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Shi P, Chen W, Li J, Weng Y, Zhang M, Zheng X. Novelty-retrieval-extinction paradigm to decrease high-intensity fear memory recurrence. J Affect Disord 2024; 354:26-35. [PMID: 38452938 DOI: 10.1016/j.jad.2024.02.088] [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: 07/14/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The retrieval-extinction paradigm based on memory reconsolidation can prevent fear memory recurrence more effectively than the extinction paradigm. High-intensity fear memories tend to resist reconsolidation. Novelty-retrieval-extinction can promote the reconsolidation of fear memory lacking neuroplasticity in rodents; however, whether it could effectively promote high-intensity fear memory reconsolidation in humans remains unclear. METHODS Using 120 human participants, we implemented the use of the environment (novel vs. familiar) with the help of virtual reality technology. Novelty environment exploration was combined with retrieval-extinction in fear memory of two intensity levels (normal vs. high) to examine whether novelty facilitates the reconsolidation of high-intensity fear memory and prevents recurrence. Skin conductance responses were used to clarify novelty-retrieval-extinction effects at the behavioral level across three experiments. RESULTS Retrieval-extinction could prevent the reinstatement of normal-intensity fear memory; however, for high-intensity fear memory, only the novelty-retrieval-extinction could prevent recurrence; we further validated that novelty-retrieval-extinction may be effective only when the environment is novel. LIMITATIONS Although the high-intensity fear memory is higher than normal-intensity in this study, it may be insufficient relative to fear experienced in real-world contexts or by individuals with mental disorders. CONCLUSIONS To some extent, these findings indicate that the novelty-retrieval-extinction paradigm could prevent the recurrence of high-intensity fear memory, and we infer that novelty of environment may play an important role in novelty-retrieval-extinction paradigm. The results of this study have positive implications for the existing retrieval extinction paradigm and the clinical treatment of phobia.
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Affiliation(s)
- Pei Shi
- School of Psychology, South China Normal University, Guangzhou, China; Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Wei Chen
- School of Psychology, South China Normal University, Guangzhou, China; Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Junjiao Li
- College of Teacher Education, Guangdong University of Education, Guangzhou, China
| | - Yuhan Weng
- School of Psychology, South China Normal University, Guangzhou, China; Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Mingyue Zhang
- School of Psychology, South China Normal University, Guangzhou, China; Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou, China; Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
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2
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Karner A, Zhang M, Lor CS, Steyrl D, Götzendorfer SJ, Weidt S, Melinscak F, Scharnowski F. The "SpiDa" dataset: self-report questionnaires and ratings of spider images from spider-fearful individuals. Front Psychol 2024; 15:1327367. [PMID: 38873522 PMCID: PMC11169805 DOI: 10.3389/fpsyg.2024.1327367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Alexander Karner
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Mengfan Zhang
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Cindy Sumaly Lor
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | | | - Steffi Weidt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Filip Melinscak
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
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Wannemueller A, Margraf J, Busch M, Jöhren HP, Suchan B. More than fear? Brain activation patterns of dental phobic patients before and after an exposure-based treatment. J Neural Transm (Vienna) 2024; 131:393-404. [PMID: 38424282 PMCID: PMC11016127 DOI: 10.1007/s00702-024-02754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Hyperactivation of brain networks conferring defensive mobilization is assumed to underlie inappropriate defensive-preparation in patients with Specific Phobia. However, studies targeting Dental Phobia (DP) yielded quite heterogeneous results and research concerning the effects of exposure treatments on phobic brain activation so far is missing. This functional Magnetic Resonance Imaging (fMRI) study aimed to investigate activation patterns in DP patients during exposure to phobia-related stimuli and the effects of an exposure-based fear treatment on phobia-related activation. Seventeen patients with DP and seventeen non-phobic, healthy controls participated in this fMRI experiment presenting dental-related and neutral auditory and visual stimuli. After completing a short exposure-based CBT program, patients were scanned a second time to illustrate treatment-related changes in brain activation patterns. Pre-treatment fMRI results demonstrate enhanced activation in DP-patients mainly in the precuneus and lateral parietal cortex. Moreover, a small activation focus was observed in the amygdala and anterior cingulate cortex (ACC) as parts of classically fear-related structures. Activation in all these clusters decreased significantly from pre- to post-treatment assessment and in the case of the ACC was correlated with dental fear reduction. Activation changes in the precuneus and lateral parietal cortex suggest a pronounced first-person perspective memory processing including a vivid recall of contextual information from an egocentric perspective triggered by exposure to phobia-related stimuli. Besides a treatment-sensitive hyperactivity of fear-sensitive structures, DP may also be characterized by a disturbed memory retrieval that can be reorganized by successful exposure treatment.
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Affiliation(s)
- André Wannemueller
- Center for the Study and Treatment of Mental Health, Ruhr University Bochum, Massenbergstr. 9-13, 44787, Bochum, Germany.
| | - Jürgen Margraf
- Center for the Study and Treatment of Mental Health, Ruhr University Bochum, Massenbergstr. 9-13, 44787, Bochum, Germany
| | - Martin Busch
- Grönemeyer-Institut for Microtherapy, Bochum, Germany
| | | | - Boris Suchan
- Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University, Bochum, Germany
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4
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Roesmann K, Leehr EJ, Böhnlein J, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Dannlowski U, Lueken U. Mechanisms of action underlying virtual reality exposure treatment in spider phobia: Pivotal role of within-session fear reduction. J Anxiety Disord 2023; 100:102790. [PMID: 37879242 DOI: 10.1016/j.janxdis.2023.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Although virtual-reality exposure treatment (VRET) for anxiety disorders is an efficient treatment option for specific phobia, mechanisms of action for immediate and sustained treatment response need to be elucidated. Towards this aim, core therapy process variables were assessed as predictors for short- and long-term VR treatment outcomes. In a bi-centric study, n = 186 patients with spider phobia completed a baseline-assessment, a one-session VRET, a post-therapy assessment, and a 6-month-follow-up assessment (ClinicalTrials.gov, ID: NCT03208400). Short- and long-term outcomes regarding self-reported symptoms in the spider phobia questionnaire (SPQ) and final patient-spider distance in the behavioral avoidance test (BAT) were predicted via logistic regression models with the corresponding baseline score, age, initial fear activation, within-session fear reduction and fear expectancy violation as predictors. To predict long-term remission status at 6-month-follow-up, dimensional short-term changes in the SPQ and BAT were additionally included. Higher within-session fear reductions predicted better treatment outcomes (long-term SPQ; short- and long-term BAT). Lower initial fear activation tended to be associated with better long-term outcomes (SPQ), while fear expectancy violation was not associated with any outcome measure. Short-term change in the SPQ predicted remission status. Findings highlight that in VRET for spider phobia, the experience of fear reduction is central for short- and long-term treatment success and should be focused by therapists.
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Affiliation(s)
- Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Psychology, Unit for Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany.
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Diemer J, Mühlberger A, Yassouridis A, Zwanzger P. Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial. J Behav Ther Exp Psychiatry 2023; 81:101860. [PMID: 37141687 DOI: 10.1016/j.jbtep.2023.101860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/03/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects. METHODS Thirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital. RESULTS Both conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions. LIMITATIONS Eye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size. CONCLUSIONS A balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.
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Affiliation(s)
- Julia Diemer
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany.
| | - Andreas Mühlberger
- Department of Clinical Psychology and Psychotherapy, University of Regensburg, Universitaetsstr. 31, 93053, Regensburg, Germany
| | - Alexander Yassouridis
- Max-Planck-Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany; Ethics Committee, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychiatry and Psychotherapy, LMU Munich, Nußbaumstr. 7, 80336, Munich, Germany
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6
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Hasan S, Alhaj H, Hassoulas A. The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review. JMIR Ment Health 2023; 10:e51318. [PMID: 38032710 PMCID: PMC10722365 DOI: 10.2196/51318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment. OBJECTIVE This systematic review investigated the novel technology's efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia. METHODS An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022. RESULTS A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object. CONCLUSIONS The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET's cost-effectiveness and examine its efficacy in other populations and anxiety conditions.
