Memory modification as an outcome variable in anxiety disorder treatment

Evaluating the Association of High Trait Anxiety With a Bias in Familiarity-Based Recognition of Emotional Stimuli

Abstract. In the past decades the role of cognitive biases as maintaining factors of anxiety has been widely researched. This theoretical framework assumes that vulnerability self-referential thoughts promote a hyper-vigilant mode of processing environmental stimuli. In this mode, threatening information increases attentional capture and therefore encoding and retrieval of such stimuli is enhanced. Although this attentional bias has been confirmed, the evidence concerning the memory bias is contradictory. Our hypothesis is that the bias in memory is expressed through the pattern of recognition. Particularly, the aim of this study was to evaluate the association of anxiety with familiarity, a deficient form of recognition which consists only in the identification of the item without retrieval of contextual information. Two groups of 17 participants with low and high anxiety levels performed an experimental task of visual recognition memory, using neutral, positive, and negative pictures. The experiment had two test phases, with a 24-hour interval, to evaluate possible effects of consolidation. The pattern of recognition was measured, behaviorally (through an independent Remember/Know paradigm) and through event-related potentials (ERP). Participants with higher levels of anxiety developed a bias in recognition of arousing stimuli (positive and negative) compared with the control group. This bias was observed behaviorally through an increase of familiarity-based recognition, and was associated with a positive modulation of a right parietal late positive component (LPC) at approximately 600 ms of latency. Participants with higher levels of anxiety are capable of recognizing arousing stimuli but lack efficiency in retrieving past contextual information compared to lower level anxiety participants. A recognition bias can be the first step in cognitive distortions that generate anxiety. This is, to our knowledge, the first study to explore the association of anxiety with familiarity-based recognition, using an independent Remember/Know paradigm combined with electrophysiological data. Further studies with bigger samples and more recording channels are needed to confirm the electrophysiological findings.

Time is nothing: emotional consistency of autobiographical memory and its neural basis

The emotional aspect of autobiographical memories (AMs) is associated with self-related processing, which plays an important role in mental health. However, the emotional consistency dimension of AMs and its neural underpinnings remain largely unexplored. Twenty-five healthy participants were involved in this study. Participants were first asked to recall important AMs and assess the emotional ratings of each AM. Four weeks later, they were asked to retrieve the details of both positive and negative AMs during functional magnetic resonance imaging (fMRI) scanning. Behavioral results showed that the emotional valence of negative memories changed more strongly than positive memories over time (i.e., lower consistency). fMRI data showed that the activation level of the precuneus was positively correlated with self-rating valence consistency in the positive AM condition. Additionally, the precuneus connected to a key region of the self-referential network, the medial prefrontal cortex, in both the positive and negative AM conditions. Finally, the precuneus showed stronger connections with the inferior parietal lobule when comparing the positive with the negative AM conditions. Our results suggest that the precuneus is a key area of emotional consistency in positive AMs; this brain area may be involved in the maintenance of a positive self-image by strengthening positive AMs.

Reward memory relieves anxiety-related behavior through synaptic strengthening and protein kinase C in dentate gyrus

Anxiety disorders are presumably associated with negative memory. Psychological therapies are widely used to treat this mental deficit in human beings based on the view that positive memory competes with negative memory and relieves anxiety status. Cellular and molecular processes underlying psychological therapies remain elusive. Therefore, we have investigated its mechanisms based on a mouse model in which food reward at one open-arm of the elevated plus-maze was used for training mice to form reward memory and challenge the open arms. Mice with the reward training showed increased entries and stay time in reward open-arm versus neutral open-arm as well as in open-arms versus closed-arms. Accompanying with reward memory formation and anxiety relief, glutamatergic synaptic transmission in dentate gyrus in vivo and dendritic spines in granule cells became upregulated. This synaptic up-regulation was accompanied by the expression of more protein kinase C (PKC) in the dendritic spines. The inhibition of PKC by chelerythrine impaired the formation of reward memory, the relief of anxiety-related behavior and the up-regulation of glutamate synapses. Our results suggest that reward-induced positive memory relieves mouse anxiety-related behavior by strengthening synaptic efficacy and PKC in the hippocampus, which imply the underlying cellular and molecular processes involved in the beneficial effects of psychological therapies treating anxiety disorders.

D-cycloserine augmentation in behavioral therapy for obsessive-compulsive disorder: a meta-analysis

OBJECTIVE

To evaluate the overall effect of D-cycloserine (DCS) augmentation on exposure and response prevention (ERP) therapy for obsessive-compulsive disorder (OCD).

