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Rotstein MS, Zimmerman-Brenner S, Davidovitch S, Ben-Haim Y, Koryto Y, Sion R, Rubinstein E, Djerassi M, Lubiniaker N, Peleg TP, Steinberg T, Leitner Y, Raz G. Gamified Closed-Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial. Mov Disord 2024. [PMID: 38881244 DOI: 10.1002/mds.29875] [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: 03/01/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Gamification of behavioral intervention for tic disorders (TDs) potentially enhances compliance and offers key clinical advantages. By delivering immediate positive feedback upon tic-suppression, games may counteract negative reinforcement, which presumably contribute to tic consolidation by relieving uncomfortable premonitory urges. OBJECTIVES We developed a gamified protocol (XTics), which leverages this potential by combining gamified tic-triggering with immediate feedback, and evaluated its clinical value in enhancing tic suppression. METHODS XTics encompasses two conditions: Immediate and Contingent Reward (ICR), where game progression is contingent upon successful tic suppression, and Delayed Reward (DR), where game events' outcomes are random. Employing a randomized crossover design, 35 participants (aged 7-15 years) underwent daily gaming sessions over a week per condition. Improvements in our primary measures, including the inter-tic interval (ITI) and tic severity assessment by blinded evaluators (Yale Global Tic Severity-Total Tic Score [YGTSS-TTS], Rush), and parents (Parent Tic Questionnaire [PTQ]), were compared between ICR and DR, and assessed across conditions for the 4-week protocol. RESULTS No participant voluntarily left the study before completing its two-phase protocol. As expected, ITI showed significantly larger improvement (Z = 4.19, P = 2.85 × 10-5) after ICR (1442 ± 2250%) versus DR (242 ± 493%) training, increasing at a higher pace (t(67) = 3.15, P = 0.0025). Similarly, Rush tic severity scores reduced more post-ICR versus DR (t(47) = 3.47, P = 0.002). We observed a clinically significant reduction of 25.69 ± 23.39% in YGTSS-TTS following a f4-week protocol including both conditions. Parent-reported tic severity decreased by 42.99 ± 31.69% from baseline to 3 months post-treatment. CONCLUSIONS The combination of gamified tic-triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, boosting traditional therapeutic methods. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michael S Rotstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Development Institute, The Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Israel
- The Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Yael Ben-Haim
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Yuval Koryto
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel
| | - Romi Sion
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Einat Rubinstein
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Meshi Djerassi
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nitzan Lubiniaker
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel
- The Neuropsychological Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Tamar Steinberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Matta and Harry Freund Neuropsychiatric Tourette Clinic, Department of Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yael Leitner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Development Institute, The Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Israel
- The Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gal Raz
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- The Steve Tisch School of Film and Television, Faculty of the Arts, Tel Aviv University, Tel-Aviv, Israel
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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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Opdensteinen KD, Rach H, Gruszka P, Schaan L, Adolph D, Pané-Farré CA, Benke C, Dierolf AM, Schneider S, Hechler T. "The mere imagination scares me"-evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain. Pain 2024; 165:621-634. [PMID: 37703402 DOI: 10.1097/j.pain.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/17/2023] [Indexed: 09/15/2023]
Abstract
ABSTRACT According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed. Adolescents (11-18 years) with chronic headache (CH, n = 46) or chronic abdominal pain (CAP, n = 29) and a control group (n = 28) were asked to imagine individualized pain-associated, neutral and standardized fear scripts. During pain-associated compared with neutral imagery, both pain groups showed higher mean HR, with CH also showing higher HR reactivity, while HR acceleration was not observed within control group. In contrast, during pain-associated compared with neutral imagery, startle response magnitude and SCL remained unchanged in all groups. Additionally, overall levels in self-reports were higher during pain-associated compared with neutral imagery, but significantly more pronounced in the pain groups compared with the control group. Results suggest that the mere imagination of pain-associated sensations elicits specific autonomic fear responses accompanied by increased self-reported fear in adolescents with chronic pain. The specific modulation of heart rate shed new light on our understanding of multimodal fear responses in adolescents with chronic pain and may help to refine paradigms to decrease fear of interoceptive sensations in chronic pain.