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Affiliation(s)
- Safa Hasan
- Cardiff University, Cardiff, United Kingdom
| | - Hamid Alhaj
- University of Sharjah, Sharjah, United Arab Emirates
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Farias ZBBMD, Campello CP, da Silveira MMF, Moraes SLD, do Egito Vasconcelos BC, Pellizzer EP. The influence of anxiety on pain perception and its repercussion on endodontic treatment: a systematic review. Clin Oral Investig 2023; 27:5709-5718. [PMID: 37526740 DOI: 10.1007/s00784-023-05181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To evaluate the influence of dental anxiety on the perception of pain before and during endodontic treatments. MATERIALS AND METHODS The PRISMA checklist was followed. A search was conducted in Scopus, Medline/PubMed, The Cochrane Library, and Web of Science databases. Based on PECOS criteria, the first outcome was a possible association between pre-operative pain and anxiety. The second outcome was a possible association between intraoperative pain and anxiety. The type of studies was observational. The JBI Critical Appraisal Checklist was used to evaluate the methodological quality of articles. The certainty of the evidence was analyzed using the GRADE approach. RESULTS Four articles were included with a total of 471 patients. Two studies found a positive association between pain and pre-endodontic treatment anxiety. Three studies investigated the relationship between anxiety and intraoperative pain; two identified an extremely significant positive association. One article noted that anxiety influences pain expectancy. The studies were of good quality as assessed by the JBI Critical Appraisal Checklist for cross-sectional studies. However, the certainty of the evidence was considered low and very low. CONCLUSIONS Dental anxiety can be directly associated with pre- and intraoperative pain during endodontic procedures. CLINICAL RELEVANCE It is necessary to identify patients with dental anxiety to employ therapies to bring their anxiety under control, avoiding the increase of endodontic infections, and the postponement and evasion of endodontic treatments.
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Affiliation(s)
- Zilda Betânia Barbosa Medeiros de Farias
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Camilla Porto Campello
- Department of Hebiatrics, Determinants of Health in Adolescence, School of Dentistry, University of Pernambuco (UPE), Recife, Brazil
| | - Márcia Maria Fonseca da Silveira
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.
| | | | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifacio street 1193, Araçatuba, São Paulo, 1605000, Brazil
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Geng W, Cao J, Jin L, Wei J. Case report: specific phobia of vaginal penetration in a pregnant patient. Front Psychiatry 2023; 14:1218900. [PMID: 37593448 PMCID: PMC10427344 DOI: 10.3389/fpsyt.2023.1218900] [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: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Specific phobia is frequently unrecognized or untreated unless it causes significant impairment. In this report, we documented a rare case of a pregnant patient who had a specific fear related to vaginal penetration. Due to abnormal fetal cardiac development in the second trimester, the patient was admitted for termination of pregnancy. The patient's persistent request for surgical termination via cesarean delivery prompted the obstetrician to seek psychiatric consultation for tokophobia, a labor- and childbirth-related phobia. The consulting psychiatrist discovered that the patient had developed a significant fear of vaginal penetration during adolescence. Throughout the extended period of this specific phobia, the patient established a range of avoidance strategies. Had it not been for the unforeseen need for abortion, her phobia may not have been identified. Psychoeducation on specific phobias, exposure therapy, muscle relaxation techniques, and the administration of anxiolytics were implemented. The pregnancy was terminated through a vaginal labor induction procedure 2 days later. Collaboration across disciplines is necessary to support a thorough assessment of obstetric patients who express hesitancy toward vaginal delivery.
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Affiliation(s)
- Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Jin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Rahman MA, Brown DJ, Mahmud M, Harris M, Shopland N, Heym N, Sumich A, Turabee ZB, Standen B, Downes D, Xing Y, Thomas C, Haddick S, Premkumar P, Nastase S, Burton A, Lewis J. Enhancing biofeedback-driven self-guided virtual reality exposure therapy through arousal detection from multimodal data using machine learning. Brain Inform 2023; 10:14. [PMID: 37341863 DOI: 10.1186/s40708-023-00193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023] Open
Abstract
Virtual reality exposure therapy (VRET) is a novel intervention technique that allows individuals to experience anxiety-evoking stimuli in a safe environment, recognise specific triggers and gradually increase their exposure to perceived threats. Public-speaking anxiety (PSA) is a prevalent form of social anxiety, characterised by stressful arousal and anxiety generated when presenting to an audience. In self-guided VRET, participants can gradually increase their tolerance to exposure and reduce anxiety-induced arousal and PSA over time. However, creating such a VR environment and determining physiological indices of anxiety-induced arousal or distress is an open challenge. Environment modelling, character creation and animation, psychological state determination and the use of machine learning (ML) models for anxiety or stress detection are equally important, and multi-disciplinary expertise is required. In this work, we have explored a series of ML models with publicly available data sets (using electroencephalogram and heart rate variability) to predict arousal states. If we can detect anxiety-induced arousal, we can trigger calming activities to allow individuals to cope with and overcome distress. Here, we discuss the means of effective selection of ML models and parameters in arousal detection. We propose a pipeline to overcome the model selection problem with different parameter settings in the context of virtual reality exposure therapy. This pipeline can be extended to other domains of interest where arousal detection is crucial. Finally, we have implemented a biofeedback framework for VRET where we successfully provided feedback as a form of heart rate and brain laterality index from our acquired multimodal data for psychological intervention to overcome anxiety.
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Affiliation(s)
- Muhammad Arifur Rahman
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - David J Brown
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - Mufti Mahmud
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK.
- Medical Technologies Innovation Facility, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK.
- Computing and Informatics Research Centre, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK.
| | - Matthew Harris
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - Nicholas Shopland
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - Nadja Heym
- School of Social Sciences, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Alexander Sumich
- School of Social Sciences, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Zakia Batool Turabee
- School of Social Sciences, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Bradley Standen
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - David Downes
- Nottingham School of Art & Design, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Yangang Xing
- School of ADBE, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Carolyn Thomas
- Nottingham School of Art & Design, Nottingham Trent University, Shakespeare St, Nottingham, NG1 4FQ, UK
| | - Sean Haddick
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - Preethi Premkumar
- Division of Psychology, London South Bank University, London, SE1 0AA, UK
| | | | - Andrew Burton
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - James Lewis
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
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Bocci F, Ferrari A, Sarini M. Putting the Gaming Experience at the Center of the Therapy-The Video Game Therapy ® Approach. Healthcare (Basel) 2023; 11:1767. [PMID: 37372884 DOI: 10.3390/healthcare11121767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Video games have been increasingly used as a form of therapy for various mental health conditions. Research has shown that video games can be used to treat conditions such as depression, anxiety, PTSD, and addiction. One of the main benefits of video games in therapy is that they can provide a sense of engagement and immersion that traditional therapy methods may lack. Additionally, video games can teach valuable skills such as problem solving, decision making, and coping strategies. Video games can also simulate real-life scenarios, allowing individuals to practice and improve social skills in a safe and controlled environment. Furthermore, video games can provide feedback and track progress objectively and quantifiably. This paper proposes an approach, the Video Game Therapy® (VGT®) approach, where game experience is put at the center of the therapy in a tailored way, connecting the individual patient's personality, the therapy's goals, and the suggested type of video game through the Myers Briggs Type Indicator (MBTI).VGT®'s core assumption is that playing video games could facilitate patients in reaching conditions where traditional methodologies and therapeutic approaches could work best. VGT® was elaborated according to the Adlerian therapy vision and, consequently, the different phases of Adlerian therapy and VGT® match. Despite the use of video games in psychotherapy might have some adverse effects in specific cases, VGT® is currently used in three associations with positive results in promoting emotional experimentation and literacy, social feeling, sense of identity, and activating cognitive processes. Future developments include expanding the use of VGT® further to validate such results from a statistical point of view.
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Affiliation(s)
- Francesco Bocci
- Playability Association, Via Sersane, 56, 25050 Ome, Italy
- Game Science Research Center, Via San Ponziano, 6, 55100 Lucca, Italy
| | - Ambra Ferrari
- Playability Association, Via Sersane, 56, 25050 Ome, Italy
| | - Marcello Sarini
- Game Science Research Center, Via San Ponziano, 6, 55100 Lucca, Italy
- Department of Psychology, University of Milano, Bicocca Piazza Ateneo Nuovo 1, 20126 Milano, Italy
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11
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Camerman E, Scheveneels S, Bosmans G. In safe hands: Attachment figures' safety properties and the link with attachment style. Behav Res Ther 2023; 163:104274. [PMID: 36803742 DOI: 10.1016/j.brat.2023.104274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
According to the Learning Theory of Attachment, naturalistic learning experiences about others' responsiveness during distress are an underlying mechanism in the development of attachment. Previous studies have demonstrated attachment figures' unique safety-inducing effects in highly controlled conditioning procedures. Yet, neither have studies examined the presumed influence of safety learning on state attachment, nor have they examined how attachment figures' safety-inducing effects relate to attachment styles. To address these gaps, a differential fear conditioning paradigm was used in which pictures of participants' attachment figure and two control stimuli served as safety cues (CS-). US-expectancy and distress ratings were measured as indicators of fear responding. Results indicate that attachment figures evoked enhanced safety responding compared to control safety cues at the start of acquisition, which was maintained throughout acquisition and when presented together with a danger cue. Attachment figures' safety-inducing effects were reduced in individuals with higher attachment avoidance, although attachment style did not affect the rate of new safety learning. Finally, safe experiences with the attachment figure in the fear conditioning procedure resulted in diminished anxious state attachment. Adding to previous work, these findings underscore the importance of learning processes for attachment development and attachment figures' provision of safety.
