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Ribé-Viñes JM, Gutiérrez-Maldonado J, Zabolipour Z, Ferrer-Garcia M. Virtual reality exposure with vibrotactile stimulation for the treatment of fear of flying: A pilot study. J Behav Ther Exp Psychiatry 2024; 82:101915. [PMID: 37862878 DOI: 10.1016/j.jbtep.2023.101915] [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: 07/21/2022] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) interventions are becoming more prevalent in treating fear of flying (FoF). Since multisensory stimulation can enhance the sense of presence in a virtual environment, the present study compared virtual reality exposure with and without vibrotactile cues to determine its contribution to the realism of the virtual experience. METHODS A repeated measures design was used. Thirty-one participants were exposed to two experimental conditions with a minimum of a one-week interval between them: one in which participants were exposed to the virtual environment with vibrotactile cues (smart chair, SC), and another in which participants were exposed to the virtual environment without vibrotactile cues (ordinary chair, OC). The administration order of both conditions was counterbalanced to avoid possible order effects. RESULTS Participants felt higher levels of sense of presence when using the SC than the OC. However, the addition of vibrotactile stimulation partially influenced experienced anxiety. Some personality traits were also associated with participants' sense of presence and anxiety responses during the exposure. LIMITATIONS The sample size was smaller than required. Moreover, only self-reported measures were used. Finally, a roller coaster instead of an airplane scenario was used for the exposure, which might not have been suitable enough for provoking anxiety in participants with FoF. CONCLUSIONS Vibrotactile cues enhanced the sense of presence. However, the addition of vibrotactile stimulation did not have a consistent effect on anxiety experienced during exposure. Therefore, the benefits of incorporating vibrotactile cues in virtual reality environments for exposure therapy are not clear.
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Affiliation(s)
- J M Ribé-Viñes
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain.
| | - J Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain
| | - Zahra Zabolipour
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain
| | - M Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain.
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Meyerbröker K, Morina N, Kerkhof GA, Emmelkamp PMG. Potential Predictors of Virtual Reality Exposure Therapy for Fear of Flying: Anxiety Sensitivity, Self-efficacy and the Therapeutic Alliance. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mor S, Botella C, Campos D, Tur C, Castilla D, Soler C, Quero S. An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study. Internet Interv 2021; 24:100387. [PMID: 33936953 PMCID: PMC8076687 DOI: 10.1016/j.invent.2021.100387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Flying Phobia (FP) is a prevalent disorder that can cause serious interference in a person's life. ICBT interventions have already shown their efficacy in several studies, but studies in the field of specific phobias are still scarce. Moreover, few studies have investigated the feasibility of using different types of images in exposure scenarios in ICBTs and no studies have been carried out on the role of sense of presence and reality judgement. The aim of the present study is to explore the feasibility of an ICBT for FP (NO-FEAR Airlines) using two types of images with different levels of immersion (still and navigable images). A secondary aim is to explore the potential effectiveness of the two experimental conditions using two types of images compared to a waiting list control group. Finally, the role of navigable images compared to the still images in the level of anxiety, sense of presence, and reality judgement will also be explored. This paper presents the study protocol. METHODS This study is a three-armed feasibility pilot study with the following conditions: NO-FEAR Airlines with navigable images, NO-FEAR Airlines with still images, and a waiting list group. A minimum of 60 participants will be recruited. The intervention will have a maximum duration of 6 weeks. Measurements will be taken at four different moments: baseline, post-intervention, and two follow-ups (3- and 12-month). Participants' opinions, preference, satisfaction and acceptance regarding the images used in the exposure scenarios will be assessed. FP symptomatology outcomes will also be considered for secondary analyses. The anxiety, sense of presence, and reality judgement in the exposure scenarios will also be analysed. DISCUSSION This study will conduct a pilot study on the feasibility of an ICBT for FP and it is the first one to explore the evaluation of patients of the two type of images (still and navigable) and the role of presence and reality judgement in exposure scenarios delivered through the Internet. Research in this field can have an impact on the way these scenarios are designed and developed, as well as helping to explore whether they have any effect on adherence. TRIAL REGISTRATION NCT03900559. Trial Registration date 3 April 2019, retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | | | | | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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Madison A, Vasey M, Emery CF, Kiecolt-Glaser JK. Social anxiety symptoms, heart rate variability, and vocal emotion recognition in women: evidence for parasympathetically-mediated positivity bias. ANXIETY STRESS AND COPING 2020; 34:243-257. [PMID: 33156720 DOI: 10.1080/10615806.2020.1839733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Individuals with social anxiety disorder show pronounced perceptual biases in social contexts, such as being hypervigilant to threat and discounting positive social cues. Parasympathetic activity influences responses to the social environment and may underlie these biases. This study examined the associations among social anxiety symptoms, heart rate variability (HRV), and vocal emotion recognition. DESIGN AND METHOD Female undergraduate students (N = 124) self-reported their social anxiety symptoms using the Social Anxiety Disorder Dimensional Scale and completed a computerized vocal emotion recognition task using stimuli from the Ryerson Audio-Visual Database of Emotional Speech and Song stimulus set. HRV was measured at baseline and during the emotion recognition task. RESULTS Women with more social anxiety symptoms had higher emotion recognition accuracy (p = .021) and rated positive stimuli as less intense (p = .032). Additionally, although those with greater social anxiety symptoms did not have lower resting HRV (p = .459), they did have lower task HRV (p = .026), which mediated their lower positivity bias and greater recognition accuracy. CONCLUSIONS A parasympathetically-mediated positivity bias may indicate or facilitate normal social functioning in women. Additionally, HRV during a symptom- or disorder-relevant task may predict task performance and reveal parasympathetic differences that are not found at baseline.
