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Wu JY, Tsai YY, Chen YJ, Hsiao FC, Hsu CH, Lin YF, Liao LD. Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing. Med Biol Eng Comput 2024:10.1007/s11517-024-03209-6. [PMID: 39400854 DOI: 10.1007/s11517-024-03209-6] [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: 03/03/2024] [Accepted: 09/17/2024] [Indexed: 10/15/2024]
Abstract
Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.
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Affiliation(s)
- Ju-Yu Wu
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- Doctoral Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ying-Ying Tsai
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- Department of Biomedical Engineering & Environmental Sciences, National Tsing-Hua University, Hsinchu, Taiwan
| | - Yu-Jie Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Fan-Chi Hsiao
- Department of Counseling, Clinical and Industrial/Organizational Psychology, Ming Chuan University, Taoyuan City, Taiwan
| | - Ching-Han Hsu
- Department of Biomedical Engineering & Environmental Sciences, National Tsing-Hua University, Hsinchu, Taiwan
| | - Yen-Feng Lin
- Center for Neuropsychiatric Research, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County, 350, Taiwan
| | - Lun-De Liao
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan.
- Doctoral Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.
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Leehr EJ, Brede LS, Böhnlein J, Roesmann K, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Klahn AL, Weber H, Schiele MA, Domschke K, Lueken U, Dannlowski U. Impact of NPSR1 gene variation on the neural correlates of phasic and sustained fear in spider phobia-an imaging genetics and independent replication approach. Soc Cogn Affect Neurosci 2024; 19:nsae054. [PMID: 39167471 PMCID: PMC11412251 DOI: 10.1093/scan/nsae054] [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: 10/21/2023] [Revised: 05/13/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024] Open
Abstract
The functional neuropeptide S receptor 1 (NPSR1) gene A/T variant (rs324981) is associated with fear processing. We investigated the impact of NPSR1 genotype on fear processing and on symptom reduction following treatment in individuals with spider phobia. A replication approach was applied [discovery sample: Münster (MS) nMS = 104; replication sample Würzburg (WZ) nWZ = 81]. Participants were genotyped for NPSR1 rs324981 [T-allele carriers (risk) versus AA homozygotes (no-risk)]. A sustained and phasic fear paradigm was applied during functional magnetic resonance imaging. A one-session virtual reality exposure treatment was conducted. Change of symptom severity from pre to post treatment and within session fear reduction were assessed. T-allele carriers in the discovery sample displayed lower anterior cingulate cortex (ACC) activation compared to AA homozygotes independent of condition. For sustained fear, this effect was replicated within a small cluster and medium effect size. No association with symptom reduction was found. Within-session fear reduction was negatively associated with ACC activation in T-allele carriers in the discovery sample. NPSR1 rs324981 genotype might be associated with fear processing in the ACC in spider phobia. Interpretation as potential risk-increasing function of the NPSR1 rs324981 T-allele via impaired top-down control of limbic structures remains speculative. Potential association with symptom reduction warrants further research.
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Affiliation(s)
- Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster 48149, Germany
| | - Leonie S Brede
- Institute for Translational Psychiatry, University of Münster, Münster 48149, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster 48149, Germany
| | - Kati Roesmann
- Institute for Clinical Psychology, University of Siegen, Siegen 57072, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster 48149, Germany
- Institute for Psychology, Unit for Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück 49076, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster 48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster 48149, Germany
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster 48149, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69115, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster 48149, Germany
| | - Anna Luisa Klahn
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg 41345, Sweden
| | - Heike Weber
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79104, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79104, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Wurzburg 97080, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 12489, Germany
- German Center for Mental Health (DZPG), partner site Berlin-Potsdam
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster 48149, Germany
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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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Tillman GD, Morris EE, Bass C, Turner M, Watson K, Brooks JT, Rawlinson T, Kozel FA, Kraut MA, Motes MA, Hart J. P3a amplitude to trauma-related stimuli reduced after successful trauma-focused PTSD treatment. Biol Psychol 2023; 182:108648. [PMID: 37482132 DOI: 10.1016/j.biopsycho.2023.108648] [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: 02/24/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
An elevated P3a amplitude to trauma-related stimuli is strongly associated with posttraumatic stress disorder (PTSD), yet little is known about whether this response to trauma-related stimuli is affected by treatment that decreases PTSD symptoms. As an analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the P3a in responses in a three-condition oddball visual task that included trauma-related (combat scenes) and trauma-unrelated (threatening animals) distractors. Fifty-five U.S. veterans diagnosed with combat-related PTSD were randomized to receive either active or sham repetitive transcranial magnetic stimulation (rTMS). All received cognitive processing therapy, CPT+A, which requires a written account of the index trauma. They were tested before and 6 months after protocol completion. P3a amplitude and response time decreases were driven largely by the changes in the responses to the trauma-related stimuli, and this decrease correlated to the decrease in PTSD symptoms. The amplitude changes were greater in those who received rTMS + CPT than in those who received sham rTMS + CPT, suggesting that rTMS plays beneficial role in reducing arousal and threat bias, which may allow for more effective engagement in trauma-focused PTSD treatment.
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Affiliation(s)
- Gail D Tillman
- Callier Center, University of Texas at Dallas, Dallas, TX, USA.
| | | | - Christina Bass
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Mary Turner
- Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelsey Watson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Jared T Brooks
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Tyler Rawlinson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Michael A Kraut
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Motes
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - John Hart
- Callier Center, University of Texas at Dallas, Dallas, TX, USA; Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA; Departments of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hu X, Feng B, Chen L, Luo W. Threat shapes visual context sensitivity selectively through low-spatial-frequency channels. Cognition 2023; 230:105305. [PMID: 36228380 DOI: 10.1016/j.cognition.2022.105305] [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: 07/08/2022] [Revised: 08/26/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
Threat has long been supposed to affect human cognitive processing including visual size perception. Whether such threat-related modulation effect varies as a function of spatial frequency is largely unexplored. Here we used low- or high-pass filtered threatening animal and fearful face images as primes and measured their effects on the processing of the Ebbinghaus illusion. Results showed that threatening-animal primes relative to neutral ones significantly decreased the illusion magnitude in low-spatial-frequency rather than in high-spatial-frequency ranges. However, fearful- and neutral-face primes had a comparable effect on the illusion magnitude in both spatial frequency ranges. Notably, when inhibitory transcranial magnetic stimulation was applied to the left temporo-parietal junction (TPJ), fearful-face primes significantly decreased the illusion magnitude in low-spatial-frequency rather than in high-spatial-frequency ranges. However, the opposite pattern of results was observed with right TPJ stimulation. The findings suggest that threat shapes basic aspects of visual perception in a spatial frequency-specific manner, possibly via magnocellular projections from both subcortical and cortical fear-processing systems to early visual cortex.
