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Levy-Gigi E, Shamay-Tsoory S. Affect labeling: The role of timing and intensity. PLoS One 2022; 17:e0279303. [PMID: 36580454 PMCID: PMC9799301 DOI: 10.1371/journal.pone.0279303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/05/2022] [Indexed: 12/30/2022] Open
Abstract
A growing number of studies have shown that labeling negative feelings can down-regulate distress. The present study aimed to test the effectiveness of affect labeling while manipulating two factors known to influence the emotion regulation process, namely timing, and emotional intensity. In Experiment 1, sixty-three participants completed a performance-based affect labeling paradigm in which they had to choose between two labels that best describe their feeling. Participants were randomly assigned to one of three experimental conditions: (1) Simultaneous labeling- the labeling occurs while watching the aversive picture. (2) Subsequent labeling- the labeling occurs immediately after watching the aversive picture. (3) Delayed labeling- the labeling occurs 10 seconds after watching the aversive picture. We found that affect labeling efficiently down-regulated distress independent of the labeling timing. In Experiment 2, seventy-nine participants utilized simultaneous labeling for aversive pictures with low and high intensity. We revealed that while affect labeling reduces distress in high-intensity aversive conditions, it increases distress in low-intensity conditions. The results question the standard advice, which calls to count to 10 before you speak in highly aversive states. In addition, it suggests that affect labeling can be beneficial in high-intensity conditions. However, it should be used with caution in low-intensity conditions.
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Affiliation(s)
- Einat Levy-Gigi
- Faculty of Education Bar-Ilan University, Ramat-Gan, Israel
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- * E-mail:
| | - Simone Shamay-Tsoory
- Department of Psychology, University of Haifa, Haifa, Mount Carmel, Haifa, Israel
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2
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Heinzel S, Schwefel M, Sanchez A, Heinen D, Fehm L, Henze R, Terán C, Kallies G, Rapp MA, Fydrich T, Ströhle A, Heissel A. Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial. J Affect Disord 2022; 319:90-98. [PMID: 36113693 DOI: 10.1016/j.jad.2022.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date. METHODS 120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT. RESULTS Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response. LIMITATIONS The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included. CONCLUSIONS High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.
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Affiliation(s)
- Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Melanie Schwefel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Alba Sanchez
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Darlene Heinen
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Romy Henze
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Terán
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Gunnar Kallies
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heissel
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Jungmann SM, Becker F, Witthöft M. Erfassung der Lebendigkeit mentaler Vorstellungsbilder. DIAGNOSTICA 2022. [DOI: 10.1026/0012-1924/a000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Mentale Vorstellungsfähigkeit bezeichnet ein Konstrukt von enormer Bedeutung für diverse psychische Funktionen (z. B. Motivation, Emotion und Handlungssteuerung). Die Lebendigkeit gilt hierbei als ein zentrales und interindividuell variierendes Merkmal mentaler Vorstellungen. Bislang mangelt es allerdings an validierten deutschsprachigen Fragebögen zur Erfassung der Lebendigkeit. Daher wurden an einer Stichprobe von N = 300 Personen aus der Allgemeinbevölkerung (81 % Studierende) deutschsprachige Versionen des Vividness of Visual Imagery Questionnaire (VVIQ; visuelle Vorstellungen) und des Plymouth Sensory Imagery Questionnaire (PSI-Q; multisensorische Erfassung) adaptiert und validiert. Für den VVIQ und PSI-Q konnten die faktorielle (mittels Exploratory Structural Equation Modeling), konvergente und diskriminante Validität belegt werden. Es ergaben sich akzeptable bis hohe interne Konsistenzen, die Retest-Korrelationen (8 Monate) variierten je nach Subskala. Die Lebendigkeit mentaler Vorstellungen zeigte erwartungskonform negative Zusammenhänge mit Defiziten in der emotionalen Verarbeitung (Alexithymie). Insgesamt stellen die beiden Fragebögen ökonomische, reliable und valide Verfahren dar, um die Lebendigkeit mentaler Vorstellungen zu erfassen.