METHODS

Clinical studies on the effect of DCS augmentation on ERP therapy for OCD compared to placebo were included for meta analysis. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Meta-analyses were performed with a random-effect model or a fixed-effect model using the Cochrane Review Manager (RevMan, version 5.2) to calculate the odds ratio and the mean difference, with their corresponding 95% confidence intervals.

RESULTS

A total of six studies was included in the current meta-analyses, and their data were extracted. Among them, four were for analyses of DCS and Y-BOCS at midtreatment, six for analysis at posttreatment, and four at 3-month follow-up. Besides, three of the six eligible studies were included in the meta-analysis of the DCS and Clinical Global Impression-Severity Scale at posttreatment, and three in the meta-analysis of DCS and proportions of treatment responders and of subjects attaining clinical remission status criteria at posttreatment. Our meta-analyses do not reveal a significant effect of DCS augmentation in ERP therapy for OCD patients, except when measured at midtreatment. Compared to the placebo group, DCS augmentation did show a trend toward significantly lower/decreased Y-BOCS; when measured at posttreatment and in the subpopulation of DCS taken before some of the ERP sessions, DCS augmentation showed a trend toward significantly lower/decreased Y-BOCS.

CONCLUSION

Our result suggested that with the careful optimization of DCS-augmented ERP therapy by fine-tuning timing and dosing of DCS administration and number and frequency of ERP sessions, DCS may enhance the efficacy of ERP therapy in reducing the symptomatic severity of OCD patients, especially at early stage of the treatment; therefore, DCS augmentation could possibly reduce treatment cost, reduce treatment drop and refusal rate, and help to improve access to the limited number of experienced therapists.

A non-linear dynamical approach to belief revision in cognitive behavioral therapy

Belief revision is the key change mechanism underlying the psychological intervention known as cognitive behavioral therapy (CBT). It both motivates and reinforces new behavior. In this review we analyze and apply a novel approach to this process based on AGM theory of belief revision, named after its proponents, Carlos Alchourrón, Peter Gärdenfors and David Makinson. AGM is a set-theoretical model. We reconceptualize it as describing a non-linear, dynamical system that occurs within a semantic space, which can be represented as a phase plane comprising all of the brain's attentional, cognitive, affective and physiological resources. Triggering events, such as anxiety-producing or depressing situations in the real world, or their imaginal equivalents, mobilize these assets so they converge on an equilibrium point. A preference function then evaluates and integrates evidentiary data associated with individual beliefs, selecting some of them and comprising them into a belief set, which is a metastable state. Belief sets evolve in time from one metastable state to another. In the phase space, this evolution creates a heteroclinic channel. AGM regulates this process and characterizes the outcome at each equilibrium point. Its objective is to define the necessary and sufficient conditions for belief revision by simultaneously minimizing the set of new beliefs that have to be adopted, and the set of old beliefs that have to be discarded or reformulated. Using AGM, belief revision can be modeled using three (and only three) fundamental syntactical operations performed on belief sets, which are expansion; revision; and contraction. Expansion is like adding a new belief without changing any old ones. Revision is like adding a new belief and changing old, inconsistent ones. Contraction is like changing an old belief without adding any new ones. We provide operationalized examples of this process in action.

Current research on cognitive aspects of anxiety disorders

PURPOSE OF REVIEW

Cognitive dysfunction is frequently reported in anxiety disorders. Our aim is to describe recent advances concerning these cognitive aspects.

RECENT FINDINGS

Cognitive dysfunction in anxiety disorders can be classified into four domains. The first concerns executive functions, mainly attentional processes. The second concerns memory, including deficits in working, episodic, and autobiographical memory. The third encompasses maladaptive cognitions, or thoughts and beliefs. Finally, a burgeoning area of research (mainly in obsessive-compulsive disorder and posttraumatic stress disorder) concerns metacognitions, or thoughts and beliefs about one's own thoughts and beliefs. All of these dysfunctions may contribute to maintain or aggravate anxiety disorders. When developing and implementing interventions, researchers and clinicians alike must consider these cognitive aspects, and may need to tailor their approaches accordingly.

SUMMARY

Advances have clearly been made in the elucidation of the cognitive functioning associated with anxiety disorders. It remains unclear if particular cognitive profiles can help to distinguish anxiety disorders from one another, although emerging evidence suggests this may be the case. Further clarification will add to our understanding of the development and maintenance of these disorders, and may provide targets for future therapy and endophenotypes.