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Affiliation(s)
- Xuhua Hu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, PR China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, PR China
| | - Bengang Feng
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, PR China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, PR China
| | - Lihong Chen
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, PR China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, PR China.
| | - Wenbo Luo
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, PR China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, PR China.
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6
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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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Knowles KA, Tolin DF. Mechanisms of Action in Exposure Therapy. Curr Psychiatry Rep 2022; 24:861-869. [PMID: 36399234 DOI: 10.1007/s11920-022-01391-8] [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] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness. RECENT FINDINGS Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction. Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.
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Affiliation(s)
- Kelly A Knowles
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA. .,Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
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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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Richard Y, Tazi N, Frydecka D, Hamid MS, Moustafa AA. A systematic review of neural, cognitive, and clinical studies of anger and aggression. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35693838 PMCID: PMC9174026 DOI: 10.1007/s12144-022-03143-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 01/23/2023]
Abstract
Anger and aggression have large impact on people's safety and the society at large. In order to provide an intervention to minimise aggressive behaviours, it is important to understand the neural and cognitive aspects of anger and aggression. In this systematic review, we investigate the cognitive and neural aspects of anger-related processes, including anger-related behaviours and anger reduction. Using this information, we then review prior existing methods on the treatment of anger-related disorders as well as anger management, including mindfulness and cognitive behavioural therapy. At the cognitive level, our review that anger is associated with excessive attention to anger-related stimuli and impulsivity. At the neural level, anger is associated with abnormal functioning of the amygdala and ventromedial prefrontal cortex. In conclusions, based on cognitive and neural studies, we here argue that mindfulness based cognitive behavioural therapy may be better at reducing anger and aggression than other behavioural treatments, such as cognitive behavioural therapy or mindfulness alone. We provide key information on future research work and best ways to manage anger and reduce aggression. Importantly, future research should investigate how anger related behaviours is acquired and how stress impacts the development of anger.
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Affiliation(s)
| | - Nadia Tazi
- Arabian Gulf University, Manama, Bahrain
- Universite Med 5th, Rabat, Morocco
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland
| | | | - Ahmed A. Moustafa
- Department of Human Anatomy and Physiology, the Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2193 South Africa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD Australia
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Wittfoth D, Beise J, Manuel J, Bohne M, Wittfoth M. Bifocal emotion regulation through acupoint tapping in fear of flying. Neuroimage Clin 2022; 34:102996. [PMID: 35378497 PMCID: PMC8980501 DOI: 10.1016/j.nicl.2022.102996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
Very few studies have investigated the neural underpinnings of bifocal-multisensory interventions such as acupoint tapping (tapping) despite their well-documented efficacy. The present study aims to investigate the neural and behavioral responses to tapping during the perception of phobic and generally fear-inducing stimulation in a group of participants with fear of flying. We studied 29 flight-phobic participants who were exposed to phobia-related, fear-inducing and neutral stimulation while undergoing fMRI and a bifocal-multisensory intervention session consisting of tapping plus cognitive restructuring in a within-subject design. During tapping we found an up-regulation of neural activation in the amygdala, and a down-regulation in the hippocampus and temporal pole. These effects were different from automatic emotion regulatory processes which entailed down-regulation in the amygdala, hippocampus, and temporal pole. Mean scores (±SD) on the Fear of Flying scale dropped from 2.51(±0.65) before the intervention to 1.27(±0.68) after the intervention (p <.001). The proportion of participants meeting the criteria for fear of flying also dropped from 89.7 percent before the intervention to 24.0 percent after the intervention (p <.001). Taken together, our results lend support to the effectiveness of tapping as a means of emotion regulation across multiple contexts and add to previous findings of increased amygdala activation during tapping, as opposed to amygdala down-regulation found in other emotion regulation techniques. They expand on previous knowledge by suggesting that tapping might modulate the processing of complex visual scene representations and their binding with visceral emotional reponses, reflected by the down-regulation of activation in the hippocampus and temporal pole. Bifocal emotion regulation was useful in ameliorating aversive reactions to phobic stimuli in people with fear of flying.
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Affiliation(s)
- Dina Wittfoth
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Jelena Beise
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jorge Manuel
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Michael Bohne
- Fortbildungsinstitut für PEP, Tiedgestrasse 5, Hannover, Germany
| | - Matthias Wittfoth
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany
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Bryant RA, Erlinger M, Felmingham K, Klimova A, Williams LM, Malhi G, Forbes D, Korgaonkar MS. Reappraisal-related neural predictors of treatment response to cognitive behavior therapy for post-traumatic stress disorder. Psychol Med 2021; 51:2454-2464. [PMID: 32366351 DOI: 10.1017/s0033291720001129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), one-third of patients are treatment non-responders. To identify neural markers of treatment response to TF-CBT when participants are reappraising aversive material. METHODS This study assessed PTSD patients (n = 37) prior to TF-CBT during functional magnetic brain resonance imaging (fMRI) when they reappraised or watched traumatic images. Patients then underwent nine sessions of TF-CBT, and were then assessed for symptom severity on the Clinician-Administered PTSD Scale. FMRI responses for cognitive reappraisal and emotional reactivity contrasts of traumatic images were correlated with the reduction of PTSD severity from pretreatment to post-treatment. RESULTS Symptom improvement was associated with decreased activation of the left amygdala during reappraisal, but increased activation of bilateral amygdala and hippocampus during emotional reactivity prior to treatment. Lower connectivity of the left amygdala to the subgenual anterior cingulate cortex, pregenual anterior cingulate cortex, and right insula, and that between the left hippocampus and right amygdala were also associated with symptom improvement. CONCLUSIONS These findings provide evidence that optimal treatment response to TF-CBT involves the capacity to engage emotional networks during emotional processing, and also to reduce the engagement of these networks when down-regulating emotions.
