 months. Mixed-effects modelling was used to investigate symptom changes over time. The proportion of participants meeting criteria for treatment response, clinically significant change, and remission of depression and anxiety symptoms were calculated, including proportions demonstrating each outcome sustained up to each timepoint. RESULTS Multivariate analyses yielded statistically significant reductions in depression (β = -5.40) and anxiety (β = -3.31) symptoms from baseline to end of treatment (8 weeks). Symptom levels remained significantly reduced from baseline through 24 months. The proportion of participants meeting criteria for clinical treatment outcomes remained constant over 24 months, although there were linear decreases in the proportions experiencing sustained clinical outcomes. CONCLUSIONS Treatment gains were made for depression and anxiety symptoms at the end of treatment and up to 24 months. Future studies should determine the feasibility of integrating post-treatment programmes into DMHIs to address symptom deterioration.
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Affiliation(s)
- Adam K Pettitt
- Meru Health, San Mateo, California, USA
- Center for Digital Mental Health, University of Oregon, Eugene, Oregon, USA
| | - Benjamin W Nelson
- Meru Health, San Mateo, California, USA
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Valerie L Forman-Hoffman
- Meru Health, San Mateo, California, USA
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Nicholas C Peiper
- Meru Health, San Mateo, California, USA
- Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, USA
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50
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Liu R, Chao Y, Ma X, Sha X, Sun L, Li S, Chang S. ERTNet: an interpretable transformer-based framework for EEG emotion recognition. Front Neurosci 2024; 18:1320645. [PMID: 38298914 PMCID: PMC10827927 DOI: 10.3389/fnins.2024.1320645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Background Emotion recognition using EEG signals enables clinicians to assess patients' emotional states with precision and immediacy. However, the complexity of EEG signal data poses challenges for traditional recognition methods. Deep learning techniques effectively capture the nuanced emotional cues within these signals by leveraging extensive data. Nonetheless, most deep learning techniques lack interpretability while maintaining accuracy. Methods We developed an interpretable end-to-end EEG emotion recognition framework rooted in the hybrid CNN and transformer architecture. Specifically, temporal convolution isolates salient information from EEG signals while filtering out potential high-frequency noise. Spatial convolution discerns the topological connections between channels. Subsequently, the transformer module processes the feature maps to integrate high-level spatiotemporal features, enabling the identification of the prevailing emotional state. Results Experiments' results demonstrated that our model excels in diverse emotion classification, achieving an accuracy of 74.23% ± 2.59% on the dimensional model (DEAP) and 67.17% ± 1.70% on the discrete model (SEED-V). These results surpass the performances of both CNN and LSTM-based counterparts. Through interpretive analysis, we ascertained that the beta and gamma bands in the EEG signals exert the most significant impact on emotion recognition performance. Notably, our model can independently tailor a Gaussian-like convolution kernel, effectively filtering high-frequency noise from the input EEG data. Discussion Given its robust performance and interpretative capabilities, our proposed framework is a promising tool for EEG-driven emotion brain-computer interface.
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Affiliation(s)
- Ruixiang Liu
- School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
| | - Yihu Chao
- School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
| | - Xuerui Ma
- School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
| | - Xianzheng Sha
- School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
| | - Limin Sun
- Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai, China
| | - Shuo Li
- School of Life Sciences, China Medical University, Shenyang, Liaoning, China
| | - Shijie Chang
- School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
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