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Affiliation(s)
- Stefanie M. Jungmann
- Abteilung für Klinische Psychologie, Psychotherapie und Experimentelle Psychopathologie, Johannes Gutenberg-Universität Mainz
| | - Fritz Becker
- Abteilung für Klinische Psychologie, Psychotherapie und Experimentelle Psychopathologie, Johannes Gutenberg-Universität Mainz
- Leibniz-Institut für Wissensmedien, Tübingen
| | - Michael Witthöft
- Abteilung für Klinische Psychologie, Psychotherapie und Experimentelle Psychopathologie, Johannes Gutenberg-Universität Mainz
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Baumel WT, Lu L, Huang X, Drysdale AT, Sweeny JA, Gong Q, Sylvester CM, Strawn JR. Neurocircuitry of Treatment in Anxiety Disorders. Biomark Neuropsychiatry 2022; 6. [PMID: 35756886 PMCID: PMC9222661 DOI: 10.1016/j.bionps.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Affiliation(s)
- W. Tommy Baumel
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Correspondence to: University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA. (W.T. Baumel)
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Andrew T. Drysdale
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - John A. Sweeny
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chad M. Sylvester
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Jeffrey R. Strawn
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Goldin PR, Thurston M, Allende S, Moodie C, Dixon ML, Heimberg RG, Gross JJ. Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1134-1142. [PMID: 34287622 PMCID: PMC8295897 DOI: 10.1001/jamapsychiatry.2021.1862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD. OBJECTIVE To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020. INTERVENTIONS CBGT and MBSR. MAIN OUTCOMES AND MEASURES Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment. RESULTS Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment. CONCLUSIONS AND RELEVANCE The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02036658.
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Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach. J Anxiety Disord 2021; 83:102448. [PMID: 34298236 DOI: 10.1016/j.janxdis.2021.102448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/07/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP). N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation. Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.
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Hutschemaekers MHM, de Kleine RA, Hendriks GJ, Kampman M, Roelofs K. The enhancing effects of testosterone in exposure treatment for social anxiety disorder: a randomized proof-of-concept trial. Transl Psychiatry 2021; 11:432. [PMID: 34417443 PMCID: PMC8379251 DOI: 10.1038/s41398-021-01556-8] [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: 06/28/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
Individuals with a social anxiety disorder (SAD) show hypofunctioning of the hypothalamus-pituitary-gonadal (HPG) axis, which is linked to social fear and avoidance behavior. As testosterone administration has been shown to facilitate social-approach behavior in this population, it may enhance the effectiveness of exposure treatment. In this proof-of-concept study, we performed a randomized clinical assay in which 55 women diagnosed with SAD received two exposure therapy sessions. Session 1 was supplemented with either testosterone (0.50 mg) or placebo. Next, transfer effects of testosterone augmentation on within-session subjective fear responses and SAD symptom severity were assessed during a second, unenhanced exposure session (session 2) and at a 1-month follow-up, respectively. The participants having received testosterone showed a more reactive fear pattern, with higher peaks and steeper reductions in fear levels in session 2. Post-hoc exploration of moderating effects of endogenous testosterone levels, revealed that this pattern was specific for women with high basal testosterone, both in the augmented and in the transfer session. In contrast, the participants with low endogenous testosterone showed reduced peak fear levels throughout session 1, again with transfer to the unenhanced session. Testosterone did not significantly affect self-reported anxiety. The effects of testosterone supplementation on fear levels show transfer to non-enhanced exposure, with effects being modulated by endogenous testosterone. These first preliminary results indicate that testosterone may act on important fear mechanisms during exposure, providing the empirical groundwork for further exploration of multi-session testosterone-enhanced exposure treatment for SAD.