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Affiliation(s)
- Eline Camerman
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
| | - Sara Scheveneels
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Guy Bosmans
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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12
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Scheveneels S, De Witte N, Van Daele T. The first steps in facing your fears: The acceptability of virtual reality and in vivo exposure treatment for specific fears. J Anxiety Disord 2023; 95:102695. [PMID: 36921510 DOI: 10.1016/j.janxdis.2023.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Phobic individuals are often reluctant to engage in exposure in vivo (IVE). We examined whether providing exposure in virtual reality (VRE) can increase the acceptability. In Study 1, we provided 186 fearful participants with (hypothetical) VRE and IVE treatment offers and examined their willingness to engage in treatment, estimated success, negative beliefs, acceptance/refusal and their preference. Almost 70 % preferred VRE over IVE and acceptance rates were higher for the VRE offer (58 %) than for IVE (35 %). Although participants held fewer negative beliefs about VRE, they did rate IVE as slightly more successful. In Study 2, we examined whether VRE can serve as a stepping stone to IVE in a sample of 102 spider fearful individuals. Willingness to engage, estimated success and negative beliefs about IVE were assessed before and after VRE. After VRE, participants rated IVE as more successful, but were not more willing to engage in IVE, nor were they more inclined to accept an IVE offer. No decreases in negative beliefs were observed. In conclusion, VRE is deemed more acceptable than IVE and could lower refusal rates, hereby resulting in more phobic individuals receiving treatment. Future research should shed light on underlying motivations and associations.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
| | - Nele De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tom Van Daele
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
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13
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Maples-Keller JL, Sherrill A, Reddi P, Norrholm SD, Rothbaum BO. Extinction-Based Exposure Therapies Using Virtual Reality. Curr Top Behav Neurosci 2023; 64:335-352. [PMID: 37566312 DOI: 10.1007/7854_2023_437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The focus of this chapter is an overview of integrating virtual reality (VR) technology within the context of exposure therapy for anxiety disorders, a gold standard treatment, with a focus on how VR can help facilitate extinction learning processes integral to these interventions. The chapter will include an overview of advantages of incorporating VR within exposure therapy, and benefits specifically within an inhibitory learning approach for extinction training. A review of the empirical literature on the effectiveness of VR exposure therapy for specific phobia and PTSD will be provided, as well as practical overview of how to effectively incorporate VR within exposure therapy.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrew Sherrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Preethi Reddi
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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14
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Odgers K, Kershaw KA, Li SH, Graham BM. The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behav Res Ther 2022; 159:104203. [PMID: 36323055 DOI: 10.1016/j.brat.2022.104203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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Affiliation(s)
- Katarzyna Odgers
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Kelly A Kershaw
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Sophie H Li
- Black Dog Institute, University Of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University Of New South Wales, Sydney, Australia.
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15
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Adults with Animal Phobia: Systematic Replication of Clinical Cases. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Animal phobia is common in children, but it is also frequent in adults who maintain the problem throughout their lives. Eleven cases of animal phobia that were treated with progressive multimedia exposure are presented. The participants were two men and nine women (aged 19–27 years), with anxiety and avoidance problems in relation to various animals. A single-case A-B-Follow-up design was carried out, with concurrent control of several baselines; and a systematic between-subjects replication, with the same treatment repeated across different participants and types of phobias. A behavioural interview, phobia questionnaires, and Multimedia Behavioural Avoidance Test (M-BAT) with pictures and videos of animals, as well as heart rate, were used for assessment purposes. The intervention was the progressive multimedia exposure in four phases (photographs, videos, simulated animals, and live exposure), in addition to diaphragmatic breathing, and homework assignments. The results replicate the same efficacy in each of the participants, with statistically significant and clinical changes in their daily lives. Also, the data as a group show this success with a high Cohen's d effect size (between −1.63 and −30.03). We conclude with an appraisal of the usefulness of the procedure for adults with phobias who do not tolerate direct exposure.
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Azimisefat P, de Jongh A, Rajabi S, Kanske P, Jamshidi F. Efficacy of virtual reality exposure therapy and eye movement desensitization and reprocessing therapy on symptoms of acrophobia and anxiety sensitivity in adolescent girls: A randomized controlled trial. Front Psychol 2022; 13:919148. [PMID: 36186313 PMCID: PMC9521642 DOI: 10.3389/fpsyg.2022.919148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAcrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to investigate the efficacy of two therapies that may ameliorate symptoms of acrophobia and anxiety sensitivity, i.e., virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy with a Waiting List Control Condition (WLCC).MethodsWe applied a three-armed randomized controlled pre-post-test design with 45 female adolescent students. Students who met DSM-5 criteria for acrophobia were randomly assigned to either VRET (N = 15; Mage = 17.26; SD = 1.32), EMDR (N = 15; Mage = 17.15; SD = 1.57), or a WLCC (N = 15; Mage = 17.50; SD = 1.26). The study groups were evaluated one week before the intervention and one week after the last intervention session regarding symptoms of acrophobia (Severity Measure for Acrophobia) and anxiety sensitivity (Anxiety Sensitivity Index).ResultsThe data showed that both the application of VRET and EMDR therapy were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and anxiety sensitivity (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List.LimitationsThe sample consisted only of adolescent women. Due to the recognizable differences between the two interventions, the therapists and the participants were not blind to the conditions.ConclusionThe results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity in female adolescents.Clinical Trial Registrationhttps://www.irct.ir/trial/57391, identifier: IRCT20210213050343N1.
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Affiliation(s)
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - Soran Rajabi
- Department of Psychology, Persian Gulf University, Bushehr, Iran
- *Correspondence: Soran Rajabi,
| | - Philipp Kanske
- Clinical Psychology and Behavioural Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Fatemeh Jamshidi
- Department of Psychology, Persian Gulf University, Bushehr, Iran
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17
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Sunkara C, Thakkar R, Ong T, Bunnell BE. Characterizing Consumer Smartphone Apps for Virtual Reality-Based Exposure Therapy: Content Analysis (Preprint). J Med Internet Res 2022; 25:e41807. [PMID: 37058343 PMCID: PMC10148210 DOI: 10.2196/41807] [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: 08/09/2022] [Revised: 11/18/2022] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. OBJECTIVE The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. METHODS We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. RESULTS The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. CONCLUSIONS None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions.
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Affiliation(s)
- Charvi Sunkara
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rajvi Thakkar
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Triton Ong
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
| | - Brian E Bunnell
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
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18
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Fumero A, Marrero RJ, Olivares T, Rivero F, Alvarez-Pérez Y, Pitti C, Peñate W. Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing Therapeutic Components of Cognitive Behavioral Therapy. Life (Basel) 2022; 12:life12081132. [PMID: 36013311 PMCID: PMC9410164 DOI: 10.3390/life12081132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Cognitive behavioral therapy (CBT) packages for anxiety disorders, such as phobias, usually include gradual exposure to anxious contexts, positive self-verbalizations, and relaxation breathing. The objective of this research was to analyze the specific neural activation produced by the self-verbalizations (S) and breathing (B) included in CBT. Thirty participants with clinical levels of a specific phobia to small animals were randomly assigned to three fMRI conditions in which individuals were exposed to phobic stimuli in real images: a group underwent S as a technique to reduce anxiety; a second group underwent B; and a control group underwent exposure only (E). Simple effects showed higher brain activation comparing E > S, E > B, and S > B. In particular, in the E group, compared to the experimental conditions, an activation was observed in sensory-perceptive and prefrontal and in other regions involved in the triggering of emotion (i.e., amygdala, supplementary motor area, and cingulate gyrus) as well as an activation associated with interoceptive sensitivity (i.e., insula and cingulate cortex). According to the specific tool used, discrepancies in the neural changes of CBT efficacy were observed. We discuss the theoretical implications according to the dual model of CBT as a set of therapeutic tools that activate different processes.