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Affiliation(s)
- Richard A Bryant
- University of New South Wales, School, Sydney, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - May Erlinger
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Kim Felmingham
- Department of Psychological Medicine, University of Melbourne, Melbourne, Australia
| | - Aleksandra Klimova
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, San Francisco, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, San Francisco, USA
| | - Gin Malhi
- Department of Psychiatry, University of Sydney, Sydney, Australia
| | - David Forbes
- Phoenix Australia, University of Melbourne, Melbourne, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
- Department of Psychiatry, University of Sydney, Sydney, Australia
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12
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Böhnlein J, Leehr EJ, Roesmann K, Sappelt T, Platte O, Grotegerd D, Sindermann L, Repple J, Opel N, Meinert S, Lemke H, Borgers T, Dohm K, Enneking V, Goltermann J, Waltemate L, Hülsmann C, Thiel K, Winter N, Bauer J, Lueken U, Straube T, Junghöfer M, Dannlowski U. Neural processing of emotional facial stimuli in specific phobia: An fMRI study. Depress Anxiety 2021; 38:846-859. [PMID: 34224655 DOI: 10.1002/da.23191] [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: 01/19/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with specific phobia (SP) show altered brain activation when confronted with phobia-specific stimuli. It is unclear whether this pathogenic activation pattern generalizes to other emotional stimuli. This study addresses this question by employing a well-powered sample while implementing an established paradigm using nonspecific aversive facial stimuli. METHODS N = 111 patients with SP, spider subtype, and N = 111 healthy controls (HCs) performed a supraliminal emotional face-matching paradigm contrasting aversive faces versus shapes in a 3-T magnetic resonance imaging scanner. We performed region of interest (ROI) analyses for the amygdala, the insula, and the anterior cingulate cortex using univariate as well as machine-learning-based multivariate statistics based on this data. Additionally, we investigated functional connectivity by means of psychophysiological interaction (PPI). RESULTS Although the presentation of emotional faces showed significant activation in all three ROIs across both groups, no group differences emerged in all ROIs. Across both groups and in the HC > SP contrast, PPI analyses showed significant task-related connectivity of brain areas typically linked to higher-order emotion processing with the amygdala. The machine learning approach based on whole-brain activity patterns could significantly differentiate the groups with 73% balanced accuracy. CONCLUSIONS Patients suffering from SP are characterized by differences in the connectivity of the amygdala and areas typically linked to emotional processing in response to aversive facial stimuli (inferior parietal cortex, fusiform gyrus, middle cingulate, postcentral cortex, and insula). This might implicate a subtle difference in the processing of nonspecific emotional stimuli and warrants more research furthering our understanding of neurofunctional alteration in patients with SP.
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Affiliation(s)
- Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Kati Roesmann
- Institute for Clinical Psychology, University of Siegen, Siegen, Germany.,Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Teresa Sappelt
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ole Platte
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Lisa Sindermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Hannah Lemke
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Verena Enneking
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Lena Waltemate
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Carina Hülsmann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Thiel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, School of Medicine, University of Münster, Münster, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
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13
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Kinney KL, Burkhouse KL, Chang F, MacNamara A, Klumpp H, Phan KL. Neural mechanisms and predictors of SSRI and CBT treatment of anxiety: A randomized trial focused on emotion and cognitive processing. J Anxiety Disord 2021; 82:102449. [PMID: 34274600 PMCID: PMC8364887 DOI: 10.1016/j.janxdis.2021.102449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Anxiety disorders (ADs) are common and difficult to treat. While research suggests ADs are characterized by an imbalance between bottom-up and top-down attention processes and that effective treatments work by correcting this dysfunction, there is insufficient data to explain how and for whom treatments work. The late positive potential (LPP), an event-related potential reflecting elaborative processing of motivationally salient stimuli, is sensitive to both bottom-up and top-down processes. The present study examines the LPP in healthy controls (HC) and patients with ADs under low and high working memory (WM) load to assess its utility as a predictor and index of symptom reduction in patients who underwent cognitive behavioral therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The LPP when viewing negative and neutral distractor images and WM performance were assessed in 96 participants (40 HC, 32 CBT, 24 SSRI) during a letter recall task at Week 0 and in a subset of the study sample (23 CBT, 16 SSRI) at Week 12. Patients were randomly assigned to twelve weeks of CBT or SSRI treatment. Participants completed self-reported symptom measures at each time point. Greater Week 0 LPP to negative images under low WM load predicted greater symptom reduction in the SSRI, but not the CBT, group. Regression analyses examining the LPP to negative images as an index of symptom reduction revealed a smaller decrease in the LPP to negative images under low WM load was associated with less anxiety reduction across treatment modalities. Findings suggest the LPP during low WM load may serve as a cost-effective predictor and index of treatment outcome in ADs. Clinical Trials Registration: ClinicalTrials.gov (Identifier: NCT01903447).
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Affiliation(s)
- Kerry L Kinney
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States.
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Fini Chang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States; Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, United States
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14
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Pizzie RG, McDermott CL, Salem TG, Kraemer DJM. Neural evidence for cognitive reappraisal as a strategy to alleviate the effects of math anxiety. Soc Cogn Affect Neurosci 2021; 15:1271-1287. [PMID: 33258958 PMCID: PMC7759208 DOI: 10.1093/scan/nsaa161] [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] [Received: 03/29/2019] [Revised: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Math anxiety (MA) describes feelings of tension, apprehension and fear that interfere with math performance. High MA (HMA) is correlated with negative consequences, including lower math grades, and ultimately an avoidance of quantitative careers. Given these adverse consequences, it is essential to explore effective intervention strategies to reduce MA. In the present functional magnetic resonance imaging (fMRI) study, we investigated the efficacy of cognitive reappraisal as a strategy to alleviate the effects of MA. Cognitive reappraisal, an emotion regulation strategy, has been shown to decrease negative affect and amygdala responsivity to stimuli that elicit negative emotion. We compared a reappraisal strategy to participants’ natural strategy for solving math problems and analogies. We found that HMA individuals showed an increase in accuracy and a decrease in negative affect during the reappraisal condition as compared to the control condition. During math reappraise trials, increased activity in a network of regions associated with arithmetic correlated with improved performance for HMA individuals. These results suggest that increased engagement of arithmetic regions underlies the performance increases we identify in HMA students when they use reappraisal to augment their math performance. Overall, cognitive reappraisal is a promising strategy for enhancing math performance and reducing anxiety in math anxious individuals.