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Affiliation(s)
- Kim D Opdensteinen
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Hannah Rach
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Piotr Gruszka
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Luca Schaan
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Dirk Adolph
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Christiane A Pané-Farré
- Department of Psychology, Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Christoph Benke
- Department of Psychology, Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Angelika M Dierolf
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Silvia Schneider
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tanja Hechler
- Department of Clinical Psychology for Children and Adolescents, University of Münster, Münster, Germany
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Kirchner L, Kube T, D'Astolfo L, Strahler J, Herbstreit R, Rief W. How to modify expectations of social rejection? An experimental study using a false-feedback paradigm. J Behav Ther Exp Psychiatry 2023; 81:101859. [PMID: 37182428 DOI: 10.1016/j.jbtep.2023.101859] [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: 03/31/2022] [Revised: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Negative expectations (NEs) are fundamental to various mental disorders. Finding ways to modulate NEs would help to improve clinical treatment. The present study investigated how previously formed expectations of social rejection are revised in the context of novel positive social experiences, and whether their revision can be modulated by differentially shifting participants' attentional focus. METHODS Our sample of 124 healthy participants was randomly assigned to four experimental conditions and received manipulated social feedback in multiple alleged webcam conferences. All groups went through three experimental phases that began with predominantly negative social feedback, then either transitioned to predominantly positive social feedback or continued to predominantly negative social feedback, and ultimately transitioning to a phase with no explicit social feedback. The experimental conditions differed in what they were instructed to focus on when receiving positive social feedback. RESULTS Receiving novel positive social feedback led to substantial changes in social expectations, but this effect was not modulated by the instructions the participants were given. Descriptive trends revealed that both instructions improved NE modification, although this effect was not robust to extinction in one condition. LIMITATIONS To prevent our cover story from being compromised, we could not perform an immediate manipulation check of the instructions given. Nevertheless, some of the sample seemed suspicious about the cover story. CONCLUSION Our results suggest that established expectations of social rejection can be revised when unexpectedly experiencing social acceptance. Nevertheless, more research is needed on potential instructions that could be used to optimize the modification of NEs.
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Affiliation(s)
- Lukas Kirchner
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Tobias Kube
- University of Koblenz-Landau, Ostbahnstraße 10, 76829, Landau, Germany
| | - Lisa D'Astolfo
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jana Strahler
- Albert-Ludwigs-University of Freiburg, Sandfangweg 4, 79102, Freiburg, Germany
| | - René Herbstreit
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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Suntai Z, Laha-Walsh K, Albright DL. Perspectives on a good death: A comparative study of veterans and civilians. DEATH STUDIES 2023; 48:276-285. [PMID: 37288754 DOI: 10.1080/07481187.2023.2219641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans (n = 241) and nonveterans (n = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | | | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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van der Hoeven ML, Assink M, Stams GJJM, Daams JG, Lindauer RJL, Hein IM. Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:269-283. [PMID: 37234839 PMCID: PMC10205941 DOI: 10.1007/s40653-022-00500-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 05/27/2023]
Abstract
A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children's trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the "Demographic and Family" risk domain (r = .121), with factors including being male, child protective services involvement or placement, and minority status, and for the "Youth Alliance" risk domain (r = .207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the "Demographic and Family" domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-022-00500-2.