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Affiliation(s)
- Moniek H. M. Hutschemaekers
- grid.491369.00000 0004 0466 1666Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Rianne A. de Kleine
- grid.5132.50000 0001 2312 1970Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Gert-Jan Hendriks
- grid.491369.00000 0004 0466 1666Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirjam Kampman
- grid.491369.00000 0004 0466 1666Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Karin Roelofs
- grid.5590.90000000122931605Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroimaging, Radboud University, Nijmegen, The Netherlands
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Ashar YK, Clark J, Gunning FM, Goldin P, Gross JJ, Wager TD. Brain markers predicting response to cognitive-behavioral therapy for social anxiety disorder: an independent replication of Whitfield-Gabrieli et al. 2015. Transl Psychiatry 2021; 11:260. [PMID: 33934101 PMCID: PMC8088432 DOI: 10.1038/s41398-021-01366-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 02/03/2023] Open
Abstract
Predictive brain markers promise a number of important scientific, clinical, and societal applications. Over 600 predictive brain markers have been described in published reports, but very few have been tested in independent replication attempts. Here, we conducted an independent replication of a previously published marker predicting treatment response to cognitive-behavioral therapy for social anxiety disorder from patterns of resting-state fMRI amygdala connectivity1. The replication attempt was conducted in an existing dataset similar to the dataset used in the original report, by a team of independent investigators in consultation with the original authors. The precise model described in the original report positively predicted treatment outcomes in the replication dataset, but with marginal statistical significance, permutation test p = 0.1. The effect size was substantially smaller in the replication dataset, with the model explaining 2% of the variance in treatment outcomes, as compared to 21% in the original report. Several lines of evidence, including the current replication attempt, suggest that features of amygdala function or structure may be able to predict treatment response in anxiety disorders. However, predictive models that explain a substantial amount of variance in independent datasets will be needed for scientific and clinical applications.
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Affiliation(s)
- Yoni K Ashar
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Joseph Clark
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - James J Gross
- Department of Psychology, Stanford University, Palo Alto, CA, USA
| | - Tor D Wager
- Psychological and Brain Sciences Department, Dartmouth College, Hanover, NH, USA.
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Chahal R, Gotlib IH, Guyer AE. Research Review: Brain network connectivity and the heterogeneity of depression in adolescence - a precision mental health perspective. J Child Psychol Psychiatry 2020; 61:1282-1298. [PMID: 32458453 PMCID: PMC7688558 DOI: 10.1111/jcpp.13250] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescence is a period of high risk for the onset of depression, characterized by variability in symptoms, severity, and course. During adolescence, the neurocircuitry implicated in depression continues to mature, suggesting that it is an important period for intervention. Reflecting the recent emergence of 'precision mental health' - a person-centered approach to identifying, preventing, and treating psychopathology - researchers have begun to document associations between heterogeneity in features of depression and individual differences in brain circuitry, most frequently in resting-state functional connectivity (RSFC). METHODS In this review, we present emerging work examining pre- and post-treatment measures of network connectivity in depressed adolescents; these studies reveal potential intervention-specific neural markers of treatment efficacy. We also review findings from studies examining associations between network connectivity and both types of depressive symptoms and response to treatment in adults, and indicate how this work can be extended to depressed adolescents. Finally, we offer recommendations for research that we believe will advance the science of precision mental health of adolescence. RESULTS Nascent studies suggest that linking RSFC-based pathophysiological variation with effects of different types of treatment and changes in mood following specific interventions will strengthen predictions of prognosis and treatment response. Studies with larger sample sizes and direct comparisons of treatments are required to determine whether RSFC patterns are reliable neuromarkers of treatment response for depressed adolescents. Although we are not yet at the point of using RSFC to guide clinical decision-making, findings from research examining the stability and reliability of RSFC point to a favorable future for network-based clinical phenotyping. CONCLUSIONS Delineating the correspondence between specific clinical characteristics of depression (e.g., symptoms, severity, and treatment response) and patterns of network-based connectivity will facilitate the development of more tailored and effective approaches to the assessment, prevention, and treatment of depression in adolescents.