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Affiliation(s)
- Rachel G Pizzie
- PhD in Educational Neuroscience Program, Gallaudet University, 800 Florida Ave NE, Washington, DC 20002, USA
| | - Cassidy L McDermott
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6018, USA
| | - Tyler G Salem
- Department of Education and Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA
| | - David J M Kraemer
- Department of Education and Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA
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15
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Fear extinction learning and anandamide: an fMRI study in healthy humans. Transl Psychiatry 2021; 11:161. [PMID: 33723207 PMCID: PMC7961038 DOI: 10.1038/s41398-020-01177-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Anxiety- and trauma-related disorders are severe illnesses with high prevalence. Current treatment options leave room for improvement and the endocannabinoid system (ECS) has become a key target in psychopharmacological research. Rodent models suggest an anxiolytic effect of endocannabinoids and demonstrated that the ECS is involved in the modulation of fear learning and aversive memory consolidation. So far, one prominent target was inhibition of fatty acid amino hydrolase (FAAH), the degrading enzyme of the endocannabinoid anandamide (AEA). Research in humans remains scarce, but genetic studies have found that the single-nucleotide polymorphism (SNP) FAAH C385A (rs324420) is associated with lower catabolic performance of FAAH and increased levels of AEA. Translational research on the ECS in fear learning processes is rare, yet crucial to understand the mechanisms involved. To address this lack of research, we designed a fear conditioning, extinction learning paradigm with 51 healthy, male humans who underwent functional magnetic resonance imaging (fMRI) before analysing baseline and task-related changes of AEA, as well as the FAAH polymorphism (rs324420). The results indicate higher AEA levels in AC-heterozygotes than in CC-individuals (SNP rs324420), but no difference between the groups during extinction learning. However, neural activation of the anterior cingulate cortex and anterior insular cortex during extinction learning correlated positively with AEA baseline levels, and task-related changes in AEA were found particularly during fear extinction, with a modulatory effect on neural activation related to extinction learning. Results indicate a putative role for AEA in fear extinction learning. Pre-treatment with AEA-enhancing drugs could promote extinction learning during psychotherapeutic interventions.
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16
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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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17
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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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18
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Sambuco N, Costa VD, Lang PJ, Bradley MM. Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock. J Affect Disord 2020; 276:1142-1148. [PMID: 32791350 PMCID: PMC7490761 DOI: 10.1016/j.jad.2020.07.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 explicitly states that the neural system model of specific phobia is centered on the amygdala. However, this hypothesis is predominantly supported by human studies on animal phobia, whereas visual cuing of other specific phobias, such as dental fear, do not consistently show amygdala activation. Considering that fear of anticipated pain is one of the best predictors of dental phobia, the current study investigated neural and autonomic activity of pain anticipation in individuals varying in the degree of fear of dental pain. METHOD Functional brain activity (fMRI) was measured in women (n = 31) selected to vary in the degree of self-reported fear of dental pain when under the threat of shock, in which one color signaled the possibility of receiving a painful electric shock and another color signaled safety. RESULTS Enhanced functional activity during threat, compared to safety, was found in regions including anterior insula and anterior/mid cingulate cortex. Importantly, threat reactivity in the anterior insula increased as reported fear of pain increased and further predicted skin conductance changes during pain anticipation. LIMITATIONS The sample was comprised of women. CONCLUSIONS Individual differences in fear of pain vary with activation in the anterior insula, rather than with the amygdala, indicating that fear is not uniquely associated with amygdala activation. Whereas coping techniques such as emotion regulation have been found to vary with activation in a frontal-amygdala circuit when confronted with visual cues, precision psychiatry may need to target specific brain circuits to diagnose and treat different types of specific phobia.
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Affiliation(s)
- Nicola Sambuco
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL.
| | - Vincent D Costa
- Department of Behavioral Neuroscience, Oregon Health & Science University
| | - Peter J Lang
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
| | - Margaret M Bradley
- Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL
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19
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TATHAN BEKAROĞLU E, YILMAZ T. Nomofobi: Ayırıcı Tanı ve Tedavisi. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2020. [DOI: 10.18863/pgy.528897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Hengen KM, Alpers GW. What's the Risk? Fearful Individuals Generally Overestimate Negative Outcomes and They Dread Outcomes of Specific Events. Front Psychol 2019; 10:1676. [PMID: 31417450 PMCID: PMC6682660 DOI: 10.3389/fpsyg.2019.01676] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Although it is an adaptive mechanism that danger usually elicits fear, it seems that fearful individuals overestimate the danger associated with their feared objects or situations. Previous research has not systematically distinguished between the estimated risk of an encounter with fear-relevant stimuli and the expected unpleasant outcomes of such encounters. Furthermore, it is not clear if biased risk perception is specific to an individual's fear or generalized to all negative events. In an online-survey (N = 630) we assessed the estimated risk to encounter fear-relevant stimuli and the expectations of negative outcomes of such encounters. Items contained three domains (spiders, snakes, and everyday fear triggers). In regression analyses we examined the specific associations between fear and risk estimations. In addition, we compared subgroups with specific fears and low fearful individuals. While an individual's fear score was not related to the estimated risk of an encounter with fear-specific stimuli, it was related to an overestimation of negative outcomes in all domains. The perceived risk of aversive outcomes was most pronounced for an individual's specific fear. Furthermore, an individual's specific fear was most predictive of the estimated risk of a negative fear-relevant outcome. Highly fearful individuals overestimate the risk of negative outcomes of fear-relevant encounters. Specifically, they dread outcomes of encounters with their feared object. Differentiating fear-relevant components of risk perception provides insights into the cognitions which may motivate maladaptive avoidance behavior.
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Affiliation(s)
- Kristina M. Hengen
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Georg W. Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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21
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Ballanger B, Bath KG, Mandairon N. Odorants: a tool to provide nonpharmacological intervention to reduce anxiety during normal and pathological aging. Neurobiol Aging 2019; 82:18-29. [PMID: 31377537 DOI: 10.1016/j.neurobiolaging.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023]
Abstract
Anxiety disorders represent 1 of the most common classes of psychiatric disorders. In the aging population and for patients with age-related pathology, the percentage of people suffering of anxiety is significantly elevated. Furthermore, anxiety carries with it an increased risk for a variety of age-related medical conditions, including cardiovascular disease, stroke, cognitive decline, and increased severity of motor symptoms in Parkinson's disease. A variety of anxiolytic compounds are available but often carry with them disturbing side effects that impact quality of life. Among nonmedicinal approaches to reducing anxiety, odor diffusion and aromatherapy are the most popular. In this review, we highlight the emerging perspective that the use of odorants may reduce anxiety symptoms or at least potentiate the effect of other anxiolytic approaches and may serve as an alternative form of therapy to deal with anxiety symptoms. Such approaches may be particularly beneficial in aging populations with elevated risk for these disorders. We also discuss potential neural mechanisms underlying the anxiolytic effects of odorants based on work in animal models.
