Empirically supported psychological treatments and the Research Domain Criteria (RDoC)

Detecting negative valence symptoms in adolescents based on longitudinal self-reports and behavioral assessments

BACKGROUND

Given the high prevalence of depressive symptoms reported by adolescents and associated risk of experiencing psychiatric disorders as adults, differentiating the trajectories of the symptoms related to negative valence at an individual level could be crucial in gaining a better understanding of their effects later in life.

METHODS

A longitudinal deep learning framework is presented, identifying self-reported and behavioral measurements that detect the depressive symptoms associated with the Negative Valence System domain of the NIMH Research Domain Criteria (RDoC).

RESULTS

Applied to the annual records of 621 participants (age range: 12 to 17 years) of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), the deep learning framework identifies predictors of negative valence symptoms, which include lower extraversion, poorer sleep quality, impaired executive control function and factors related to substance use.

LIMITATIONS

The results rely mainly on self-reported measures and do not provide information about the underlying neural correlates. Also, a larger sample is required to understand the role of sex and other demographics related to the risk of experiencing symptoms of negative valence.

CONCLUSIONS

These results provide new information about predictors of negative valence symptoms in individuals during adolescence that could be critical in understanding the development of depression and identifying targets for intervention. Importantly, findings can inform preventive and treatment approaches for depression in adolescents, focusing on a unique predictor set of modifiable modulators to include factors such as sleep hygiene training, cognitive-emotional therapy enhancing coping and controllability experience and/or substance use interventions.

Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature

BACKGROUND

Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning.

METHODS

We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response.

RESULTS

A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently.

LIMITATIONS

The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature.

CONCLUSIONS

Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.

Towards a Clinically Valid Mechanistic Assessment of Exposure and Response Prevention: Preliminary Utility of an Exposure Learning Tool for Children with OCD

Despite advances in understanding mechanisms underlying fear processes, there remains a significant gap between insights produced via laboratory assessment and concrete tools for harnessing these insights in clinical practice. In addressing this gap, researchers would ideally introduce tools that are feasible for patients in clinical practice, easily disseminated to practitioners, and clinically useful. We present pilot data on the Exposure Experience Questionnaire (EEQ), a brief measure designed to assess exposure learning mechanisms. Ten children (ages 8-15) with a primary diagnosis of obsessive-compulsive disorder (OCD) underwent exposure and response prevention in which they completed weekly exposures in clinic and at home. During each exposure, children completed an exposure practice form which included the EEQ. Results suggest the preliminary feasibility and internal consistency of this measure, with comparable utility in clinic and home settings. The EEQ was associated in the expected direction with slope of OCD symptoms, such that greater exposure learning in both clinic and homework exposures predicted improved outcome. Although limited by small sample size, these data support the continued research on the feasibility and utility of the EEQ and suggest that quantifying learning processes following exposure may be a useful addition to mechanistic research in OCD.

Empirically supported interventions in psychology: contributions of Research Domain Criteria

Empirically supported interventions in psychological disorders should provide (1) evidence supporting the underlying psychological mechanisms of psychopathology to target in the intervention and (2) evidence supporting the efficacy of the intervention. However, research has been dedicated in a greater extent to efficacy than to the acquisition of empirical support for the theoretical basis of therapies. Research Domain Criteria (RDoC) emerges as a new framework to provide empirically based theories about psychological mechanisms that may be targeted in intervention and tested for its efficacy. The current review aims to demonstrate the possible applications of RDoC to design empirically supported interventions for psychological disorders. Two RDoC-inspired interventions are reviewed, and the RDoC framework is broadly explored in terms of its contributions and limitations. From preliminary evidence, RDoC offers many avenues for improving evidence-based interventions in psychology, but some limitations must be anticipated to increase the RDoC applicability to naturalistic settings.

Perceived emotion regulation and emotional distress tolerance in patients with hoarding disorder

Emotional distress tolerance (EDT) and emotion regulation (ER) appear to be highly relevant to hoarding pathology, as excessive saving and/or acquiring may be motivated by emotional avoidance or other attempts to regulate negative affect. While findings with nonclinical samples have suggested and EDT/ER predicts hoarding symptoms, there is little data on clinical samples. The aim of the current study was to examine several self-report measures of EDT and ER in individuals with HD (n = 87) and age-matched nonclinical controls (n = 46), and to explore whether this was predictive of treatment compliance and/or outcome in group CBT for HD. Results suggested that, the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) total score, DERS goals and awareness subscales, and Intolerance of Uncertainty Scale (IUS; Buhr & Dugas, 2002) were predictive of hoarding severity. However, EDT/ER did not change with treatment, did not mediate treatment outcome, and did not predicted treatment retention, compliance, or outcome. Results suggest that some EDT/ER constructs, such as uncertainty intolerance, difficulty persisting in goal behaviors when upset, and low emotional awareness, may explain significant variance in HD symptoms, although they did not appear to be mechanisms of change in CBT for HD.

Examining neural correlates of psychopathology using a lesion-based approach

Studies of individuals with focal brain damage have long been used to expand understanding of the neural basis of psychopathology. However, most previous studies were conducted using small sample sizes and relatively coarse methods for measuring psychopathology or mapping brain-behavior relationships. Here, we examined the factor structure and neural correlates of psychopathology in 232 individuals with focal brain damage, using their responses to the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Factor analysis and voxel-based lesion symptom mapping were used to examine the structure and neural correlates of psychopathology in this sample. Consistent with existing MMPI-2-RF literature, separate internalizing, externalizing, and psychotic symptom dimensions were found. In addition, a somatic dimension likely reflecting neurological symptoms was identified. Damage to the medial temporal lobe, including the hippocampus, was associated with scales related to both internalizing problems and psychoticism. Damage to the medial temporal lobe and orbitofrontal cortex was associated with both a general distrust of others and beliefs that one is being personally targeted by others. These findings provide evidence for the critical role of dysfunction in specific frontal and temporal regions in the development of psychopathology.

Low pre-treatment end-tidal CO2 predicts dropout from cognitive-behavioral therapy for anxiety and related disorders

Recent clinical trial research suggests that baseline low end-tidal CO₂ (ETCO₂, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO₂ among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO₂, and respiration rate (the first minute was analyzed). Lower ETCO₂ was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO₂ significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO₂ significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO₂ patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO₂ is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO₂ might benefit from additional intervention that targets respiratory abnormality.