1
|
Peters W, Rice S, Alvarez-Jimenez M, Hetrick SE, Halpin E, Kamitsis I, Santesteban-Echarri O, Bendall S. Relative efficacy of psychological interventions following interpersonal trauma on anxiety, depression, substance use, and PTSD symptoms in young people: A meta-analysis. Early Interv Psychiatry 2022; 16:1175-1184. [PMID: 35106931 PMCID: PMC9786735 DOI: 10.1111/eip.13265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/21/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
AIM Interpersonal trauma exposures are associated with anxiety, depression, and substance use in youth populations (aged 12-25 years). This meta-analysis reports on the efficacy of psychological interventions on these symptom domains in addition to post-traumatic stress. METHODS Following PRISMA guidelines, a search of electronic databases was performed for randomized controlled trials (RCTs) assessing interventions for young people following interpersonal trauma exposure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analysed using random-effects meta-analyses. RESULTS Of the 4832 records screened, 78 studies were reviewed, and 10 RCTs, involving 679 participants (mean age 15.6 years), were analysed. There was a large pooled effect size for post-traumatic stress (7 studies, g = 1.43, 95% CI [0.37, 2.15], p = .002) and substance use (2 studies, g = 0.70, 95% CI [-0.11, 1.22], p < .001) and small effect sizes for anxiety (4 studies, g = 0.30, 95% CI [0.10, 0.49], p = .003), and trend-level effect for depression (10 studies, g = 0.27, 95% CI [0.00, 0.54], p = .052). Heterogeneity was significant for post-traumatic stress and moderate for depression. CONCLUSIONS High-quality RCTs of psychological interventions for anxiety, depression, substance use, and post-traumatic stress symptoms in young people exposed to interpersonal trauma are scarce. While available studies show either statistically significant or trend-level efficacy for psychological interventions in reducing these symptoms, wide confidence intervals, heterogeneity and small sample size mean that results need to be interpreted with caution.
Collapse
Affiliation(s)
- Wilma Peters
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon Rice
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Centre for Youth Mental Health, University of Auckland, Auckland, New Zealand
| | - Emma Halpin
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ilias Kamitsis
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Olga Santesteban-Echarri
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Bendall
- Department of Research and Translation, Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
2
|
Who benefits most from an evidence-based program to reduce anxiety and depression in children? A latent profile analysis. Dev Psychopathol 2021; 34:1636-1644. [PMID: 34099077 DOI: 10.1017/s0954579421000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Comorbidity between anxiety and depression symptoms is often high in children. Person-oriented statistical approaches are useful to detect heterogeneity of individuals and diverse patterns of response to treatment. This study aimed to explore the different profiles in a sample of Spanish children who received the Super Skills for Life (SSL) transdiagnostic program, to identify which profile of individuals benefited most from the intervention and the likelihood of transition of symptom patterns over time. Participants were 119 children (42.9% were female) aged 8-12 years old (M = 9.39; SD = 1.26). Children completed anxiety and depression measures at the baseline, postintervention, and 12-months follow-up. Results from latent transition analysis (LTA) revealed two groups depending on the severity of the anxiety and depression symptoms: low symptoms (LS) and high symptoms (HS). LS group remained stable and HS decreased by 25%, switching to the LS group. Children with greater social anxiety benefited most from the program over time. Furthermore, older children were more likely to improve rapidly one year after the intervention compared to younger children. This study provides information to consider when implementing preventive interventions for schoolchildren and to tailor them according to the target population characteristics to increase their effectiveness.
Collapse
|
3
|
Chae S, Shin J, Ji D, Choi JW, Lee JY, Hong M, Park TW, Kim KM, Lee S, Kim SY, Kim K, Kim JW. A Brief Depression and Anxiety Rating Scale for Sexual Violence Victims. Psychiatry Investig 2021; 18:172-178. [PMID: 33601869 PMCID: PMC7960751 DOI: 10.30773/pi.2020.0390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/12/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study aimed to develop a brief self-report measure of depressive and anxiety symptoms in victims of sexual violence. METHODS The sample, which consisted of 215 victims and 255 healthy controls, was recruited between December 2016 and November 2018 from eight Sunflower Centers. Eligible items were selected from existing scales of depression (CES-DC and CES-D) and anxiety (SAI-C and BAI) symptoms by item-total correlation coefficients and item response theory (IRT) analysis. Internal consistency coefficients were computed and the receiver operating characteristics curve was inspected to assess the validity of the brief scale and determine optimal cutoff scores. RESULTS The brief scales showed high internal consistency across all age groups. The optimal cutoff score of brief depression scale was 1.5 for children, 2.5 for adolescents, and 2.5 for the adults. That of brief anxiety scale was 8.5, 6.5, and 3.5, respectively. CONCLUSION The results underscore the need for age-appropriate screening measures of depressive and anxiety symptoms in victims of sexual violence.