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Affiliation(s)
- Mara L. van der Hoeven
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Mark Assink
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands
| | - Geert-Jan J. M. Stams
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Ramón J. L. Lindauer
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Irma M. Hein
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
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De Baets L, Meulders A, Van Damme S, Caneiro JP, Matheve T. Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain. J Orthop Sports Phys Ther 2023; 53:307–316. [PMID: 36884314 DOI: 10.2519/jospt.2023.11420] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND: Generic self-report measures do not reflect the complexity of a person's pain-related behavior. Since variations in a person's fear of movement and avoidance behavior may arise from contextual and motivational factors, a person-centered evaluation is required-addressing the cognitions, emotions, motivation, and actual behavior of the person. CLINICAL QUESTION: Most musculoskeletal rehabilitation clinicians will recognize that different people with chronic pain have very different patterns of fear and avoidance behavior. However, an important remaining question for clinicians is "How can I identify and reconcile discrepancies in fear of movement and avoidance behavior observed in the same person, and adapt my management accordingly?" KEY RESULTS: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centered evaluation (ie, patient interview, self-report measures, and behavioral assessment) when working with patients to manage fear of movement and avoidance behavior. CLINICAL APPLICATION: Understanding the discrepancies in a person's fear of movement and avoidance behavior is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviors. J Orthop Sports Phys Ther 2023;53(5):1-10. Epub: 9 March 2023. doi:10.2519/jospt.2023.11420.
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Samantaray NN, Mishra A, Singh AR, Sudhir PM, Singh P. Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting. J Affect Disord 2023; 324:92-101. [PMID: 36584701 DOI: 10.1016/j.jad.2022.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/09/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD). METHOD The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session. RESULTS The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes. CONCLUSIONS AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.
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Affiliation(s)
- Narendra Nath Samantaray
- Dept. of Clinical Psychology, School of Medical and Paramedical Science, Mizoram University, Aizawl 796004, India.
| | - Abinash Mishra
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack 753007, India
| | | | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Preeti Singh
- Dept. of Psychiatry, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur 492001, India
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Essayli JH, Forrest LN, Zickgraf HF, Stefano EC, Keller KL, Lane-Loney SE. The impact of between-session habituation, within-session habituation, and weight gain on response to food exposure for adolescents with eating disorders. Int J Eat Disord 2023; 56:637-645. [PMID: 36626314 PMCID: PMC9992286 DOI: 10.1002/eat.23894] [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: 09/13/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between-session and within-session habituation. METHOD We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology. RESULTS Multilevel models found that pre-exposure SUDS decreased over time, providing some evidence that between-session habituation occurred. In contrast, the difference between pre-exposure and post-exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Weight gain predicted greater between-session habituation to feared foods, but did not predict within-session habituation. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure. DISCUSSION Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within-session habituation, and to better understand between-session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs. PUBLIC SIGNIFICANCE This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within-session habituation when conducting food exposure for EDs, and understand the importance of between-session habituation as a potential mechanism of food exposure.
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Affiliation(s)
- Jamal H Essayli
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Hana F Zickgraf
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily C Stefano
- Bariatric and Weight Management Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen L Keller
- Department of Nutritional Sciences, Pennsylvania State University, Pennsylvania, USA
- Department of Food Science, Pennsylvania State University, Pennsylvania, USA
| | - Susan E Lane-Loney
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Knowles KA, Jessup SC, Olatunji BO. Facing Uncertainty: A Comparison of Hierarchical and Variable Exposure Interventions for Contamination Fear. J Obsessive Compuls Relat Disord 2023; 36:100777. [PMID: 36582425 PMCID: PMC9794192 DOI: 10.1016/j.jocrd.2022.100777] [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] [Indexed: 12/08/2022]
Abstract
Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N=73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d=.78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.