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Affiliation(s)
- Rajpreet Chahal
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Amanda E. Guyer
- Department of Human Ecology, University of California, Davis, Davis, CA, USA,Center for Mind and Brain, University of California, Davis, Davis, CA, USA
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Young KS, Rennalls SJ, Leppanen J, Mataix-Cols D, Simmons A, Suda M, Campbell IC, O'Daly O, Cardi V. Exposure to food in anorexia nervosa and brain correlates of food-related anxiety: findings from a pilot study. J Affect Disord 2020; 274:1068-1075. [PMID: 32663934 DOI: 10.1016/j.jad.2020.05.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the primary target of treatment for anorexia nervosa (AN) is weight gain, established psychological interventions focus on maintaining factors of AN, and do not specifically address eating behaviours. We have previously reported results of a case series investigating in-vivo food exposure in AN, demonstrating the feasibility and acceptability of this treatment together with evidence of significant clinical change (Cardi, Leppanen, Mataix-Cols, Campbell, & Treasure, 2019). The current study examined the neural circuitry of food-related anxiety. METHODS We examined neural reactivity (fMRI) to food images pre- and post-food exposure therapy (n=16), and compared it to a group of healthy control participants (HC n=21) who were scanned on two occasions. RESULTS Prior to treatment, the AN group (compared to HC) showed less reactivity in the anterior cingulate cortex (ACC). Following exposure treatment, patients (compared to HC), show increased activity in the dorsolateral prefrontal cortex, decreased activity in the superior parietal lobe and no differences in the ACC. The level of activation of the insula (pre-treatment) predicted the degree of post-treatment reduction in self-reported food anxiety in AN. Changes in food-related anxiety were also associated with changes in neural activation in a cluster located in the middle temporal gyrus/lateral parietal cortex. LIMITATIONS The primary limitations of this work are the small sample size and lack of patient comparison group. CONCLUSIONS Exposure to food in AN may be associated with changes in neural circuitries implicated in emotion regulation and attentional processes. However, these findings need replication in larger and controlled studies.
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Affiliation(s)
- Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Samantha J Rennalls
- Dept. of Neuroimaging, King's College London's, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Jenni Leppanen
- Dept. of Psychological Medicine, Section of Eating Disorders, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK
| | - David Mataix-Cols
- Centre for Psychiatric Research and Education, Dept. of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Simmons
- Dept. of Neuroimaging, King's College London's, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Masashi Suda
- Dept. of Psychiatry and Neuroscience, Gunma University, Japan
| | - Iain C Campbell
- Dept. of Psychological Medicine, Section of Eating Disorders, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Owen O'Daly
- Dept. of Neuroimaging, King's College London's, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Valentina Cardi
- Dept. of Psychological Medicine, Section of Eating Disorders, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK; fDepartment of General Psychology, University of Padova, Italy.