Collapse
Affiliation(s)
- Soohyun Chae
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiyoon Shin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dajung Ji
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Tae-Won Park
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Sunhwa Lee
- Sunflower Center of Chungnam for Women and Children Victims of Violence, Cheonan, Republic of Korea
| | - Soo Yeon Kim
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
| | - Kihyun Kim
- Department of Social Welfare, College of Social Sciences, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
4
|
Bisby MA, Baker KD, Richardson R. Deficits in opioid receptor-mediated prediction error contribute to impaired fear extinction during adolescence. Behav Res Ther 2020; 133:103713. [PMID: 32841761 DOI: 10.1016/j.brat.2020.103713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Adolescent-onset anxiety disorders are more common and costly than those that emerge later in life. Unfortunately, nearly half of adolescents undergoing cognitive behavioural therapies, including exposure therapies, show significant symptom relapse. Such poor treatment outcomes are consistent with preclinical work examining fear extinction, in which adolescents show persistent fear to extinguished cues. Both extinction and exposure are dependent on the generation of prediction error (i.e., the difference between the expected and actual outcome of a cue presentation), a process which involves the opioid system. We investigated the contribution of prediction error signalling to extinction during adolescence using the opioid receptor antagonist naloxone. We demonstrated that unlike in juvenile and adult rats, fear expression during extinction training and test in adolescent rats was unaffected by naloxone, suggesting that adolescent rats are impaired in using prediction error signalling to extinguish fear under typical conditions. However, in two circumstances where adolescents exhibit good extinction retention, opioid receptor blockade impaired extinction retention, suggesting that the recruitment of prediction error signalling mechanisms promotes extinction in this age group, just as it does in adults. Importantly, additional extinction training may be required to enable prediction error mechanisms to be recruited during adolescence.
Collapse
Affiliation(s)
- Madelyne A Bisby
- School of Psychology, UNSW Sydney, NSW, Australia; eCentreClinic, Department of Psychology, Macquarie University, NSW, Australia.
| | | | | |
Collapse
|
5
|
Aziz N, Wal A, Wal P, Bhalla R. Internet Addiction in India: Its Current Prevalence and Psychological and Complementary Treatment Techniques. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200106120104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
In this technical era, undoubtedly, the internet has brought a great revolution
worldwide. Smartphones and technology-mediated social networking sites have caused a drastic
increase in internet usage in all age groups of people. This has caused internet captivity leading
to its addiction.
Objective:
The paper focussed on the mediators and predictors of internet addiction in India in all
age groups of people. Its long-term solutions, i.e. psychological and complementary treatments were
focussed that work on personal level rather than disease level.
Methods:
An extensive literature review was done on the prevalence of the internet and its psychological
and complementary treatment. The possible non-pharmacological treatment, specifically
cognitive behaviour treatment, art and music therapy, internet fasting and cosmic medicine were
focussed on its efficient improvement in one’s health.
Conclusion:
As evident from our study, internet addiction is one of the growing challenges of
health complications in all age groups of people. The mainly discussed psychological and complementary
treatments of internet addiction have ample opportunity of seeking betterment with healthy
social and mental well being.