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Smits JAJ, Monfils MH, Otto MW, Telch MJ, Shumake J, Feinstein JS, Khalsa SS, Cobb AR, Parsons EM, Long LJ, McSpadden B, Johnson D, Greenberg A. CO 2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC Psychiatry 2022; 22:831. [PMID: 36575425 PMCID: PMC9793569 DOI: 10.1186/s12888-022-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
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Affiliation(s)
- Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Marie-H. Monfils
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Michael W. Otto
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Michael J. Telch
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Jason Shumake
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Justin S. Feinstein
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Adam R. Cobb
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Ralph H. Johnson VAHCS, 67 President Street MSC 862, Charleston, SC 29425 USA
| | - E. Marie Parsons
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Laura J. Long
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Bryan McSpadden
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - David Johnson
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Alma Greenberg
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
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Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Effects of confronting the feared outcome during exposure therapy on the return of fear: An analogue study. J Behav Ther Exp Psychiatry 2022; 76:101747. [PMID: 35738693 DOI: 10.1016/j.jbtep.2022.101747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Although exposure therapy is an efficacious treatment for anxiety disorders, fear often returns after treatment. From an inhibitory learning perspective, long-term improvement depends not only on learning that feared stimuli are safe, but also that it is safe to experience the emotional response triggered by these stimuli. Accordingly, the current study examined the effects of occasional threat reinforcement during repeated exposure to multiple cues on the return of fear in snake phobia by incorporating reminders of the feared outcome. METHODS Snake fearful community adults (N = 74) were randomized to either repeated exposure to multiple cues or exposure to multiple cues that also explicitly depicted the feared outcome (snake biting someone). A measure of self-reported threat expectancy and a threat-relevant behavioral approach task (BAT) were administered pre-exposure, post-exposure, and at a one-week follow-up. RESULTS Compared to the multiple-cue exposure group, the multiple-cue + fear-outcome group showed significantly less subjective expectancy for a snake to bite and increased behavioral approach of snake images at one-week follow-up. The fear-outcome group also reported significantly greater variability in distress during exposure than the multiple-cue exposure group and this difference mediated the intervention effect on behavioral approach at follow-up. LIMITATIONS Findings are limited by the use of videos as an analogue to exposure and a computer-delivered BAT. CONCLUSIONS These findings suggest presentation of the feared outcome may result in more variability in distress during exposure therapy and this may partially explain the maintenance of behavioral gains.
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Baerg L, Bruchmann K. COVID-19 information overload: Intolerance of uncertainty moderates the relationship between frequency of internet searching and fear of COVID-19. Acta Psychol (Amst) 2022; 224:103534. [PMID: 35189539 PMCID: PMC8843333 DOI: 10.1016/j.actpsy.2022.103534] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic has led to unprecedented levels of uncertainty for people around the world. Research suggests that internet searching resulting in contradictory information can lead to increased levels of distress, particularly for people who have a high intolerance of uncertainty (IU). In the present correlational study, U.S. undergraduate students (N = 317) indicated their IU, the frequency with which they search for COVID-19 related information online, their overall health anxiety, their fear of COVID-19 (FCV-19), and engagement in prevention behaviors. Consistent with previous research, individual differences in IU moderated the relationship between internet searches and FCV-19 such that for people high in IU, more internet searching was associated with greater fear. In turn, we also found that greater FCV-19 predicted more social-distancing behaviors. These findings are important in both future mental health and public health initiatives.
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Hoeboer CM, Oprel DAC, Kooistra MJ, Schoorl M, van der Does W, van Minnen A, de Kleine RA. Temporal Relationship Between Change in Subjective Distress and PTSD Symptom Decrease During Prolonged Exposure Therapy for Posttraumatic Stress Disorder. Behav Ther 2022; 53:170-181. [PMID: 35227396 DOI: 10.1016/j.beth.2021.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
There is growing evidence that change in distress is an indicator of change during Prolonged Exposure (PE) for posttraumatic stress disorder (PTSD). However, temporal sequencing studies investigating whether change in distress precedes PTSD symptom decline are lacking. These studies are essential since the timeline between indicators of change and treatment outcome is a key assumption for mediation. The aim of the present study was to assess the temporal relationship between within- and between-session change in subjective distress and PTSD symptom decrease. We analyzed session data from 86 patients with PTSD. Data were analyzed using dynamic panel models. We distinguished temporal effects (within-persons) from averaged effects (between-persons). Results regarding the temporal effect showed that within-session change in subjective distress preceded PTSD symptom improvement while the reversed effect was absent. Averaged within-session change in subjective distress was also related to PTSD symptom improvement. Results regarding the temporal effect of between-session change in subjective distress showed that it did not precede PTSD symptom improvement. Averaged between-session change in subjective distress was related to PTSD symptom improvement. This study provides evidence for within- but not between-session change in subjective distress as indicator of change during PE. We also found that the way of modeling potential indicators of change affects results and implications. We recommend future studies to analyze mediators during treatment using temporal rather than averaged effects.