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Affiliation(s)
- Benedicte Ballanger
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Neuroplasticity and Neuropathology of Olfactory Perception Team, Lyon F-69000, France; University Lyon, Lyon F-69000, France; University Lyon 1, Villeurbanne, F-69000, France
| | - Kevin G Bath
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence RI 02912, United States
| | - Nathalie Mandairon
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Neuroplasticity and Neuropathology of Olfactory Perception Team, Lyon F-69000, France; University Lyon, Lyon F-69000, France; University Lyon 1, Villeurbanne, F-69000, France.
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22
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Magni LR, Carcione A, Ferrari C, Semerari A, Riccardi I, Nicolo’ G, Lanfredi M, Pedrini L, Cotelli M, Bocchio L, Pievani M, Gasparotti R, Rossi R. Neurobiological and clinical effect of metacognitive interpersonal therapy vs structured clinical model: study protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:195. [PMID: 31234864 PMCID: PMC6591903 DOI: 10.1186/s12888-019-2127-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The "gold standard" treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to assess the clinical and neurobiological changes following Metacognitive Interpersonal Therapy (MIT) compared with Structured Clinical Management (SCM) derived from specific recommendations in APA (American Psychiatric Association) guidelines for BPD. METHODS The study design is a randomized parallel controlled clinical trial and will include 80 BPD outpatients, aged 18-45 enrolled at 2 recruitment centers. Primary outcome will be the clinical change in emotion regulation capacities assessed with the Difficulties in Emotion Regulation Scale (DERS). We will also investigated the effect of psychotherapy on metacognitive abilities and several clinical features such as BPD symptomatology, general psychopathology, depression, personal functioning, and trait dimensions (anger, impulsivity, alexithymia). We will evaluate changes in brain connectivity patterns and during the view of emotional pictures. A multidimensional assessment will be performed at the baseline, at 6, 12, 18 months. We will obtain structural and functional Magnetic Resonance Images (MRIs) in MIT-Treated BPD (N = 30) and SCM-treated BPD (N = 30) at baseline and after treatment, as well as in a group of 30 healthy and unrelated volunteers that will be scanned once for comparison. DISCUSSION The present study could contribute to elucidate the neurobiological mechanisms underlying psychotherapy efficacy. The inclusion of a multidisciplinary study protocol will allow to study BPD considering different features that can affect the treatment response and their reciprocal relationships. TRIAL REGISTRATION NCT02370316 . Registered 02/24/2015.
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Affiliation(s)
- Laura Rosa Magni
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Clarissa Ferrari
- grid.419422.8Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Ilaria Riccardi
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolo’
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy ,Dipartimento Salute Mentale Roma 5, Rome, Italy
| | - Mariangela Lanfredi
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Pedrini
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- grid.419422.8Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisella Bocchio
- grid.425670.2IRCCS Istituto Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Michela Pievani
- grid.419422.8Laboratory Alzheimer’s Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberto Gasparotti
- 0000000417571846grid.7637.5Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Chen X, van Gerven J, Cohen A, Jacobs G. Human pharmacology of positive GABA-A subtype-selective receptor modulators for the treatment of anxiety. Acta Pharmacol Sin 2019; 40:571-582. [PMID: 30518829 DOI: 10.1038/s41401-018-0185-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders arise from disruptions among the highly interconnected circuits that normally serve to process the streams of potentially threatening stimuli. The resulting imbalance among these circuits can cause a fundamental misinterpretation of neural sensory information as threatening and can lead to the inappropriate emotional and behavioral responses observed in anxiety disorders. There is considerable preclinical evidence that the GABAergic system, in general, and its α2- and/or α5-subunit-containing GABA(A) receptor subtypes, in particular, are involved in the pathophysiology of anxiety disorders. However, the clinical efficacy of GABA-A α2-selective agonists for the treatment of anxiety disorders has not been unequivocally demonstrated. In this review, we present several human pharmacological studies that have been performed with the aim of identifying the pharmacologically active doses/exposure levels of several GABA-A subtype-selective novel compounds with potential anxiolytic effects. The pharmacological selectivity of novel α2-subtype-selective GABA(A) receptor partial agonists has been demonstrated by their distinct effect profiles on the neurophysiological and neuropsychological measurements that reflect the functions of multiple CNS domains compared with those of benzodiazepines, which are nonselective, full GABA(A) agonists. Normalizing the undesired pharmacodynamic side effects against the desired on-target effects on the saccadic peak velocity is a useful approach for presenting the pharmacological features of GABA(A)-ergic modulators. Moreover, combining the anxiogenic symptom provocation paradigm with validated neurophysiological and neuropsychological biomarkers may provide further construct validity for the clinical effects of novel anxiolytic agents. In addition, the observed drug effects on serum prolactin levels support the use of serum prolactin levels as a complementary neuroendocrine biomarker to further validate the pharmacodynamic measurements used during the clinical pharmacological study of novel anxiolytic agents.
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Kim N, Kang SG, Lee YJ, Kim SJ, Kim S, Choi JW, Oh SM, Park J, Gwak AR, Kim HK, Jeong DU. Decreased regional brain activity in response to sleep-related sounds after cognitive behavioral therapy for psychophysiological insomnia. Psychiatry Clin Neurosci 2019; 73:254-261. [PMID: 30663182 DOI: 10.1111/pcn.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
AIM Patients with psychophysiological insomnia (PI) experience hyperarousal, especially as a reaction to sound stimuli. In the current study, we explored brain activity changes in response to sleep-related sounds (SS) in patients with insomnia after cognitive behavioral therapy for insomnia (CBT-I). METHODS In 14 drug-free PI patients, regional brain activity in response to SS, and to white noise sound (NS) as neutral stimuli, was investigated before and after individual CBT-I using functional magnetic resonance imaging. Blood oxygen level-dependent (BOLD) signals to SS and NS were compared before and after CBT-I. In addition, the association between clinical improvement after CBT-I and changes in brain activity in response to SS and NS was analyzed. RESULTS Compared with baseline, regional brain activity in response to SS after CBT-I decreased in the left middle temporal and left middle occipital gyrus. In regression analysis, a reduction in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale score after CBT-I was associated with decrease in brain activity in response to SS in both thalami. However, brain activity in response to NS showed no BOLD signal changes and no association with DBAS change. CONCLUSION Cortical hyperactivity, which may cause hyperarousal in PI, was found to decrease after CBT-I. CBT-I targeting changes in beliefs and attitudes about sleep may induce its therapeutic effects by reducing thalamic brain activity in response to sleep-related stimuli.