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Affiliation(s)
- Ascensión Fumero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
- Correspondence:
| | - Rosario J. Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
| | - Teresa Olivares
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
| | - Francisco Rivero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, 38300 La Orotava, Tenerife, Spain
| | | | - Carmen Pitti
- Dirección General de Salud Pública, Servicio Canario de la Salud, 38006 Santa Cruz, Tenerife, Spain;
| | - Wenceslao Peñate
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
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Lacey C, Frampton C, Beaglehole B. oVRcome - Self-guided virtual reality for specific phobias: A randomised controlled trial. Aust N Z J Psychiatry 2022; 57:736-744. [PMID: 35818296 DOI: 10.1177/00048674221110779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mobile health applications for mental health are widely accessible but most have had limited research evaluation. Virtual reality exposure therapy is an emerging treatment for specific phobias. Most virtual reality studies have investigated high-end virtual reality devices, typically only available in research and limited clinical settings for a single phobia. This study evaluated the effectiveness of oVRcome, a mobile health application combining self-guided virtual reality exposure and cognitive behaviour therapy, for five specific phobias. METHODS This is a 2-arm 6-week randomised controlled trial, with a waitlist control group and follow-up at week 12. Participants were required to live in New Zealand; be aged 18-64 years; have a fear of flying, heights, spiders, dogs and needles; score above 4 on the Brief Standard Self-rating scale for phobic patients; and have access to a smartphone and Internet. oVRcome consists of six modules of psychoeducation, relaxation, mindfulness, cognitive techniques, exposure through virtual reality and relapse prevention over 6 weeks. The primary outcome was the change from baseline to week 6 on the Severity Measures for Specific Phobia - Adults. All analyses were performed on intention-to-treat set. RESULTS A total of 126 participants were randomised, and 109 completed the follow-up at week 6, for a retention rate of 86.5%. The mean change in Severity Measures for Specific Phobia - Adults score from baseline to week 6 was greater in the active group compared with the waitlist group (active group -20.53 [standard deviation = 8.24]; waitlist group: - 12.31 [standard deviation = 10.66]; p < 0.001). The effect size for this difference was 0.86. CONCLUSION Self-guided use of the oVRcome app was effective at reducing severity of specific phobia symptoms in a sample of people with a self-reported fear of flying, heights, spiders, dogs or needles.Trial registry clinicaltrials.gov NCT04909177.
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Affiliation(s)
- Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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20
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Baldini A, Frumento S, Menicucci D, Gemignani A, Scilingo EP, Greco A. Modeling subjective fear using skin conductance: a preliminary study in virtual reality. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3451-3454. [PMID: 36086358 DOI: 10.1109/embc48229.2022.9871557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Reliably measuring fear perception could help evaluate the effectiveness of treatments for pathological conditions such as specific phobias or post-traumatic stress syndrome (e.g., exposure therapy). In this study, we developed a novel vir-tual reality (VR) scenario to induce fear and evaluate the related physiological response by the analysis of skin conductance (SC) signal. Eighteen subjects voluntarily experienced the fear VR scenario while their SC was recorded. After the experiment, each participant was asked to score the perceived subjective fear using a Likert scale from 1 to 10. We used the cvxEDA algorithm to process the collected SC signals and extract several features able to estimate the autonomic response to the fearful stimuli. Finally, the extracted features were linearly combined to model the subjective fear perception scores by means of LASSO linear regression. The sparsification imposed by the LASSO procedure to mitigate the overfitting risk identified an optimal linear model including only the standard deviation of the tonic SC component as a regressor (p = 0.007; R2 = 0.3337). The significant contribution of this feature to the model suggests that subjects experiencing more intense subjective fear have a more variable and unstable sympathetic tone.
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21
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Binder FP, Pöhlchen D, Zwanzger P, Spoormaker VI. Facing Your Fear in Immersive Virtual Reality: Avoidance Behavior in Specific Phobia. Front Behav Neurosci 2022; 16:827673. [PMID: 35571283 PMCID: PMC9094686 DOI: 10.3389/fnbeh.2022.827673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
Specific phobias are the most common anxiety disorder and are characterized by avoidance behavior. Avoidance behavior impacts daily function and is proposed to impair extinction learning. However, despite its prevalence, its objective assessment remains a challenge. To this end, we developed a fully automated experimental procedure using immersive virtual reality. The procedure contained a behavioral search, forced-choice, and an approach task with varying degrees of freedom and task relevance of the stimuli. In this study, we examined the sensitivity and feasibility of these tasks to assess avoidance behavior in patients with specific phobia. We adapted the tasks by replacing the originally conditioned stimuli with a spider and a neutral animal and investigated 31 female participants composed of 15 spider-phobic and 16 non-phobic participants. As the non-phobics were quite heterogeneous in terms of their Fear of Spiders Questionnaire (FSQ) scores, we subdivided them into six “fearfuls” that had elevated FSQ scores, and 10 “non-fearfuls” that had no fear of spiders. The phobics successfully managed to complete the procedure and showed consistent avoidance behavior across all behavioral tasks. Compared to the non-fearfuls, which did not show any avoidance behavior at all, the phobics looked at the spider much more often and clearly directed their body toward it in the search task. In the approach task, they hesitated most when they were close to the spider, and their difficulty to touch the spider was reflected in a strong increase in right hand acceleration changes. The fearfuls showed avoidance behavior depending on the tasks: strongest in the search task and weakest in the approach task. Additionally, we identified subjective valence ratings of the spider as the main influence on both objective avoidance behavior and subjective well-being after exposure, mediating the effect of the FSQ. In summary, the behavioral tasks are well suited to assess avoidance behavior in phobic participants and provide detailed insights into the process of avoidance.
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Affiliation(s)
- Florian P. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Max Planck Institute of Psychiatry, Munich, Germany
- *Correspondence: Florian P. Binder,
| | - Dorothee Pöhlchen
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Max Planck Institute of Psychiatry, Munich, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Hospital, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine and Geriatrics, Wasserburg am Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Victor I. Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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22
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Mor S, Botella C, Campos D, Carlbring P, Tur C, Quero S. An internet-based treatment for flying phobia using 360° images: A feasibility pilot study. Internet Interv 2022; 28:100510. [PMID: 35242593 PMCID: PMC8866141 DOI: 10.1016/j.invent.2022.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND More research is needed in the field of Internet-delivered Cognitive Behavioral Treatments (ICBTs) for specific phobia in order to understand which characteristics are important in online exposure scenarios. The aim of the present work was to conduct a feasibility pilot study to explore participants' opinions, preferences, and acceptability ratings of two types of images (still images vs 360° navigable images) in an ICBT for Flying Phobia (FP). A secondary aim was to test the potential effectiveness of the two active treatment arms compared to a waiting list control group. An exploratory aim was to compare the role of navigable images vs. still images in the level of sense of presence and reality judgment and explore their possible mediation in treatment effectiveness. METHODS Participants were randomly allocated to three conditions: NO-FEAR Airlines with still images (n = 26), NO-FEAR Airlines with still and navigable images (n = 26), and a waiting list group (n = 26). Primary outcome measures were participants' opinions, preferences, satisfaction, and acceptance regarding the images used in the exposure scenarios. Secondary outcome measures included FP symptomatology outcomes and measures of sense of presence and reality judgment. RESULTS Participants in the study preferred navigable images over still images before and after treatment (over 84%), and they considered them more effective and logical for the treatment of their problem. However, adherence in the experimental conditions was low (42.3% dropout rate), and more participants withdrew from the group that included navigable images compared to the group that only included still images (14 vs. 8), with no statistical differences in attrition between the two conditions. NO-FEAR Airlines proved to be effective in reducing FP symptomatology compared to the control group, with large between-group effect sizes on all FP measures (ranging from 0.76 to 2.79). No significant mediation effect was found for sense of presence or reality judgment in treatment effectiveness. DISCUSSION The results of the current study suggest that participants prefer more immersive images in exposure scenarios, providing data that can help to design useful exposure scenarios to treat specific phobias in the future. They also provide evidence supporting the effectiveness of an ICBT for FP. TRIAL REGISTRATION Registered at Clinicaltrials.gov (NCT03900559) on April 9, 2019. Retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- 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
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain.
