Does CBT for anxiety-related disorders alter suicidal ideation? Findings from a naturalistic sample

Neural responsiveness to reward and suicidal ideation in social anxiety and major depression before and after psychotherapy

Suicidality is prevalent in Social Anxiety Disorder (SAD) and Major Depressive Disorder (MDD). Limited data indicate the reward positivity (RewP), a neurophysiological index of reward responsivity, and subjective capacity for pleasure may serve as brain and behavioral assays for suicide risk though this has yet to be examined in SAD or MDD in the context of psychotherapy. Therefore, the current study tested whether suicidal ideation (SI) relates to RewP and subjective capacity for anticipatory and consummatory pleasure at baseline and whether Cognitive Behavioral Therapy (CBT) impacts these measures. Participants with SAD (n = 55) or MDD (n = 54) completed a monetary reward task (gains vs. losses) during electroencephalogram (EEG) before being randomized to CBT or supportive therapy (ST), a comparator common factors arm. EEG and SI data were collected at baseline, mid-treatment, and post-treatment; capacity for pleasure was collected at baseline and post-treatment. Baseline results showed participants with SAD or MDD were comparable in SI, RewP, and capacity for pleasure. When controlling for symptom severity, SI negatively corresponded with RewP following gains and SI positively corresponded with RewP following losses at baseline. Yet, SI did not relate to subjective capacity for pleasure. Evidence of a distinct SI-RewP association suggests RewP may serve as a transdiagnositic brain-based marker of SI. Treatment outcome revealed that among participants with SI at baseline, SI significantly decreased regardless of treatment arm; also, consummatory, but not anticipatory, pleasure increased across participants regardless of treatment arm. RewP was stable following treatment, which has been reported in other clinical trial studies.

Demographic and clinical correlates of social anxiety disorder among US veterans: findings from the NESARC-III study

PURPOSE

Social anxiety disorder (SAD) is among the most highly prevalent and debilitating psychiatric disorders within the US population, but SAD has gone relatively unnoticed within the US veteran population. Preliminary research has demonstrated that SAD is related to decreased mental and physical functioning as well as posttraumatic stress disorder (PTSD) and depression among veterans.

METHODS

The present study investigated SAD and its relationship with demographic factors, psychiatric disorders, suicidality, treatment seeking, and social support among veterans. Multivariate survey weighted logistic regression analyses were conducted to observe these associations utilizing data from National Epidemiologic Survey on Alcohol and Related Conditions which contained data on 3119 veterans.

RESULTS

SAD was found to be strongly related to PTSD and other anxiety disorder, and these disorders were related to increased treatment seeking for SAD. Further, SAD was associated with lifetime suicide attempts and decreased perceived social support in multivariate models adjusting for demographic factors and psychiatric comorbidities.

CONCLUSION

This study highlights the relationships of SAD among veterans by demonstrating its associations with other psychiatric disorders, treatment seeking, suicide attempts, and social support. A deeper understanding of the impact of SAD within the veteran population will inform future prevention and treatment efforts.

High Rates of Anxiety Among Adolescents in a Partial Hospitalization Program

Background

Anxiety disorders are garnering increasing attention for their contribution to high-risk issues and functional impairment. Adolescents are typically admitted to partial hospitalization programs (PHPs) due to high-risk presentations. However, the frequency of anxiety disorders in PHPs is not well-established, in part because anxiety can be overlooked in acute settings due to limited lengths of stay and focus on stabilization.

Objective

This study aims to evaluate the frequency and severity of anxiety disorders among a sample of adolescent PHP patients to assess the need for anxiety-specific assessment and interventions in higher acuity settings.

Methods

Participants were 158 youths ages 13 to 19 years old (M = 15.49 years, SD = 1.50) who were admitted to an adolescent PHP and their caregivers. Clinician-reported diagnostic information was collected from the youth's electronic medical record, and self- and caregiver-rated severity of anxiety was collected using the Screen for Child Anxiety Related Emotions Disorders (SCARED-C/P). Frequency of anxiety and related disorder diagnoses and self- and caregiver-reported severity were assessed using descriptive statistical methods.

Results

75% of participants were diagnosed with an anxiety disorder (n = 118). On average, participants with anxiety disorders had elevated SCARED-C scores. Youths with depressive disorders had elevated SCARED-C scores even when they did not carry anxiety disorder diagnoses. Caregiver ratings of the youth's anxiety symptoms on the SCARED-P were elevated when youths had anxiety disorders.

Conclusions

These findings suggest that anxiety is common in an adolescent PHP setting and support investing in evidence-based assessment and treatment of anxiety in high-acuity settings.