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Affiliation(s)
| | | | | | | | - Willem van der Does
- Leiden University; Parnassiagroep, PsyQ, The Hague; Leiden University Medical Center
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Sánchez CG, Ferrer SD, Cuellar JAA, Martín JLM, Ruiz SR. I Look at my whole body and i feel better: attentional bias, emotional and psychophysiological response by pure exposure treatment in women with obesity. Psychother Res 2022; 32:748-762. [PMID: 34983319 DOI: 10.1080/10503307.2021.2021310] [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] [Indexed: 10/19/2022] Open
Abstract
Obesity is one of the most important health problems nowadays. In addition to the direct physical consequences, it is also a risk factor in the development of psychological (Eating disorders, body dissatisfaction, depression, anxiety, etc.) and social problems. Among there, body dissatisfaction is key for development and maintenance of such problems. OBJECTIVE to deepen the effectiveness of the body exposure treatment, both in its pure form and guided modality in subjective, psychological and attentional levels in people with body dissatisfaction and obesity. METHODS Evaluations were carried out in a total of 16 women with obesity and body dissatisfaction at the beginning and end of 6 treatment sessions of pure exposure in front of the mirror. The changes experienced at the subjective level (questionnaires and subjective discomfort during the sessions) and psychophysiological (eye-tracking and heart rate) were analyzed. RESULTS Pure exposure treatment reduces negative thoughts and emotions towards the body itself, as well as the experienced discomfort towards the most conflictive parts. Selective attention to those parts of the body classified as uglier by the participants (especially the rear view of the body) show a decrease in physiological reactivity. CONCLUSIONS Pure exposure treatment seems to be effective in reducing subjective and psychological symptoms associated with body dissatisfaction in people with obesity, this technique could be considered a good choice for the treatment of body dissatisfaction. This step is essential to guarantee the long-term therapeutic success of any other treatment (nutritional or/and physical activity) in the future.
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Affiliation(s)
- Cristina González Sánchez
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sandra Díaz Ferrer
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | | | - José Luis Mata Martín
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sonia Rodríguez Ruiz
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
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18
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Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3813. [DOI: 10.32872/cpe.3813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background
Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far.
Method
The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches.
Results and Conclusion
Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.
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I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:171-179. [PMID: 36325301 PMCID: PMC9616306 DOI: 10.1016/j.bpsgos.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023] Open
Abstract
Background Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety. Methods A meta-analysis of studies from different laboratories (18 experiments; sample N = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory, and prospective subscales), trait anxiety, and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety. Results All the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over trait anxiety. Conclusions The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.