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Affiliation(s)
- Annelise Madison
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA.,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Michael Vasey
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Charles F Emery
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA.,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA.,Department of Psychiatry and Behavioral Health, The Ohio State University Harding Hospital, Columbus, OH, USA
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5
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Busscher B, Spinhoven P, de Geus EJC. Synchronous change in subjective and physiological reactivity during flight as an indicator of treatment outcome for aviophobia: A longitudinal study with 3-year follow-up. J Behav Ther Exp Psychiatry 2020; 67:101443. [PMID: 30583795 DOI: 10.1016/j.jbtep.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 11/02/2018] [Accepted: 12/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Emotion can be seen as the organizing process that coordinates response systems to deal effectively with challenges and opportunities. Synchronous change in subjective and physiological reactivity is regarded as an indication of this organizing process. Synchrony is expected to increase with the intensity of emotional stimuli. Conversely, adaptive emotional functioning could be indicated by progressive synchrony upon increasing demands, and the magnitude of synchrony could be an indication of progress during therapy. METHODS We examined whether synchronous change in subjective and physiological reactivity over repeated exposures increased from watching a flight video through simulated flight to actual flight, and whether the magnitude of synchronous change predicted favourable short- and long-term treatment outcome within a group of 77 aviophobic participants during CBT. RESULTS Results did not show a relationship between the intensity of the phobic stimuli and the magnitude of synchronous change in subjective and physiological reactivity. Moreover, synchronous change across both response systems did not predict treatment outcome. LIMITATIONS By design this study had no control group. Additional treatment or life events between end of treatment and 3-year follow-up were not assessed. CONCLUSION The results provide only weak support for the functionalistic view that successful treatment of anxiety disorders is indicated by synchronous change in reactivity across emotional response systems. The relationship between these systems is likely to be affected by many intervening variables including higher order cognitive processes.
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Affiliation(s)
- Bert Busscher
- VALK Foundation, Postbox 110, 2300, AC, Leiden, the Netherlands; Institute of Psychology, Leiden University, the Netherlands.
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, the Netherlands; Department of Psychiatry, Leiden University Medical Center, the Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neurosci Biobehav Rev 2020; 108:796-820. [DOI: 10.1016/j.neubiorev.2019.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/24/2022]
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Anxiety sensitivity moderates the subjective experience but not the physiological response to psychosocial stress. Int J Psychophysiol 2019; 141:76-83. [DOI: 10.1016/j.ijpsycho.2019.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022]
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Mor S, Baños R, Quero S. Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial. BMC Psychiatry 2019; 19:86. [PMID: 30841930 PMCID: PMC6404352 DOI: 10.1186/s12888-019-2060-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. METHODS A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. RESULTS NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. CONCLUSION FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 ( https://clinicaltrials.gov/ct2/show/NCT02298478 ). Trial registration date 3 November 2014.