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Affiliation(s)
- Nambeom Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Soohyun Kim
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychology, University at Buffalo, New York, USA
| | - Ah Reum Gwak
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Biomedical Engineering, Gachon University, Incheon, Republic of Korea
| | - Do-Un Jeong
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
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Gentili C, Messerotti Benvenuti S, Lettieri G, Costa C, Cecchetti L. ROI and phobias: The effect of ROI approach on an ALE meta-analysis of specific phobias. Hum Brain Mapp 2019; 40:1814-1828. [PMID: 30548734 PMCID: PMC6865604 DOI: 10.1002/hbm.24492] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022] Open
Abstract
About 90% of fMRI findings on specific phobias (SP) include analysis of region of interest (ROI). This approach characterized by higher sensitivity may produce inflated results, particularly when findings are aggregated in meta-analytic maps. Here, we conducted a systematic review and activation likelihood estimation (ALE) meta-analysis on SP, testing the impact of the inclusion of ROI-based studies. ALE meta-analyses were carried out either including ROI-based results or focusing on whole-brain voxelwise studies exclusively. To assess the risk of bias in the neuroimaging field, we modified the Newcastle-Ottawa Scale (NOS) and measured the reliability of fMRI findings. Of the 31 selected investigations (564 patients and 485 controls) one-third did not motivate ROI selection: five studies did not report an explicit rationale, whereas four did not cite any specific reference in this regard. Analyses including ROI-based studies revealed differences between phobics and healthy subjects in several regions of the limbic circuit. However, when focusing on whole-brain analysis, only the anterior midcingulate cortex differentiated SP from controls. Notably, 13 studies were labeled with low risk of bias according to the adapted NOS. The inclusion of ROI-based results artificially inflates group differences in fMRI meta-analyses. Moreover, a priori, well-motivated selection of ROIs is desirable to improve quality and reproducibility in SP neuroimaging studies. Lastly, the use of modified NOS may represent a valuable way to assess and evaluate biases in fMRI studies: "low risk" of bias was reported for less than half of the included studies, indicating the need for better practices in fMRI.
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Affiliation(s)
- Claudio Gentili
- Department of General PsychologyUniversity of PadovaPadovaItaly
| | | | | | - Cristiano Costa
- Department of General PsychologyUniversity of PadovaPadovaItaly
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26
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Hoffman YSG, Pitcho-Prelorentzos S, Ring L, Ben-Ezra M. "Spidey Can": Preliminary Evidence Showing Arachnophobia Symptom Reduction Due to Superhero Movie Exposure. Front Psychiatry 2019; 10:354. [PMID: 31231249 PMCID: PMC6565891 DOI: 10.3389/fpsyt.2019.00354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/03/2019] [Indexed: 11/13/2022] Open
Abstract
Fear of insects, mainly spiders, is considered one of the most common insect phobias. However, to date, no conducted studies have examined the effects of phobic stimulus exposure (spiders/ants) within the positive context of superhero movies, such as Spider-Man or Ant-Man. A convenience sample of 424 participants divided into four groups watched different clips. Two intervention groups (Spider-Man/Ant-Man) and two control groups (Marvel opening/natural scene) were measured twice (pre-post intervention). The measures comprised an online survey assessing socio-demographic variables, familiarity with superhero movies and comics, and phobic symptoms. Reduction in phobic symptoms was significant in the Spider-Man and Ant-Man groups in comparison to the control groups. Seven-second exposure to insect-specific stimuli within a positive context reduces the level of phobic symptoms. Incorporating exposure to short scenes from superhero movies within a therapeutic protocol for such phobias may have the potential to be robustly efficacious and enhance cooperation and motivation.
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Affiliation(s)
- Yaakov S G Hoffman
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Lia Ring
- School of Social Work, Ariel University, Ariel, Israel
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27
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Abstract
The measurement of Pavlovian forms of fear extinction offers a relatively simple behavioral preparation that is nonetheless tractable, from a translational perspective, as an approach to study mechanisms of exposure therapy and biological underpinnings of anxiety and trauma-related disorders such as post-traumatic stress disorder (PTSD). Deficient fear extinction is considered a robust clinical endophenotype for these disorders and, as such, has particular significance in the current "age of RDoC (research domain criteria)." Various rodent models of impaired extinction have thus been generated with the objective of approximating this clinical, relapse prone aberrant extinction learning. These models have helped to reveal neurobiological correlates of extinction circuitry failure, gene variants, and other mechanisms underlying deficient fear extinction. In addition, they are increasingly serving as tools to investigate ways to therapeutically overcome poor extinction to support long-term retention of extinction memory and thus protection against various forms of fear relapse; modeled in the laboratory by measuring spontaneous recovery, reinstatement and renewal of fear. In the current article, we review models of impaired extinction built around (1) experimentally induced brain region and neural circuit disruptions (2) spontaneously-arising and laboratory-induced genetic modifications, or (3) exposure to environmental insults, including stress, drugs of abuse, and unhealthy diet. Collectively, these models have been instrumental in advancing in our understanding of extinction failure and underlying susceptibilities at the neural, genetic, molecular, and neurochemical levels; generating renewed interest in developing novel, targeted and effective therapeutic treatments for anxiety and trauma-related disorders.
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Affiliation(s)
- Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria.