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Morriss J, Zuj DV, Mertens G. The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. Int J Psychophysiol 2021; 166:116-126. [PMID: 34097936 DOI: 10.1016/j.ijpsycho.2021.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Daniel V Zuj
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Swansea, UK
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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21
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Kennedy SM, Hawks JL. Lessons Learned From a Randomized Controlled Pilot Trial Testing an Inhibitory Learning Approach to Exposure in Anxious Youth. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.09.011] [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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22
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Siegel P, Wang Z, Murray L, Campos J, Sims V, Leighton E, Peterson BS. Brain-based mediation of non-conscious reduction of phobic avoidance in young women during functional MRI: a randomised controlled experiment. Lancet Psychiatry 2020; 7:971-981. [PMID: 33069319 DOI: 10.1016/s2215-0366(20)30285-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Exposure therapy is the treatment of choice for anxiety disorders but requires people to confront feared situations and can be distressing. We tested the hypothesis that exposure without conscious awareness would reduce fear in participants with specific phobia by harnessing the neural circuitry supporting the automatic extinction of fear. METHODS In this single-centre, randomised controlled experiment, we recruited women aged 18-29 years from an ethnically diverse, community-based population in northeastern USA, between Sept 1, 2013, and Aug 1, 2016. Eligible participants classified as having phobia met the DSM-5 criteria for specific phobia but not for any other disorder, had scores in the top 10% of respondents to the Fear of Spiders Questionnaire, and exhibited impairing avoidance of a live tarantula. Eligible controls met no criteria for any disorder, were in the bottom 30% of questionnaire respondents, and displayed no avoidance of the tarantula. The randomisation schedule was generated with the open source Research Randomizer Tool. A research assistant randomly assigned participants to the active intervention of very brief exposure (VBE)-the repeated presentation of masked phobic stimuli (ie, spiders)-or the control intervention which used masked flowers (VBF). VBE and VBF were given code numbers to prevent staff from knowing which intervention they were administering. During a 10 min functional MRI (fMRI) task, each participant was exposed to 16 blocks of ten masked target stimuli (spiders or flowers), alternating with 16 blocks of ten masked neutral stimuli. A few minutes after fMRI, participants with spider phobia approached the tarantula again so we could measure changes in phobic behaviour. The primary outcome was real-time changes in brain activity measured by fMRI. All analyses were done by intention to treat. RESULTS We recruited 82 women, of whom 42 had spider phobia and 40 were controls. VBE generated stronger neural activity in participants with spider phobia than in controls, particularly in regions supporting emotion, emotion regulation, and attention systems, such as the inferior frontal cortex (Cohen's d 0·95, 95% CI 0·93-0·98, Bayesian posterior probability 99·5%) and the caudate nucleus (1·16, 1·14-1·18, 100·0%). In participants with phobia, VBE also generated stronger activity in these regions than did VBF (eg, dorsal anterior cingulate cortex Cohen's d 0·80, 95% CI 0·78-0·80, Bayesian posterior probability 98·5%; caudate nucleus 1·0, 0·98-1·02, 99·5%). VBE reduced avoidance of the live tarantula in participants with phobia. Regions supporting fear extinction (including ventral medial prefrontal cortex) and emotional salience processing mediated this effect. No adverse events occurred. INTERPRETATION VBE reduced fear non-consciously in participants with spider phobia by recruiting brain regions supporting automatic fear extinction, emotion regulation, and top-down attentional processing. Future studies should explore the use of VBE in other fear-based disorders. FUNDING National Institutes of Mental Health and Brain & Behavior Research Foundation.
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Affiliation(s)
- Paul Siegel
- School of Natural and Social Sciences, Purchase College, State University of New York (SUNY), Purchase, NY, USA.
| | - Zhishun Wang
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Lilly Murray
- School of Natural and Social Sciences, Purchase College, State University of New York (SUNY), Purchase, NY, USA
| | - Julianna Campos
- School of Natural and Social Sciences, Purchase College, State University of New York (SUNY), Purchase, NY, USA
| | - Virginia Sims
- School of Natural and Social Sciences, Purchase College, State University of New York (SUNY), Purchase, NY, USA
| | - Eva Leighton
- School of Natural and Social Sciences, Purchase College, State University of New York (SUNY), Purchase, NY, USA
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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23
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How many times do I need to see to believe? The impact of intolerance of uncertainty and exposure experience on safety-learning and retention in young adults. Int J Psychophysiol 2020; 153:8-17. [DOI: 10.1016/j.ijpsycho.2020.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 01/21/2023]
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24
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The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10113-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Difficulty updating threat associations to safe associations has been observed in individuals who score high in self-reported Intolerance of Uncertainty (IU). Here we sought to determine whether an instruction based on fundamental principles of Cognitive Behavioural Therapy could promote safety learning in individuals with higher levels of IU, whilst controlling for self-reported trait anxiety (STICSA).