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Tabibnia G. An affective neuroscience model of boosting resilience in adults. Neurosci Biobehav Rev 2020; 115:321-350. [DOI: 10.1016/j.neubiorev.2020.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022]
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Bas-Hoogendam JM, Westenberg PM. Imaging the socially-anxious brain: recent advances and future prospects. F1000Res 2020; 9:F1000 Faculty Rev-230. [PMID: 32269760 PMCID: PMC7122428 DOI: 10.12688/f1000research.21214.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Social anxiety disorder (SAD) is serious psychiatric condition with a genetic background. Insight into the neurobiological alterations underlying the disorder is essential to develop effective interventions that could relieve SAD-related suffering. In this expert review, we consider recent neuroimaging work on SAD. First, we focus on new results from magnetic resonance imaging studies dedicated to outlining biomarkers of SAD, including encouraging findings with respect to structural and functional brain alterations associated with the disorder. Furthermore, we highlight innovative studies in the field of neuroprediction and studies that established the effects of treatment on brain characteristics. Next, we describe novel work aimed to delineate endophenotypes of SAD, providing insight into the genetic susceptibility to develop the disorder. Finally, we outline outstanding questions and point out directions for future research.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up. Behav Res Ther 2020; 129:103612. [PMID: 32276238 DOI: 10.1016/j.brat.2020.103612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023]
Abstract
Approximately half of individuals with Social Anxiety Disorder (SAD) treated with psychological intervention do not achieve clinically significant improvement or retain long-term gains. Neurobiological models of SAD propose that disruptions in functioning of amygdala-prefrontal circuitry is implicated in short-term treatment response. However, whether treatment-related changes in functional connectivity predict long-term well-being after psychotherapy is unknown. Patients with SAD completed an incidental emotion regulation task during fMRI before and after treatment with cognitive behavioral therapy or acceptance and commitment therapy (n = 23, collapsed across groups). Psychophysiological interaction analyses using amygdala seed regions were conducted to assess changes in functional connectivity from pre-to post-treatment that predicted symptom change from 6 to 12-month follow-up. Negative change (i.e., greater inverse/weaker positive) in amygdala connectivity with the dorsomedial prefrontal cortex (dmPFC) and dorsal anterior cingulate cortex (dACC) predicted greater symptom reduction during follow-up. Positive change in amygdala connectivity with the cerebellum, fusiform gyrus, and pre-central and post-central gyri predicted less symptom reduction (e.g., no change or worsening). Results suggest that strengthened amygdala connectivity with regulatory regions may promote better long-term outcomes, whereas changes with visual and sensorimotor regions may represent sensitization to emotion-related cues, conferring poorer outcomes. Clinical implications for treatment personalization are discussed, should effects replicate in larger samples.
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Wang W, Zhornitsky S, Li CSP, Le TM, Joormann J, Li CSR. Social anxiety, posterior insula activation, and autonomic response during self-initiated action in a Cyberball game. J Affect Disord 2019; 255:158-167. [PMID: 31153052 PMCID: PMC6591038 DOI: 10.1016/j.jad.2019.05.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND An earlier study characterized the neural correlates of self-initiated actions in a Cyberball game in healthy individuals. It remains unclear how social anxiety may influence these neural processes. METHODS We examined regional activations to self-initiated actions in 25 adults with low and 25 with high social anxiety (LA and HA, respectively). Skin conductance was recorded concurrently with fMRI. We followed published routines in the analyses of imaging and skin conductance data. RESULTS We hypothesized that HA as compared to LA individuals would demonstrate increased cortical limbic activations during self-initiated actions (tossing or T > receiving or R trials, to control for motor activities) in social exclusion (EX) vs. fair game (FG) scenario. At a corrected threshold, HA as compared with LA group showed increases in bilateral posterior insula activation during T vs. R trials in EX as compared to FG. Further, HA as compared to LA showed higher skin conductance response to tossing trials during EX as compared to FG. LIMITATIONS With a limited sample size, we did not examine potential sex effects. Further, we cannot rule out the effects of depression on the findings. CONCLUSIONS Together, the results suggest that individuals with more severe social anxiety engaged the somatosensory insula to a greater extent and exhibited higher physiological arousal when initiating ball toss during social exclusion in the Cyberball game. Posterior insula response to self-initiated action may represent a biomarker of social anxiety. It remains to be investigated whether interventions to decrease physiological arousal may alleviate social anxiety.
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Affiliation(s)
- Wuyi Wang
- Department of Psychiatry, Yale University, New Haven, CT 06519
| | | | - Clara S.-P. Li
- Department of Psychiatry, Yale University, New Haven, CT 06519,Phillips Academy, Andover, MA 01810
| | - Thang M. Le
- Department of Psychiatry, Yale University, New Haven, CT 06519
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT 06520
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University, New Haven, CT 06519,Department of Neuroscience, Yale University, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520,Address correspondence to: C.-S. Ray Li, Connecticut Mental Health Center, S112, 34 Park Street, New Haven, CT 06519, U.S.A. Phone: +1 203-974-7354,
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