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD USA
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Landowska A, Roberts D, Eachus P, Barrett A. Within- and Between-Session Prefrontal Cortex Response to Virtual Reality Exposure Therapy for Acrophobia. Front Hum Neurosci 2018; 12:362. [PMID: 30443209 PMCID: PMC6221970 DOI: 10.3389/fnhum.2018.00362] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/23/2018] [Indexed: 01/30/2023] Open
Abstract
Exposure Therapy (ET) has demonstrated its efficacy in the treatment of phobias, anxiety and Post-traumatic Stress Disorder (PTSD), however, it suffers a high drop-out rate because of too low or too high patient engagement in treatment. Virtual Reality Exposure Therapy (VRET) is comparably effective regarding symptom reduction and offers an alternative tool to facilitate engagement for avoidant participants. Neuroimaging studies have demonstrated that both ET and VRET normalize brain activity within a fear circuit. However, previous studies have employed brain imaging technology which restricts people's movement and hides their body, surroundings and therapist from view. This is at odds with the way engagement is typically controlled. We used a novel combination of neural imaging and VR technology-Functional Near-Infrared Spectroscopy (fNIRS) and Immersive Projection Technology (IPT), to avoid these limitations. Although there are a few studies that have investigated the effect of VRET on a brain function after the treatment, the present study utilized technologies which promote ecological validity to measure brain changes after VRET treatment. Furthermore, there are no studies that have measured brain activity within VRET session. In this study brain activity within the prefrontal cortex (PFC) was measured during three consecutive exposure sessions. N = 13 acrophobic volunteers were asked to walk on a virtual plank with a 6 m drop below. Changes in oxygenated (HbO) hemoglobin concentrations in the PFC were measured in three blocks using fNIRS. Consistent with previous functional magnetic resonance imaging (fMRI) studies, the analysis showed decreased activity in the DLPFC and MPFC during first exposure. The activity increased toward normal across three sessions. The study demonstrates potential efficacy of a method for measuring within-session neural response to virtual stimuli that could be replicated within clinics and research institutes, with equipment better suited to an ET session and at fraction of the cost, when compared to fMRI. This has application in widening access to, and increasing ecological validity of, immersive neuroimaging across understanding, diagnosis, assessment and treatment of, a range of mental disorders such as phobia, anxiety and PTSD or addictions.
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Affiliation(s)
- Aleksandra Landowska
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - David Roberts
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Peter Eachus
- Department of Psychology, School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Alan Barrett
- Military Veterans’ Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
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Kamkuimo Kengne SA, Fossaert M, Girard B, Menelas BAJ. Action-Centered Exposure Therapy (ACET): A New Approach to the Use of Virtual Reality to the Care of People with Post-Traumatic Stress Disorder. Behav Sci (Basel) 2018; 8:E76. [PMID: 30115837 PMCID: PMC6116032 DOI: 10.3390/bs8080076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/05/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) can be seen as the result of dysfunctional beliefs that associate stimuli with a danger or a threat leading to anxious reactions. Exposure therapy is so far considered to be the most effective treatment, and research suggests that it is mainly based on a habituation process. Based on learning theories, it appears that a passive systemic exposure to traumatic stimuli should not be the best option for the treatment of PTSD. We hypothesis that an active learning of safer and healthier coping strategies combined with systematic exposure should be more effective in reducing the psychological distress associated with PTSD. In this paper, we describe the theoretical foundations of this approach that focuses on the action and activity of the patient in his or her exposure environment. In this approach, we take advantage of Virtual Reality technologies and learning mechanics of serious games to allow the patient to learn new safe associations while promoting the empowerment. We named this action-centered exposure therapy (ACET). This approach exploits behaviorism, cognitivism, and constructivism learning theories. With the different benefits of virtual reality technologies, this approach would easily integrate with in-virtuo exposure therapy and would allow us to exploit as much as possible the enormous potential of these technologies. As a first step toward validation, we present a case study that supports the ACET approach.
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Affiliation(s)
- Sorelle Audrey Kamkuimo Kengne
- Department of Computer Sciences and Mathematics, University of Quebec at Chicoutimi, 555 Blv Universite, Chicoutimi, QC G7H 2B1, Canada.
| | - Mathilde Fossaert
- Department of Computer Sciences and Mathematics, University of Quebec at Chicoutimi, 555 Blv Universite, Chicoutimi, QC G7H 2B1, Canada.
| | - Benoît Girard
- La Futaie: Therapy Center, 1061, Boulevard Tadoussac, Saint-Fulgence, QC G0V 1S0, Canada.
| | - Bob-Antoine J Menelas
- Department of Computer Sciences and Mathematics, University of Quebec at Chicoutimi, 555 Blv Universite, Chicoutimi, QC G7H 2B1, Canada.
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Holtz K, Hamm AO, Pané-Farré CA. Repeated Interoceptive Exposure in Individuals With High and Low Anxiety Sensitivity. Behav Modif 2018; 43:467-489. [PMID: 29690770 DOI: 10.1177/0145445518772269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Interoceptive exposure is one component in cognitive behavioral therapy of panic disorder. The present investigation addressed changes in defensive mobilization during repeated interoceptive exposure using a standardized hyperventilation procedure. 26 high and 22 low anxiety sensitive persons (ASI, Peterson & Reiss, 1992) went through two guided hyperventilation and normoventilation procedures, spaced one week apart. Breathing parameters, startle response magnitudes and symptom reports were measured. All participants successfully adhered to the guided breathing procedures. Both groups comparably reported more symptoms during hyperventilation than normoventilation in both sessions. Only high-AS participants displayed potentiated startle magnitudes after the first hyperventilation vs. normoventilation. One week later, when the hyperventilation exercise was repeated, this potentiation was no longer present. Thus, high and low-AS groups no longer differed in their defensive mobilization to symptom provocation. Furthermore, the number of reported baseline symptoms also decreased from session one to session two in the high-AS group. While high-AS reported increased baseline anxiety symptoms in session 1, groups did not differ in session 2. Results indicate a reduction of defensive mobilization during repeated interoceptive exposure.
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31
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Buff C, Schmidt C, Brinkmann L, Gathmann B, Tupak S, Straube T. Directed threat imagery in generalized anxiety disorder. Psychol Med 2018; 48:617-628. [PMID: 28735579 DOI: 10.1017/s0033291717001957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Worrying has been suggested to prevent emotional and elaborative processing of fears. In cognitive-behavioral therapy (CBT), generalized anxiety disorder (GAD) patients are exposed to their fears during the method of directed threat imagery by inducing emotional reactivity. However, studies investigating neural correlates of directed threat imagery and emotional reactivity in GAD patients are lacking. The present functional magnetic resonance imaging (fMRI) study aimed at delineating neural correlates of directed threat imagery in GAD patients. METHOD Nineteen GAD patients and 19 healthy controls (HC) were exposed to narrative scripts of either disorder-related or neutral content and were encouraged to imagine it as vividly as possible. RESULTS Rating results showed that GAD patients experienced disorder-related scripts as more anxiety inducing and arousing than HC. These results were also reflected in fMRI data: Disorder-related v. neutral scripts elicited elevated activity in the amygdala, dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and the thalamus as well as reduced activity in the ventromedial prefrontal cortex/subgenual anterior cingulate cortex in GAD patients relative to HC. CONCLUSION The present study presents the first behavioral and neural evidence for emotional reactivity during directed threat imagery in GAD. The brain activity pattern suggests an involvement of a fear processing network as a neural correlate of initial exposure during directed imagery in CBT in GAD.