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Affiliation(s)
- Daniel Campos
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Juana Bretón-López
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adriana Mira
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Diana Castilla
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Sonia Mor
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Rosa Baños
- 0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2173 938Xgrid.5338.dUniversitat de València, Valencia, Spain
| | - Soledad Quero
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain. .,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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Horenstein A, Potter CM, Heimberg RG. How does anxiety sensitivity increase risk of chronic medical conditions? CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arielle Horenstein
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
| | - Carrie M. Potter
- Department of Psychiatry of Cambridge Health Alliance; Harvard Medical School; Boston Massachusetts
| | - Richard G. Heimberg
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
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Azoum M, Clark GI, Rock AJ. The impact of affect labelling on responses to aversive flying-cues. PLoS One 2018; 13:e0194519. [PMID: 29672519 PMCID: PMC5908089 DOI: 10.1371/journal.pone.0194519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022] Open
Abstract
Individuals with flying phobia experience increases in subjective anxiety in response to flying-related cues. However, the cognitive processes that contribute to cue-reactive anxiety in individuals with flying-related anxiety remain poorly understood. Preliminary research suggests that changes in visual imagery and volitional control may contribute to this cue-reactive anxiety. Engaging in affect labelling during exposure therapy has been shown to reduce cue-reactive anxiety in individuals with fears relating to a variety of stimuli but has not been investigated in the fear of flying. The present study recruited 110 participants with a range of flying-related anxiety scores to complete an online cue-reactivity experiment. The study sought to evaluate whether an aversive flying cue triggered changes in imagery, volitional control and anxiety, and whether changes in imagery and volitional control predicted level of cue-reactive anxiety. Participants were randomly allocated to an affect labelling or non-affect labelling condition to additionally assess whether engaging in labelling one's emotion following exposure to an aversive flying cue would attenuate cue-reactive changes in anxiety relative to a group who did not. Significant cue-reactive changes in anxiety, and volitional control were observed from neutral to aversive flying cue were observed. After accounting for the effects of flying anxiety severity, only volitional control significantly improved the prediction of cue-reactive anxiety. Participants in the affect labelling condition reported significantly smaller increases in anxiety than the non-affect labelling group following exposure to the aversive flight cue. This is the first study to indicate affect labelling may help to regulate aspects of cue-reactive anxiety in response to aversive flying stimuli.
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Affiliation(s)
- Michelle Azoum
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Gavin I. Clark
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Adam J. Rock
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Baños R, Tortella-Feliu M, Quero S. An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:296. [PMID: 27544428 PMCID: PMC4992303 DOI: 10.1186/s12888-016-0996-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/04/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients' acceptance of the program. This paper presents the study protocol. METHODS/DESIGN The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. DISCUSSION An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 . Trial registration date 3 November 2014.
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Affiliation(s)
| | - Juana Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | | | | | - Rosa Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Universitat de València, Valencia, Spain
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Clark GI, Rock AJ. Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review. Front Psychol 2016; 7:754. [PMID: 27313550 PMCID: PMC4887486 DOI: 10.3389/fpsyg.2016.00754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/06/2016] [Indexed: 01/30/2023] Open
Abstract
Flying phobia is a highly prevalent anxiety disorder, which causes sufferers significant distress and life interference. The processes which maintain flying phobia remain poorly understood. A systematic search of the literature was performed to identify what research has been conducted into the processes which may be involved in the fear of flying and whether processes which are believed to maintain other anxiety disorder diagnoses have been investigated in flying phobia. The results of the literature review are presented and related to existing cognitive behavioral theory and research. The results indicate that little research has been conducted into a number of areas considered important in the wider cognitive behavioral literature on anxiety disorders: namely attention, mental imagery, memory, worry, and safety-seeking behaviors. The review proposes a hypothetical model, derived from cognitive behavioral theory, for the processes which may be involved in maintaining flying phobia, and considers a number of areas for future research.
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Affiliation(s)
- Gavin I. Clark
- School of Behavioural, Cognitive and Social Sciences, University of New EnglandArmidale, NSW, Australia
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Khalsa SS, Lapidus RC. Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry? Front Psychiatry 2016; 7:121. [PMID: 27504098 PMCID: PMC4958623 DOI: 10.3389/fpsyt.2016.00121] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/21/2016] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Rachel C Lapidus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Department of Psychology, University of Tulsa, Tulsa, OK, USA
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DeCaro JA. Beyond catecholamines: Measuring autonomic responses to psychosocial context. Am J Hum Biol 2015; 28:309-17. [PMID: 26638196 DOI: 10.1002/ajhb.22815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/17/2015] [Accepted: 11/11/2015] [Indexed: 11/08/2022] Open