Methods
We measured skin conductance response, pupil dilation and expectancy ratings during an associative threat learning task in which participants either received a cognitive behavioural instruction or no instruction prior to threat extinction (n = 92).
Results
Analyses revealed that both self-reported IU and STICSA similarly predicted differences in skin conductance response. Only individuals with lower IU/STICSA in the cognitive behavioural instruction condition displayed successful safety learning via skin conductance response.
Conclusions
These initial results provide some insight into how simple cognitive behavioural instructions combined with exposure are applied differently in individuals with varying levels of self-reported anxiety. The results further our understanding of the role of basic cognitive behavioural principles and self-reported anxiety in safety learning.
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Morriss J, van Reekum CM. I feel safe when i know: Contingency instruction promotes threat extinction in high intolerance of uncertainty individuals. Behav Res Ther 2019; 116:111-118. [DOI: 10.1016/j.brat.2019.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
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26
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Frank B, McKay D. Introduction to the Special Series: Clinical Applications of the Inhibitory Learning Model. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Woolf-King SE, Sheinfil AZ, Babowich JD, Siedle-Khan B, Loitsch A, Maisto SA. Acceptance and Commitment Therapy (ACT) for HIV-infected Hazardous Drinkers: A Qualitative Study of Acceptability. ALCOHOLISM TREATMENT QUARTERLY 2018; 37:342-358. [PMID: 31564766 PMCID: PMC6764523 DOI: 10.1080/07347324.2018.1539630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Alcohol use is a significant problem in HIV care, and clinical trials of alcohol interventions for people living with HIV infection (PLWH) have produced mixed results. The purpose of this qualitative study was to collect preliminary data on the practical feasibility and acceptability of Acceptance and Commitment Therapy (ACT) as a treatment for PLWH who are hazardous drinkers. A total of 25 PLWH participated in individual interviews. Four major themes emerged from the thematic analysis: (I) Perceived Appropriateness for PLWH and People who use Alcohol and/or other Substances, (II) General Satisfaction and Dissatisfaction, (III) Positive and Negative Effects on Participants and (IV) Facilitators and Barriers to Implementing ACT Intervention Strategies.
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Affiliation(s)
- Sarah E. Woolf-King
- Syracuse University, Department of Psychology, Syracuse, New York
- University of California, San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, California
| | - Alan Z Sheinfil
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - Bob Siedle-Khan
- University of California, San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, California
| | - Amanda Loitsch
- Syracuse University, Department of Psychology, Syracuse, New York
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29
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Van Minnen A, Hendriks L, Kleine RD, Hendriks GJ, Verhagen M, De Jongh A. Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder. Eur J Psychotraumatol 2018; 9:1492836. [PMID: 30034642 PMCID: PMC6052418 DOI: 10.1080/20008198.2018.1492836] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/27/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Trauma-focused treatments (TFTs) for patients with post-traumatic stress disorder (PTSD) are highly effective, yet underused by therapists.Objective: To describe a new way of implementing (adequate use of) TFTs, using a therapist rotation model in which one patient is treated by several therapists.Method: In this article, we will present two examples of working with therapist rotation teams in two treatment settings for TFT of PTSD patients. We explore the experiences with this model from both a therapist and a patient perspective.Results: Our findings were promising in that they suggested that this novel approach reduced the therapists' fear of providing TFT to PTSD patients, increased perceived readiness for TFT, and decreased avoidance behaviour within TFT sessions, possibly leading to better implementation of TFT. In addition, the therapeutic relationship as rated by patients was good, even by patients with insecure attachment styles.Conclusions: We suggest that therapist rotation is a promising novel approach to improve implementation of TFT for PTSD.
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Affiliation(s)
- Agnes Van Minnen
- PSYTREC, Bilthoven, The Netherlands
- NIJCARE, Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Lotte Hendriks
- NIJCARE, Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
| | - Rianne De Kleine
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Gert-Jan Hendriks
- NIJCARE, Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ad De Jongh
- PSYTREC, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- School of Health Sciences, University of Salford, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
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