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23
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Ueno H, Takahashi Y, Suemitsu S, Murakami S, Kitamura N, Wani K, Matsumoto Y, Okamoto M, Ishihara T. Mice can recognise water depths and will avoid entering deep water. Transl Neurosci 2022; 13:1-10. [PMID: 35173982 PMCID: PMC8805799 DOI: 10.1515/tnsci-2020-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Rodents are averse to bodies of water, and this aversion has been exploited in experiments designed to study stress in mice. However, a few studies have elucidated the characteristics of murine water aversion. In this study, we investigated how mice behave in and around areas filled with water. Using variants of the open field test that contained pools of water at corners or sides of the field, we recorded the movements of mice throughout the field under various conditions. When the water was 8 mm deep, the mice explored the water pool regardless of whether an object was placed within it, but when the water was 20 mm deep, the mice were less willing to enter it. When the mice were placed on a dry area surrounded by 3 mm-deep water, they explored the water, but when they were surrounded by 8 mm-deep water, they stayed within the dry area. Our results indicate that mice exhibit exploratory behaviours around water, they can recognise water depths and avoid unacceptably deep water, and their willingness to enter water may be reduced by situational anxiety. Our experimental method could be used to investigate water-related anxiety-like behaviours in mice.
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Affiliation(s)
- Hiroshi Ueno
- Department of Medical Technology, Kawasaki University of Medical Welfare , Okayama 701-0193 , Japan
| | - Yu Takahashi
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
| | - Shunsuke Suemitsu
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
| | - Shinji Murakami
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
| | - Naoya Kitamura
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
| | - Kenta Wani
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
| | - Yosuke Matsumoto
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama 700-8558 , Japan
| | - Motoi Okamoto
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University , Okayama 700-8558 , Japan
| | - Takeshi Ishihara
- Department of Psychiatry, Kawasaki Medical School , Kurashiki 701-0192 , Japan
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24
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Keane N, Farrell A, Hallahan B. Pregnancy-related claustrophobia. BMJ Case Rep 2022; 15:e246568. [PMID: 35027381 PMCID: PMC8762120 DOI: 10.1136/bcr-2021-246568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/03/2022] Open
Abstract
A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks' gestation. Symptoms were preceded by a nightmare about her upcoming labour. She developed repetitive intrusive thoughts of being trapped emotionally and physically in her pregnancy. Her symptoms were suggestive of new-onset claustrophobia associated with pregnancy, which has not been previously reported on. Her symptoms ameliorated with a combination of cognitive-behavioural therapy and pharmacotherapy (sertraline and low dose quetiapine). The later stages of pregnancy were associated with minimal symptoms and the resolution of her subjective 'entrapment'. A subsequent pregnancy resulted in similar although less severe symptomatology. No postpartum anxiety symptoms were demonstrated on both occasions. Anxiety symptoms can adversely impact both the mother and fetus, and thus correct identification and management of pregnancy-related claustrophobia improved symptomatology and functioning and allowed for earlier detection and reduced symptomatology in a subsequent pregnancy.
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Affiliation(s)
- Nessa Keane
- Department of Psychiatry, Galway University Hospitals, Galway, Ireland
| | - Amy Farrell
- Department of Psychiatry, Galway University Hospitals, Galway, Ireland
| | - Brian Hallahan
- Department of Psychiatry, Galway University Hospitals, Galway, Ireland
- Psychiatry, National University of Ireland Galway, Galway, Ireland
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25
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Leuchter MK, Rosenberg BM, Schapira G, Wong NR, Leuchter AF, McGlade AL, Krantz DE, Ginder ND, Lee JC, Wilke SA, Tadayonnejad R, Levitt J, Marder KG, Craske MG, Iacoboni M. Treatment of Spider Phobia Using Repeated Exposures and Adjunctive Repetitive Transcranial Magnetic Stimulation: A Proof-of-Concept Study. Front Psychiatry 2022; 13:823158. [PMID: 35370840 PMCID: PMC8965447 DOI: 10.3389/fpsyt.2022.823158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Specific phobias represent the largest category of anxiety disorders. Previous work demonstrated that stimulating the ventromedial prefrontal cortex (vmPFC) with repetitive Transcranial Magnetic Stimulation (rTMS) may improve response to exposure therapy for acrophobia. OBJECTIVE To examine feasibility of accelerating extinction learning in subjects with spider phobia using intermittent Theta Burst Stimulation (iTBS) rTMS of vmPFC. METHODS In total, 17 subjects with spider phobia determined by spider phobia questionnaires [Spider Phobia Questionnaire (SPQ) and Fear of Spiders questionnaire (FSQ)] underwent ratings of fear of spiders as well as behavioral and skin conductance data during a behavioral avoidance test (BAT). Subjects then received a sequential protocol of in vivo spider exposure followed by iTBS for three sessions administered to either active or control treatment sites (vmPFC [n = 8] or vertex [n = 9], respectively), followed 1 week later by repetition of questionnaires and BAT. RESULTS All subjects improved significantly regardless of group across both questionnaires (FSQ η2 = 0.43, p = 0.004; SPQ η2 = 0.39, p = 0.008) and skin conductance levels during BAT (Wald χ2 = 30.9, p < 0.001). Subjects in the vmPFC group tolerated lower treatment intensity than in the control group, and there was a significant correlation between treatment intensity, BAT subjective distress improvement, and physiologic measures (all ρ > 0.5). CONCLUSION This proof-of-concept study provides preliminary evidence that a sequential exposure and iTBS over vmPFC is feasible and may have rTMS intensity-dependent effects on treatment outcomes, providing evidence for future areas of study in the use of rTMS for phobias.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Giuditta Schapira
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nicole R Wong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Anastasia L McGlade
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jonathan C Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
| | - Jennifer Levitt
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Katharine G Marder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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26
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von Mücke-Heim IA, Walter I, Nischwitz S, Erhardt A. Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report. Front Psychiatry 2022; 13:915058. [PMID: 35903630 PMCID: PMC9314666 DOI: 10.3389/fpsyt.2022.915058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most frequent mental disorders. Among the different subtypes, specific phobias are the commonest. Due to the ongoing SARS-CoV-19 pandemic, blood-injury-injection phobia (BII) has gained wider attention in the context of large-scale vaccination campaigns and public health. In this BII phobia mini-review and case report, we describe the successful treatment of a severe BII phobia case with combined fainting and psychogenic non-epileptic seizures (PNES) and demonstrate the role of specialized outpatient care. CASE REPORT The patient was a 28-year-old woman. She suffered from intense fear and recurrent fainting with regard to needles, injections, injuries, and at the sight of blood since early childhood. Medical history revealed infrequent events suggestive of PNES following panic attacks after sustained exposure to phobic stimuli. Family history was positive for circulation problems and BII fears. Psychopathological evaluation confirmed BII phobia symptoms and diagnosis was made according to the DSM-5. The Multidimensional Blood/Injury Phobia Inventory short version (MBPI-K) revealed severe manifestation of the disease. Neurological examination was ordinary. Repeated electroencephalography detected no epileptic pattern. Cranial magnetic resonance imaging showed normal morphology. Treatment was carried out by a seasoned, multidisciplinary team. Cognitive behavior therapy and exposure were performed. Modification of standard treatment protocol was necessary due to hurdles posed by recurrent fainting and a severe panic-triggered dissociative PNES during in vivo exposure. Modification was implemented by limiting in vivo exposure intensity to moderate anxiety levels. In addition to applied muscle tension and ventilation techniques, increased psychoeducation, cognitive restructuring, and distress tolerance skills (e.g., ice pack, verbal self-instructions) were used to strengthen the patient's situational control during in vivo exposure. A total of 15 sessions were performed. Therapy success was proven by 83% reduction in MBPI-K rating, SARS-CoV-19 vaccination, and a blood draw without psychological assistance, fainting, or seizure. CONCLUSION Taken together, this case demonstrates the potential of and need for specialized outpatient care and individualized treatment for severe BII phobia patients in order to provide them the perspective to have necessary medical procedures done and get vaccinated.