Abstract
Despite longstanding interest among human biologists in autonomic responses to socioecological context or culture change, the adoption of autonomic measures has been limited by methodological challenges. Catecholamine secretion is the most direct measure, but not all study designs are amenable to urinary sampling, and blood pressure lacks specificity to the parasympathetic or sympathetic division of the autonomic nervous system. This article reviews three alternative approaches for measuring autonomic responses: salivary α-amylase as a nonspecific autonomic marker, respiratory sinus arrhythmia as a specific parasympathetic marker, and the pre-ejection period as a specific sympathetic marker. Study design considerations are discussed in detail, including ambulatory sampling protocols that permit the evaluation of autonomic responses to everyday life. Researchers interested in how culture and social experience "get under the skin," as well as those concerned with the evolution of social engagement, can benefit from these well-validated biomarkers that are nevertheless relatively novel in human biology. Am. J. Hum. Biol. 28:309-317, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Jason A DeCaro
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama
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Abstract
OBJECTIVES Exposure is regarded to be a crucial component of therapies for phobias. According to emotional processing theory, the success of exposure therapy is predicted by activation of subjective and physiological fear responses and their within-session habituation and between-session adaptation. This study tested this prediction for aviophobia. METHODS Seventy-nine participants following a highly standardized treatment program for aviophobia provided self-reported and physiological (heart rate, respiratory sinus arrhythmia and pre-ejection period) measurements of fear activation, within-session habituation, and between-session adaptation during exposure to flight-related stimuli, a flight simulator, and during two real flights. Multiple regression analyses were conducted to examine whether these measurements predicted therapy outcome up to 3 years after finishing therapy, including number of flights flown in this period. RESULTS Both subjective and physiological arousal measurements indicated strong fear activation and large within-session habituation and between-session adaptation during exposure. Flight anxiety measures showed large improvements up to 3 years after treatment (η between 0.72 and 0.91). Lower self-reported anxiety during flight exposure was associated with lower flight anxiety after exposure (R = 0.15) and more flights flown (R = 0.14). Within-flight habituation or between-session adaptation of self-reported anxiety had no relationship with treatment outcome. Within-flight habituation of HR reactivity (R = 0.10) and respiratory sinus arrhythmia reactivity (R = 0.11) was associated with lower flight anxiety directly after the flight, but not on flight anxiety 3 years after finishing therapy or on long-term flying behavior. CONCLUSIONS The results provide only weak support for emotional processing theory. Low self-reported anxiety during in vivo flight exposure was the best predictor of successful long-term therapy outcome.
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Akça ÖF, Ağaç Vural T, Türkoğlu S, Kılıç EZ. Anxiety sensitivity: changes with puberty and cardiovascular variables. Pediatr Int 2015; 57:49-54. [PMID: 25040018 DOI: 10.1111/ped.12443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/04/2014] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS) is a relatively stable dispositional variable that may increase the risk for anxiety-related symptoms, particularly panic attack, among individuals of all age groups. Changes in AS during adolescence in healthy individuals, however, has not been previously investigated. The aim of this study was therefore to investigate the relationship of AS with puberty level, pulse rate, and blood pressure in healthy adolescents. METHODS The sample consisted of 133 healthy adolescents (70 boys, 63 girls) aged 10-17 years. Puberty stage (i.e. Tanner stage), pulse rate, and blood pressure of each participant were determined. The Childhood Anxiety Sensitivity Inventory was used to identify AS. The correlations between AS and the clinical variables were assessed. RESULTS AS was negatively correlated with pubertal stage when age and gender were controlled. Also, AS was correlated with diastolic blood pressure when age, gender, and pubertal stage were controlled (P < 0.05). Neither systolic blood pressure nor heart rate were correlated with AS. CONCLUSION AS, which is reported to be a trait-like variable, may change during adolescence, due to the effect of pubertal growth and blood pressure interacting with AS during adolescence.
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Affiliation(s)
- Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Chalmers JA, Quintana DS, Abbott MJA, Kemp AH. Anxiety Disorders are Associated with Reduced Heart Rate Variability: A Meta-Analysis. Front Psychiatry 2014; 5:80. [PMID: 25071612 PMCID: PMC4092363 DOI: 10.3389/fpsyt.2014.00080] [Citation(s) in RCA: 498] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/26/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis. METHOD Studies comparing resting-state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis. RESULTS Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterized by lower HRV [high frequency (HF): Hedges' g = -0.29. 95% CI: -0.41 to -0.17, p < 0.001; time domain: Hedges' g = -0.45, 95% CI: -0.57 to -0.33, p < 0.001] than controls. Panic disorder (n = 447), post-traumatic stress disorder (n = 192), generalized anxiety disorder (n = 68), and social anxiety disorder (n = 90), but not obsessive-compulsive disorder (n = 40), displayed reductions in HF HRV relative to controls (all ps < 0.001). CONCLUSION Anxiety disorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.
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Affiliation(s)
- John A Chalmers
- School of Psychology, University of Sydney , Sydney, NSW , Australia
| | - Daniel S Quintana
- Brain and Mind Research Institute, University of Sydney , Sydney, NSW , Australia ; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
| | | | - Andrew H Kemp
- School of Psychology, University of Sydney , Sydney, NSW , Australia ; University Hospital and Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Discipline of Psychiatry, University of Sydney , Sydney, NSW , Australia
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