Quality over quantity? The role of social contact frequency and closeness in suicidal ideation and attempt

BACKGROUND

Social support has been identified as a protective factor against suicidal thoughts and behaviors. Research has not conclusively identified the component of social support most implicated in suicidal thoughts and behaviors: (1) frequency of social contact or (2) closeness of relationships. This study examined the relationships between these facets of social support and suicidal thoughts and behaviors in two nationally representative samples, as well as subsamples with social anxiety disorder (SAD).

METHODS

Study 1 variables for lifetime and past-year suicide ideation and attempt, social contact frequency, and closeness were calculated and examined within the National Comorbidity Survey-Replication (NCS-R). Study 2 examined the independent contributions of social contact frequency and closeness to only lifetime suicide attempt in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

RESULTS

In the NCS-R, lower social closeness but not contact frequency was uniquely associated with suicidal ideation and attempt in the general sample and those with SAD. In the NESARC-III, both components of social support were associated with lifetime suicide attempt in the general sample, while only social closeness was uniquely associated with suicide attempt in the SAD subsample.

LIMITATIONS

This study utilized cross-sectional data and was limited in the validity and specificity of the variables assessed.

DISCUSSION

Lower social closeness was more strongly associated with suicidality than social contact frequency and merits attention as a potential target for suicide-related interventions. Social closeness may be especially relevant in populations experiencing high rates of suicidal thoughts and behaviors and decreased social support.

Endorphinergic Enhancement Attenuation of Post-traumatic Stress Disorder (PTSD) via Activation of Neuro-immunological Function in the Face of a Viral Pandemic

Introduction

Polymorphic gene variants, particularly the genetic determinants of low dopamine function (hypodopaminergia), are known to associate with Substance Use Disorder (SUD) and a predisposition to PTSD. Addiction research and molecular genetic applied technologies supported by the National Institutes of Health (NIH) have revealed the complex functions of brain reward circuitry and its crucial role in addiction and PTSD symptomatology.

Discussion

It is noteworthy that Israeli researchers compared mice with a normal immune system with mice lacking adaptive immunity and found that the incidence of PTSD increased several-fold. It is well established that raising endorphinergic function increases immune response significantly. Along these lines, Blum's work has shown that D-Phenylalanine (DPA), an enkephalinase inhibitor, increases brain endorphins in animal models and reduces stress in humans. Enkephalinase inhibition with DPA treats Post Traumatic Stress Disorder (PTSD) by restoring endorphin function. The Genetic Addiction Risk Severity (GARS) can characterize relevant phenotypes, genetic risk for stress vulnerability vs. resilience. GARS could be used to pre-test military enlistees for adaptive immunity or as part of PTSD management with customized neuronutrient supplementation upon return from deployment.

Conclusion

Based on GARS values, with particular emphasis on enhancing immunological function, pro-dopamine regulation may restore dopamine homeostasis. Recognition of the immune system as a "sixth sense" and assisting adaptive immunity with Precision Behavioral Management (PBM), accompanied by other supportive interventions and therapies, may shift the paradigm in treating stress disorders.

Intervention effect of cognitive behaviour therapy under suicidology on psychological stress and emotional depression of college students

BACKGROUND

The suicide of college students had been a social topic attracting people's attention, and the generation of suicidal ideation was an inevitable link in the psychological process of suicidal behavior. It was the focus of many researches whether the pressure of college students with suicidal ideation can be detected and relieved in time.

OBJECTIVE

The study aimed to analyze the therapeutic effect of cognitive behaviour therapy on psychological stress, depression, and other negative emotions of college students with suicide ideation.

METHODS

114 people from 1,158 college students with suicide ideation in the Wuhan area were divided into an experimental group and a control group in this study. Students in the experimental group were given with the cognitive behaviour therapy, and students in the control group were not intervened in any way. The suicide ideation scale (despair, optimism, and sleep), psychological stress test rating, and self-reporting inventory (somatization, compulsion, interpersonal relationship, depression, anxiety, hostility, terror, delusion, and psychosis) were used to evaluate the objects in the pre-test stage, intermediate-test stage, and the tracking-test stage. The multivariate logistic regression was adopted to analyze the influencing factors of the suicide ideation of the college student.

RESULTS

The suicide ideation of the college student was significantly positively correlated with the psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis (P > 0.05); the total score of suicide ideation, despair, optimism, and sleep in the experimental group were lower than those in the control group (P < 0.05) in the intermediate-test stage and the tracking-test stage (P < 0.05); the psychological stress, depression, and anxiety of the college students in the experimental group in the intermediate-test and tracking-test stage were slighter than those in the control group (P < 0.05); the somatization, compulsion, and interpersonal relationship of students in the experimental group were significantly lower than those in the control group (P < 0.05).