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Affiliation(s)
- Iven-Alex von Mücke-Heim
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Isabelle Walter
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Sandra Nischwitz
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Angelika Erhardt
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Würzburg, Germany
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27
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Towards Machine Learning Driven Self-guided Virtual Reality Exposure Therapy Based on Arousal State Detection from Multimodal Data. Brain Inform 2022. [DOI: 10.1007/978-3-031-15037-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Krause L, Askew C. Preventing and reducing fear using positive modelling: A systematic review of experimental research with children. Behav Res Ther 2021; 148:103992. [PMID: 34837839 DOI: 10.1016/j.brat.2021.103992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
Fear of specific stimuli is thought to develop through associative learning mechanisms and research indicates that a form of observational (vicarious) learning known as positive modelling can counter these effects. This systematic review examined and synthesised the experimental positive modelling literature to establish its efficacy for reducing fear. Psych Info, Medline and the Psychology and Behavioural Science Collection databases were systematically searched until August 2021. Of the 1,677 papers identified, 18 experiments across 14 articles met the inclusion criteria. In the majority of these, positive modelling was found to lower fear levels in one or more of three procedures: fear prevention, fear reduction and fear reversal. Procedures inform prevention and treatment initiatives for specific phobias in several ways. The overall efficacy of positive modelling techniques and the ease in which they can be implemented highlight the importance of further research to evaluate their inclusion in prevention and treatment interventions. More research is required to establish the longevity and transferability of positive modelling.
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Affiliation(s)
- Litza Krause
- School of Psychology, University of Surrey, United Kingdom
| | - Chris Askew
- School of Psychology, University of Surrey, United Kingdom.
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29
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Reuman L, Abramowitz JS. GIV CARE: A Group Intervention to Reduce Accommodation Among Relatives of Individuals With Fear-Based Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:336-349. [PMID: 34690481 DOI: 10.1016/j.cbpra.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.
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30
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Li SH, Graham BM. Mind's eye: The impact of spider presence and cognitive therapy on size estimation biases in spider phobia. J Anxiety Disord 2021; 83:102456. [PMID: 34340170 DOI: 10.1016/j.janxdis.2021.102456] [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: 11/26/2020] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
The present study assessed the circumstances under which size estimation biases in spider phobia occur, and whether such biases are modifiable by treatment. Women with (n = 67) and without (n = 33) spider phobia approached a spider during a behavioral approach test (BAT). They provided size estimates of the spider both during and shortly after the BAT (with the spider in view, or not in view, respectively). Phobic women then received cognitive therapy or a placebo treatment and one week later they underwent a second BAT and provided size estimates of the same spider during and after the BAT. Phobic women reported larger size estimates than non-phobic women after, but not during, the BAT. Size estimates after, but not during, the BAT correlated with self-reported fear but not avoidance. Size estimates after, but not during, the BAT reduced from the first to second BAT in phobic women; an effect evident in both the cognitive therapy and placebo treatment conditions. Changes in size estimates were not associated with treatment-induced reductions in fear or avoidance. These results suggest that estimation biases in spider phobia are likely driven by non-perceptual processes. The clinical utility of size estimation measures is discussed.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, Australia.
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31
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West K. I Feel Better Naked: Communal Naked Activity Increases Body Appreciation by Reducing Social Physique Anxiety. JOURNAL OF SEX RESEARCH 2021; 58:958-966. [PMID: 32500740 DOI: 10.1080/00224499.2020.1764470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Positive body image predicts several measures of happiness, well-being, and sexual functioning. Prior research has suggested a link between communal naked activity and positive body image, but has thus far not clarified either the direction or mechanisms of this relationship. This was the first randomized controlled trial of the effects of nakedness on body image. Two potential explanatory mediators of this effect were also investigated. Fifty-one participants were randomly assigned to one of two groups in which they interacted with other people either naked (naked condition) or clothed (control condition). All participants completed measures of body appreciation before and after the intervention, as well as measures of the relative perceived attractiveness of others and social physique anxiety immediately after the intervention. Perceived attractiveness of others was neither affected by the manipulation nor correlated with body appreciation. However, as expected, participants in the naked condition reported more body appreciation, an effect that was mediated by reductions in social physique anxiety. This research provides initial evidence that naked activity can lead to improvements in body image and evidence of a specific explanatory mechanism. Theoretical and practical implications are discussed.
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Affiliation(s)
- Keon West
- Department of Psychology, Goldsmiths, University of London
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32
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Deshpande AK, Bhatt I, Rojanaworarit C. Virtual reality for tinnitus management: a randomized controlled trial. Int J Audiol 2021; 61:868-875. [PMID: 34550862 DOI: 10.1080/14992027.2021.1978568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sound therapy (ST) and stress reduction regimens have been successfully used to manage tinnitus. Virtual reality (VR) has been used to manage chronic conditions like intractable pain. The aim of the present study was to investigate whether the use of VR in conjunction with ST revealed additional improvements in tinnitus attributes as compared to ST alone. DESIGN This study was a randomised controlled trial (RCT) with a cross-over design. All participants received two interventions - ST alone (control) and ST with VR stimuli (experimental). ST consisted of fractal tones while VR stimuli comprised of nature videos presented via VR goggles. A multilevel mixed-effects linear regression model was used to estimate the intervention effect. STUDY SAMPLE Twenty adults with subjective, continuous, chronic tinnitus participated in the study. RESULTS After adjusting for period and baseline tinnitus loudness, significant improvements were observed in tinnitus loudness and Tinnitus Functional Index scores. Although not statistically significant, mean minimum masking levels were lower after the experimental intervention. CONCLUSIONS Study participants benefitted from the use of VR in conjunction with ST in a laboratory setting. Additional effectiveness trials and blinded RCTs will be needed before validating the use of VR for tinnitus management in clinical settings.
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Affiliation(s)
- Aniruddha K Deshpande
- The Hear-Ring Lab, Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY, USA.,The Long Island AuD Consortium, Garden City, NY, USA
| | - Ishan Bhatt
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Chanapong Rojanaworarit
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
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33
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Baldi E, Costa A, Rani B, Passani MB, Blandina P, Romano A, Provensi G. Oxytocin and Fear Memory Extinction: Possible Implications for the Therapy of Fear Disorders? Int J Mol Sci 2021; 22:10000. [PMID: 34576161 PMCID: PMC8467761 DOI: 10.3390/ijms221810000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Abstract
Several psychiatric conditions such as phobias, generalized anxiety, and post-traumatic stress disorder (PTSD) are characterized by pathological fear and anxiety. The main therapeutic approach used in the management of these disorders is exposure-based therapy, which is conceptually based upon fear extinction with the formation of a new safe memory association, allowing the reduction in behavioral conditioned fear responses. Nevertheless, this approach is only partially resolutive, since many patients have difficulty following the demanding and long process, and relapses are frequently observed over time. One strategy to improve the efficacy of the cognitive therapy is the combination with pharmacological agents. Therefore, the identification of compounds able to strengthen the formation and persistence of the inhibitory associations is a key goal. Recently, growing interest has been aroused by the neuropeptide oxytocin (OXT), which has been shown to have anxiolytic effects. Furthermore, OXT receptors and binding sites have been found in the critical brain structures involved in fear extinction. In this review, the recent literature addressing the complex effects of OXT on fear extinction at preclinical and clinical levels is discussed. These studies suggest that the OXT roles in fear behavior are due to its local effects in several brain regions, most notably, distinct amygdaloid regions.
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Affiliation(s)
- Elisabetta Baldi
- Section of Physiological Sciences, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Alessia Costa
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences (DSS), University of Florence, 50139 Florence, Italy; (A.C.); (B.R.); (M.B.P.)
| | - Barbara Rani
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences (DSS), University of Florence, 50139 Florence, Italy; (A.C.); (B.R.); (M.B.P.)
| | - Maria Beatrice Passani
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences (DSS), University of Florence, 50139 Florence, Italy; (A.C.); (B.R.); (M.B.P.)
| | - Patrizio Blandina
- Section of Pharmacology of Toxicology, Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy;
| | - Adele Romano
- Department of Physiology and Pharmacology ‘V. Erspamer’, Sapienza University of Rome, 00185 Rome, Italy;
| | - Gustavo Provensi
- Section of Pharmacology of Toxicology, Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy;
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34
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Townsend JA, Randall CL. Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance. Dent Clin North Am 2021; 65:731-751. [PMID: 34503664 DOI: 10.1016/j.cden.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.