Collapse
Affiliation(s)
- Namra Aziz
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur-209305, India
| | - Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur-209305, India
| | - Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur-209305, India
| | - Rupa Bhalla
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur-209305, India
| |
Collapse
|
6
|
Abend R, Gold AL, Britton JC, Michalska KJ, Shechner T, Sachs JF, Winkler AM, Leibenluft E, Averbeck BB, Pine DS. Anticipatory Threat Responding: Associations With Anxiety, Development, and Brain Structure. Biol Psychiatry 2020; 87:916-925. [PMID: 31955915 PMCID: PMC7211142 DOI: 10.1016/j.biopsych.2019.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND While translational theories link neurodevelopmental changes in threat learning to pathological anxiety, findings from studies in patients inconsistently support these theories. This inconsistency may reflect difficulties in studying large patient samples with wide age ranges using consistent methods. A dearth of imaging data in patients further limits translational advances. We address these gaps through a psychophysiology and structural brain imaging study in a large sample of patients across the lifespan. METHODS A total of 351 participants (8-50 years of age; 209 female subjects; 195 healthy participants and 156 medication-free, treatment-seeking patients with anxiety) completed a differential threat conditioning and extinction paradigm that has been validated in pediatric and adult populations. Skin conductance response indexed psychophysiological response to conditioned (CS+, CS-) and unconditioned threat stimuli. Structural magnetic resonance imaging data were available for 250 participants. Analyses tested anxiety and age associations with psychophysiological response in addition to associations between psychophysiology and brain structure. RESULTS Regardless of age, patients and healthy comparison subjects demonstrated comparable differential threat conditioning and extinction. The magnitude of skin conductance response to both conditioned stimulus types differentiated patients from comparison subjects and covaried with dorsal prefrontal cortical thickness; structure-response associations were moderated by anxiety and age in several regions. Unconditioned responding was unrelated to anxiety and brain structure. CONCLUSIONS Rather than impaired threat learning, pathological anxiety involves heightened skin conductance response to potential but not immediately present threats; this anxiety-related potentiation of anticipatory responding also relates to variation in brain structure. These findings inform theoretical considerations by highlighting anticipatory response to potential threat in anxiety.
Collapse
Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Andrea L. Gold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Pediatric Anxiety Research Center, Bradley Hospital, Riverside, RI
| | | | | | - Tomer Shechner
- Psychology Department, University of Haifa, Haifa, Israel
| | | | - Anderson M. Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Bruno B. Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of
Health, Bethesda, MD
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| |
Collapse
|
7
|
Developmental differences in the effects of CB1/2R agonist WIN55212-2 on extinction of learned fear. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109834. [PMID: 31830508 DOI: 10.1016/j.pnpbp.2019.109834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/18/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
Adolescence is characterised by substantial changes in emotion regulation and, in particular, impaired extinction consolidation and retention. In this study, we replicated the well-established finding that increasing the activation of cannabinoid receptor 1 (CB1R) via the agonist WIN55212-2 improves fear extinction in adult rodents before examining whether this adjunct would also rescue the extinction retention deficit seen in adolescent rodents. Contrary to the effects in adults, we found that WIN55212-2 impaired within-session acquisition of extinction in adolescent rats with no effect on extinction retention. The same effects of WIN55212-2 were observed for juvenile rats, and did not vary as a function of drug dose. Increased fear expression observed during extinction training was not a result of altered locomotor or anxiety-like behaviour in adolescent rats, as assessed by the open field test. Lastly, we observed a linear decrease in CB1R protein expression across age (i.e., from juveniles, to adolescents, and adults) in both the medial prefrontal cortex and amygdala, two regions implicated in fear expression and extinction, suggesting that there is continued refinement of the endocannabinoid system across development in two regions involved in extinction. Our findings suggest that the expression and extinction of fear in developing rats is differentially affected by CB1R agonism due to an immature endocannabinoid system.
Collapse
|
8
|
Nolet K, Corno G, Bouchard S. The Adoption of New Treatment Modalities by Health Professionals and the Relative Weight of Empirical Evidence in Favor of Virtual Reality Exposure Versus Mindfulness in the Treatment of Anxiety Disorders. Front Hum Neurosci 2020; 14:86. [PMID: 32269517 PMCID: PMC7109262 DOI: 10.3389/fnhum.2020.00086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
Anxiety disorders are among the most prevalent mental disorders, and cognitive-behavioral therapy (CBT) with exposure exercises is considered as the gold-standard psychological intervention. New psychotherapeutic modalities have emerged in the last decade and, among them, mindfulness has been rapidly adopted by therapists. The adoption rate is slower for the use of virtual reality (VR) to conduct exposure. The goal of the present position paper is to contrast, for the treatment of anxiety disorders, the weight of empirical evidences supporting the use of exposure in VR with the use of mindfulness-based therapy (MBT). Based on the most recent meta-analyses, we found that CBT with exposure conducted in VR was more thoroughly researched and supported than MBT, receiving validation from roughly twice as many studies with high control (i.e., randomized, active controls with clinical samples). However, this conclusion is nuanced by reviewing gaps in the literature for both therapies. Potential factors influencing clinicians' choice of treatment and suggestions for future research directions are proposed.
Collapse
Affiliation(s)
- Kevin Nolet
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Giulia Corno
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- LabPsiTec, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Valencia, Spain
| | - Stéphane Bouchard
- Cyberpsychology Laboratory of UQO, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| |
Collapse
|
9
|
Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
Collapse
Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
| |
Collapse
|