CONCLUSIONS

The psychological stress, depression, interpersonal sensitivity, anxiety, and psychosis were all risk factors for the college student to have suicide ideation. Negative emotions such as psychological stress, emotional depression, and anxiety of the college student with suicide ideation could be improved effectively by cognitive behaviour therapy, and the level of suicide ideation could be reduced finally.

Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis

INTRODUCTION

There is controversy on the magnitude of suicide risk in OCD and on the psychopathological features that raise the risk. This systematic review and meta-analysis aims to estimate the pooled prevalence of suicide attempts and suicidal ideation (current/lifetime) in subjects with OCD and identify sociodemographic and clinical factors associated with greater risk.

METHODS

We conducted a literature search in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases up to June 20, 2019, according to PRISMA guidelines. Stata statistical software (Version 15) was used to obtain forest plots, execute subgroup analyses and perform univariate and multivariate meta-regressions.

RESULTS

We found 61 eligible studies including OCD patients: 52 investigated suicide attempts and reported a pooled prevalence of 0.135 (95% CI 0.123-0.147); 26 explored current suicidal ideation and reported a pooled prevalence of 0.273 (95% CI 0.214-0.335); 22 researched lifetime suicidal ideation and reported a pooled prevalence of 0.473 (95% CI 0.397-0.548). Severity of obsessions, comorbid substance use and depressive/anxious symptoms increased the risk, whereas compulsions had a comparatively protective effect.

LIMITATIONS

Owing to the small number of studies reporting completed suicide rates, this metric was not included in the meta-analysis. The degree of heterogeneity between the studies was high.

CONCLUSION

Clinicians should keep in mind that one out of ten patients with OCD attempts suicide during his/her lifetime, about one third has current suicidal ideation and about half has had suicidal ideation in the past. Several clinical features are associated with increased risk and should be factored into clinical risk management.

Pretreatment levels of rumination predict cognitive-behavioral therapy outcomes in a transdiagnostic sample of adults with anxiety-related disorders

Increasing research has implicated rumination in the development and maintenance of many types of psychopathology, including anxiety-related disorders. A few studies have explored the impact of rumination during cognitive-behavioral therapy (CBT) for anxiety-related disorders (which relies heavily on exposure-based interventions), with mixed results. The present study assessed levels of (trait) rumination before starting treatment for predicting outcomes in 147 adults seeking CBT for anxiety-related disorders in an open treatment clinic. Results revealed that pretreatment levels of rumination significantly predicted (lower) quality of life at the end of treatment, after accounting for baseline variance in quality of life. This finding remained robust when also accounting for demographics, depression, general anxiety, and diagnosis. This result was not observed for self-reflection (a construct related to, but distinguishable from, rumination). Nevertheless, a follow-up (receiver-operator characteristic) analysis showed that pretreatment rumination did not reliably distinguish participants who showed clinically meaningful gains in quality of life during treatment from those who did not. Theoretical and clinical implications of these findings are discussed. We propose that rumination may impede emotional processing during CBT for anxiety, and warrants further attention and treatment. However, more advanced methods (e.g., multivariate modeling) are needed to improve the prognostic utility of rumination.

Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization

Post-traumatic stress disorder (PTSD) is a severe polygenic disorder triggered by environmental factors. Many polymorphic genes, particularly the genetic determinants of hypodopaminergia (low dopamine function), associate with a predisposition to PTSD as well as substance use disorder. Support from the National Institutes of Health for neuroimaging research and molecular, genetic applied technologies has improved understanding of brain reward circuitry functions that have inspired the development of new innovative approaches to their early diagnosis and treatment of some PTSD symptomatology and addiction. This review presents psychosocial and genetic evidence that vulnerability or resilience to PTSD can theoretically be impacted by dopamine regulation. From a neuroscience perspective, dopamine is widely accepted as a major neurotransmitter. Questions about how to modulate dopamine clinically in order to treat and prevent PTSD and other types of reward deficiency disorders remain. Identification of genetic variations associated with the relevant genotype-phenotype relationships can be characterized using the Genetic Addiction Risk Score (GARS®) and psychosocial tools. Development of an advanced genetic panel is under study and will be based on a new array of genes linked to PTSD. However, for now, the recommendation is that enlistees for military duty be given the opportunity to voluntarily pre-test for risk of PTSD with GARS, before exposure to environmental triggers or upon return from deployment as part of PTSD management. Dopamine homeostasis may be achieved via customization of neuronutrient supplementation "Precision Behavioral Management" (PBM™) based on GARS test values and other pro-dopamine regulation interventions like exercise, mindfulness, biosensor tracking, and meditation.