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Affiliation(s)
- Janice A Townsend
- Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, LA Suite 5A, Columbus, OH 43205, USA; Division of Pediatric Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA
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35
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Bryne E, Hean S, Evensen K, Bull V. More than just a dental practitioner: A realist evaluation of a dental anxiety service in Norway. Eur J Oral Sci 2021; 129:e12820. [PMID: 34448277 DOI: 10.1111/eos.12820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022]
Abstract
Patients with dental phobia or a history of trauma tend to avoid dental services, which may, over time, lead to poor oral health. In Norway, a specific service targets these patients by providing exposure therapy to treat their fear of attendance and subsequently enable oral restoration. Dental practitioners deliver the exposure therapy, which requires a role change that deviates from their traditional practice. This paper explores how - and under what circumstances - dental practitioners manage this new role of alleviating dental anxiety for patients with a history of trauma or dental phobia. Using a realist evaluation approach, this paper develops theory describing which contexts promote mechanisms that allow practitioners to alleviate dental anxiety for patients with trauma or dental phobia. A multi-method approach, comprising service documents (n = 13) and stakeholder interviews (n = 12), was applied. The data were then analysed through a content analysis and context-mechanism-outcome heuristic tool. Our findings reveal that dental practitioners must adopt roles that enable trust, a safe space, and gradual desensitisation of the patient to their fear triggers. Adopting these roles requires time and resources to develop practitioners' skills - enabling them to adopt an appropriate communication style and exposure pace for each patient.
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Affiliation(s)
- Emilie Bryne
- Oral Health Centre of Expertise, Stavanger, Rogaland, Norway.,Faculty of Social Sciences at the University of Stavanger, Stavanger, Norway
| | - Sarah Hean
- Faculty of Social Sciences at the University of Stavanger, Stavanger, Norway
| | - Kjersti Evensen
- Oral Health Centre of Expertise, Stavanger, Rogaland, Norway
| | - Vibeke Bull
- Oral Health Centre of Expertise, Stavanger, Rogaland, Norway
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36
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From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning. CURRENT PSYCHOLOGY 2021; 42:8697-8704. [PMID: 34429574 PMCID: PMC8376294 DOI: 10.1007/s12144-021-02158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary ‘I met you’ from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.
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Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial. J Anxiety Disord 2021; 82:102442. [PMID: 34246153 DOI: 10.1016/j.janxdis.2021.102442] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/25/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet. We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up. Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen's d = 0.57, p = 0.010). The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.
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Creative Intervention for Acrophobia Sufferers through AIVE Concept. INFORMATION 2021. [DOI: 10.3390/info12070261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research applies exposure to the visual appearance technology of virtual reality (VR). The motivation for this research is to generate a creative intervention by using regular smartphone devices and implementing them in VR using Google Cardboard as a medium visual display for exposure therapy at high altitudes. The VR application in this research is called acrophobia immersive virtual exposure (AIVE), which utilizes the Unity3D software to develop this treatment therapy application. The utilization of exposure therapy was carried out as a therapeutic medium for acrophobia sufferers. A commissioner was given to measure the usefulness of applications and devices in the VR environment created, and as many as 20 users had tested the VR device. The existing questionnaire was revised to develop a questionnaire for acrophobia sufferers, which was then used as an index measurement in the VR environment. The research is expected to be used to design a simulator and as a therapeutic medium using immersive VR devices in future studies.
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Frumento S, Menicucci D, Hitchcott PK, Zaccaro A, Gemignani A. Systematic Review of Studies on Subliminal Exposure to Phobic Stimuli: Integrating Therapeutic Models for Specific Phobias. Front Neurosci 2021; 15:654170. [PMID: 34149346 PMCID: PMC8206785 DOI: 10.3389/fnins.2021.654170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
We systematically review 26 papers investigating subjective, behavioral, and psychophysiological correlates of subliminal exposure to phobic stimuli in phobic patients. Stimulations were found to elicit: (1) cardiac defense responses, (2) specific brain activations of both subcortical (e.g., amygdala) and cortical structures, (3) skin conductance reactions, only when stimuli lasted >20 ms and were administered with intertrial interval >20 s. While not inducing the distress caused by current (supraliminal) exposure therapies, exposure to subliminal phobic stimuli still results in successful extinction of both psychophysiological and behavioral correlates: however, it hardly improves subjective fear. We integrate those results with recent bifactorial models of emotional regulation, proposing a new form of exposure therapy whose effectiveness and acceptability should be maximized by a preliminary subliminal stimulation. Systematic Review Registration: identifier [CRD42021129234].
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Affiliation(s)
- Sergio Frumento
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Paul Kenneth Hitchcott
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Andrea Zaccaro
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
- Azienda Ospedaliero-Universitaria Pisana, Dipartimento di Specialità cliniche, Pisa, Italy
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de Vries YA, Harris MG, Vigo D, Chiu WT, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Benjet C, Bruffaerts R, Bunting B, de Almeida JMC, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Moskalewicz J, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Scott K, Torres Y, Zarkov Z, Nierenberg A, Kessler RC, de Jonge P. Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys. J Affect Disord 2021; 288:199-209. [PMID: 33940429 PMCID: PMC8154701 DOI: 10.1016/j.jad.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Región de Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia (Cundinamarca University, calle 28 # 5B 02, Bogotá, 11001000 (zip), Colombia)
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Andrew Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
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Love AS, Love RJ. Considering Needle Phobia among Adult Patients During Mass COVID-19 Vaccinations. J Prim Care Community Health 2021; 12:21501327211007393. [PMID: 33813931 PMCID: PMC8020217 DOI: 10.1177/21501327211007393] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As mass vaccination is underway to combat the COVID-19 pandemic and achieve herd
immunity, healthcare professionals need to recognize the fear and phobia of
needles among their patients. Approximately 11.5 to 66 million U.S. adults may
suffer from this condition. This population often avoids seeking medical care
including vaccinations. The exact number of people suffering from this phobia is
unknown, and the potential years of life lost in the American health care system
cannot be estimated accurately. The resistance to vaccinations among this
population may delay achieving herd immunity to end this current pandemic. An
overview of needle phobia, vaccinations, and current treatments are explored.
The use of telemedicine could prove critical for reaching this population as
well as those who are hesitant about vaccinations. Providing education to
healthcare providers to identify and manage these patients during the pandemic
is necessary.
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Affiliation(s)
- Ashley S Love
- University of the Incarnate Word, San Antonio, TX, USA
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Kılıç A, Brown A, Aras I, Hui R, Hare J, Hughes LD, McCracken LM. Using Virtual Technology for Fear of Medical Procedures: A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions. Ann Behav Med 2021; 55:1062-1079. [PMID: 33821879 PMCID: PMC8557375 DOI: 10.1093/abm/kaab016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Innovations in virtual reality (VR) technologies have improved the adaptability of its use in therapeutic settings, and VR has shown to be a promising treatment for fear of medical procedures, with research increasing in this area in recent years. Purpose This review aims to collate evidence for the impact of VR on fear of medical procedures. Methods CENTRAL (Cochrane), MEDLINE, EMBASE, and PsychINFO databases were searched up to October 2020. A mix of experimental and case–control studies were included for review, which evaluated the effectiveness of VR for fear, anxiety, and pain of medical procedures for people with needle phobia, dental phobia, claustrophobia of medical scans, and burn wound care anxiety. Risk of bias (RoB) was assessed by Cochrane and ROBINS-I tools. Results Twenty-eight studies were selected. Some studies included mixed participant groups of young people adults. The interventions varied, with VR used for distraction, hypnosis, or exposure. These were shown to be effective for reducing fear of medical procedures. However, effectiveness for blood-injection-injury phobias and burn wound care patients was unclear. Conclusions Evidence on the effectiveness of VR suggests that it does decrease fear of medical procedures in some situations. However, the RoB assessment illustrated a poor quality of studies across those included in this review, limiting the ability to draw firm general conclusions from the study findings. There is a need for further research exploring the use of VR technologies in the management of anxiety in physical health care settings.
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Affiliation(s)
- Ayşenur Kılıç
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, London Bridge, London, UK
| | - Ashley Brown
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, London Bridge, London, UK
| | - Işıl Aras
- School of Orthodontics, Jacksonville University, Jacksonville, FL, USA
| | - Rita Hui
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, London Bridge, London, UK
| | - Jennifer Hare
- Dental Psychology Service, Guy's and St Thomas' NHS Trust, London, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, London Bridge, London, UK
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McGlade AL, Craske MG. Optimizing exposure: Between-session mental rehearsal as an augmentation strategy. Behav Res Ther 2021; 139:103827. [PMID: 33607459 DOI: 10.1016/j.brat.2021.103827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
Exposure therapy is widely empirically supported as a treatment for anxiety disorders, but clinically significant response rates hover around 50%. This study explores strategies for consolidating the exposure memory as a way of improving efficacy. Between-session mental rehearsal of exposure learning was examined as a way of enhancing the effects of exposure therapy. Sixty-two spider-fearful individuals completed baseline questionnaires and a behavioral approach test with a live tarantula, followed by two sessions of in vivo exposures, and a post-assessment one-week later that repeated the baseline questionnaires and behavioral approach test. Skin conductance, subjective distress, and number of steps completed were recorded at each behavioral approach test. Participants were randomized to mental rehearsal or control (non-specific) rehearsal that was prompted on three occasions after each exposure session. Participants in both conditions improved from baseline to post-assessment, but mental rehearsal participants showed significantly greater improvement than control participants across questionnaire measurements of spider fear, subjective distress, and number of steps completed during the behavioral approach test. Findings suggest that between-session mental rehearsal is an effective supplement to exposure therapy. As such, mental rehearsal may be a promising avenue toward increasing treatment response rates across many psychiatric disorders that benefit from exposure therapy.
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Affiliation(s)
- Anastasia L McGlade
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
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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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tDCS-Augmented in vivo exposure therapy for specific fears: A randomized clinical trial. J Anxiety Disord 2021; 78:102344. [PMID: 33418483 DOI: 10.1016/j.janxdis.2020.102344] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/01/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022]
Abstract
Exposure therapy is highly effective for anxiety-related disorders, but there is a need for enhancement. Recent trials of adjunctive neuromodulation have shown promise, warranting evaluation of transcranial direct current stimulation (tDCS) as an augmentation. In a double-blind, placebo-controlled trial, contamination- and animal-phobic participants (N = 49) were randomized to active tDCS (1.7 mA, 20 min; n = 27), or sham tDCS (1.7 mA, 30 s; n = 22), followed by 30 min of in-vivo exposure. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC; polarity was counterbalanced for controls. We predicted tDCS would result in accelerated and better maintained gains, contingent on the subsequent in-session response, and baseline negative prognostic indicators. Consistent with predictions, tDCS promoted engagement and reductions in threat appraisals during exposure, and greater reductions in distress and threat appraisals through 1-month, although effects did not uniformly generalize. tDCS was most beneficial given high phobic severity, anxiety sensitivity, and a suboptimal early response. tDCS may promote engagement and response among individuals who are resistant or refractory to standard treatment. tDCS should be applied to more severe anxiety-related disorders, with parameters yoked to individual differences to improve outcomes in exposure-based interventions.
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Bentz D, Wang N, Ibach MK, Schicktanz NS, Zimmer A, Papassotiropoulos A, de Quervain DJF. Effectiveness of a stand-alone, smartphone-based virtual reality exposure app to reduce fear of heights in real-life: a randomized trial. NPJ Digit Med 2021; 4:16. [PMID: 33558625 PMCID: PMC7870885 DOI: 10.1038/s41746-021-00387-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022] Open
Abstract
Smartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app-Easy Heights-and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18-60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen's d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights.
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Affiliation(s)
- Dorothée Bentz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Nan Wang
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Merle K Ibach
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Nathalie S Schicktanz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anja Zimmer
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Transfaculty Research Platform, University of Basel, Basel, Switzerland.,Division of Molecular Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Life Sciences Training Facility, Department Biozentrum, University of Basel, Basel, Switzerland.,University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Dominique J F de Quervain
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland. .,Transfaculty Research Platform, University of Basel, Basel, Switzerland. .,University Psychiatric Clinics, University of Basel, Basel, Switzerland.
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Hemyari C, Zomorodian K, Shojaee M, Sahraian A, Dolatshahi B. The Effect of Personality Traits on Cognitive Behavioral Therapy Outcomes in Student Pharmacists with Rat Phobia: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:23-31. [PMID: 33487789 PMCID: PMC7812500 DOI: 10.30476/ijms.2019.82341.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Little is known about which personality traits determine the effectiveness of various types of cognitive-behavioral therapy (CBT) on animal phobia. The objective of the present study was to investigate a possible association between personality traits and the outcome of single- and multi-session CBT. Methods: The present randomized clinical trial was conducted from November 2018 to May 2019 in Shiraz, Iran. Forty female students with rat phobia, who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria, were systematically allocated into a single- and a multi-session therapy group (odd numbers one-session treatment, even numbers multi-session treatment). In both groups, the students were gradually exposed to rats as part of the treatment. Psychological measures (state-anxiety, rat phobia, and disgust questionnaires) were used to compare pre- and post-intervention outcomes. Multivariate analysis of covariance was used to assess which personality traits influenced the intervention outcome. The statistical analysis was performed using SPSS (version 20.0) and P values<0.05 were considered statistically significant. Results: Rat phobia was positively and significantly affected by conscientiousness (P=0.001) and agreeableness (P=0.003). Of these personality traits, only a higher degree of conscientiousness resulted in a further reduction of state anxiety after the intervention (P=0.005). There were no significant differences between the pre- and post-intervention outcomes. Conclusion: The outcome of single- and multi-session rat phobia therapies was associated with specific personality traits of the participants, namely conscientiousness and agreeableness. Both intervention methods had an equal effect on reducing rat phobia.
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Affiliation(s)
- Camellia Hemyari
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kamiar Zomorodian
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shojaee
- Central Research Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Sahraian
- Substance Abuse and Mental Health Research Center, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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48
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Using targeted cognitive behavioural therapy in clinical work: a case study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x20000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Research shows high levels of complex co-morbidities within psychiatric populations, and there is an increasing need for mental health practitioners to be able to draw on evidence-based psychological interventions, such as cognitive behavioural therapy (CBT), to work with this population effectively. One way CBT may be utilised when working with complexity or co-morbidity is to target treatment at a particular aspect of an individual’s presentation. This study uses a single-case A-B design to illustrate an example of using targeted diagnosis-specific CBT to address symptoms of a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia. Results show the intervention to have been effective, with a change from a severe to mild phobia by the end of intervention. Clinical implications, limitations and areas for future research are discussed.
Key learning aims
(1)
There are high levels of co-morbid, complex mental health problems within psychiatric populations, and an increasing need for mental health practitioners to be able to work with co-morbidity effectively.
(2)
Cognitive behavioural therapy (CBT) remains one of the most well-evidenced psychological interventions with a large amount of research highlighting the effectiveness of diagnosis-specific CBT.
(3)
One way evidence-based diagnosis-specific CBT approaches could be utilised when working with more complex co-morbidity may be to target an intervention at a specific set of symptoms.
(4)
An example of using a targeted CBT intervention (to tackle a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia and ongoing hallucinations) is presented. The outcomes show significant changes in the specific phobia symptoms, suggesting that CBT can be effectively used in this targeted manner within real-world clinical settings. The impact of co-morbid mental health difficulties on therapeutic process and outcomes are highlighted.
(5)
The use of cognitive restructuring techniques was identified as key to engagement and therapeutic process, supporting the importance of including cognitive techniques in the treatment of phobias compared with purely behavioural exposure-based interventions.
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49
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Abado E, Aue T, Okon-Singer H. Cognitive Biases in Blood-Injection-Injury Phobia: A Review. Front Psychiatry 2021; 12:678891. [PMID: 34326784 PMCID: PMC8313757 DOI: 10.3389/fpsyt.2021.678891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.
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Affiliation(s)
- Elinor Abado
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Tatjana Aue
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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50
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Hinze J, Röder A, Menzie N, Müller U, Domschke K, Riemenschneider M, Noll-Hussong M. Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy-A Narrative Review. Front Psychiatry 2021; 12:704174. [PMID: 34504447 PMCID: PMC8421596 DOI: 10.3389/fpsyt.2021.704174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Recent fMRI studies on specific animal phobias, particularly spider phobia (arachnophobia), have identified a large variety of specific brain regions involved in normal and disturbed fear processing. Both functional and structural brain abnormalities have been identified among phobic patients. Current research suggests that both conscious and subconscious fear processing play a crucial role in phobic disorders. Cognitive behavioral therapy has been identified as an effective treatment for specific phobias and has been associated with neuroplastic effects which can be evaluated using current neuroimaging techniques. Recent research suggests that new approaches using virtual (VR) or augmented reality (AR) tend to be similarly effective as traditional "in vivo" therapy methods and could expand treatment options for different medical or individual scenarios. This narrative review elaborates on neural structures and particularities of arachnophobia. Current treatment options are discussed and future research questions are highlighted.
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Affiliation(s)
- Jonas Hinze
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Anne Röder
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Nicole Menzie
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Ulf Müller
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Riemenschneider
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany.,Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, Saarland University Medical Center, Homburg, Germany
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