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Affiliation(s)
- C Buff
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - C Schmidt
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - B Gathmann
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - S Tupak
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
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Rivero F, Herrero M, Viña C, Álvarez-Pérez Y, Peñate W. Neuroimaging in cockroach phobia: An experimental study. Int J Clin Health Psychol 2017; 17:207-215. [PMID: 30487896 PMCID: PMC6220927 DOI: 10.1016/j.ijchp.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 01/03/2023] Open
Abstract
In this study we explored the neuroimaging characteristics of persons with specific small animal (cockroach) phobia to determine whether there are differences in cerebral activity between persons with and without cockroach phobia under conditions of phobic and non-phobic stimulation. Method: 24 adult persons (12 with phobia) were studied. The diagnosis of phobia was obtained with a structured interview and questionnaires. All participants were exposed to a 3D video presentation during an fMRI session. Results: The phobic group showed significant differential activations that were congruent with a dual route model of fear processing through the thalamus-amygdala (route I) and the thalamus-sensory and association cortex-entorhinal cortex-hippocampus-subiculum-amygdala (route II). Apart from this dual route, we also found differential activations in the globus pallidum, parahippocampal gyrus, insula, pars orbitalis, triangularis and opercularis of the frontal cortex, and cerebellum. Respect to non-phobic group, no activations were found in the insula or the anterior cingulate cortex. Conclusions: There seems to be a dual route depending on how persons with phobia to cockroaches process phobic stimuli. This double processing can have implications for the psychological treatment of specific phobias.
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Affiliation(s)
- Francisco Rivero
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | - Manuel Herrero
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | - Conrado Viña
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | | | - Wenceslao Peñate
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
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Empirically supported psychological treatments and the Research Domain Criteria (RDoC). J Affect Disord 2017; 216:78-88. [PMID: 27836118 DOI: 10.1016/j.jad.2016.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Research Domain Criteria (RDoC) has been developed as an alternative approach to studying psychiatric disorders. The RDoC constructs and units of analysis, from genes up through paradigms, are intended to describe a hierarchy of priority measurements. Several of these have been investigated in the context of empirically-supported treatments, as either moderators or mediators of outcome. METHOD This review considers the available research on the moderating and mediating role of genes, molecules, circuits and physiology in cognitive-behavior therapy (CBT) outcome studies for negative valence system conditions. FINDINGS Based on the review, research has aspired to identify candidate genes, molecules, circuits and physiological moderators or mediators of treatment, but no definitive tests have been conducted. Instead, several candidate variables have been found that deserve further investigation. LIMITATIONS The available research is based on diagnoses from the DSM, whereas the RDoC initiative endeavors to determine empirically valid taxonomic signs. CONCLUSIONS The results of this review are discussed in the joint context of developments in empirically-supported psychological therapy and the specific aims of the RDoC initiative, and conclude with recommendations for future research.
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Miller CWT. Epigenetic and Neural Circuitry Landscape of Psychotherapeutic Interventions. PSYCHIATRY JOURNAL 2017; 2017:5491812. [PMID: 29226124 PMCID: PMC5684598 DOI: 10.1155/2017/5491812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022]
Abstract
The science behind psychotherapy has garnered considerable interest, as objective measures are being developed to map the patient's subjective change over the course of treatment. Prenatal and early life influences have a lasting impact on how genes are expressed and the manner in which neural circuits are consolidated. Transgenerationally transmitted epigenetic markers as well as templates of enhanced thought flexibility versus evasion can be passed down from parent to child. This influences gene expression/repression (impacting neuroplasticity) and kindling of neurocircuitry which can perpetuate maladaptive cognitive processing seen in a number of psychiatric conditions. Importantly, genetic factors and the compounding effects of early life adversity do not inexorably lead to certain fated outcomes. The concepts of vulnerability and resilience are becoming more integrated into the framework of "differential susceptibility," speaking to how corrective environmental factors may promote epigenetic change and reconfigure neural templates, allowing for symptomatic improvement. Psychotherapy is one such factor, and this review will focus on our current knowledge of its epigenetic and neurocircuitry impact.
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Affiliation(s)
- Christopher W. T. Miller
- University of Maryland School of Medicine, 701 W. Pratt St., 4th Floor, Baltimore, MD 21201, USA
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Zhang Y, Yang Y, Bian R, Yin Y, Hou Z, Yue Y, Chen H, Yuan Y. Group Cognitive Behavior Therapy Reversed Insula Subregions Functional Connectivity in Asthmatic Patients. Front Aging Neurosci 2017; 9:105. [PMID: 28458637 PMCID: PMC5394595 DOI: 10.3389/fnagi.2017.00105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Group cognitive behavior therapy (GCBT) is an effective treatment in improving self-management behaviors and quality of life for asthmatic patients. However, the mechanisms by which GCBT improves asthma-related clinical symptoms remain unknown. Previous studies have indicated that insula is an important region involved in the neuropathology of asthma. Therefore, we examined the possible alteration of functional connectivity (FC) in insula subregions after GCBT in asthmatic patients. Methods: Forty-two asthmatic patients and 60 healthy controls (HCs) received resting-state functional magnetic resonance imaging (rs-fMRI) scan and clinical assessments, 17 asthmatic patients completed GCBT treatment consisting of 8 sessions, and then received rs-fMRI scan and clinical assessments. Results: Asthmatic patients had greater left ventral anterior insula (vAI) FC with the left cerebellum posterior lobe, right middle temporal gyrus, and bilateral anterior cingulate cortex (ACC), but less FC with bilateral postcentral gyrus, bilateral occipital lobe, and left precentral gyrus compared with HCs. FC between left posterior insula and left medial frontal gyrus also increased in the patients. In addition, right vAI showed increased FC with right caudate and left putamen. FC between right dorsal anterior insula (dAI) and left calcarine however decreased. The increase in FC in insula subregions were significantly improved following GCBT. FC between the left vAI connectivity and left postcentral gyrus was positively correlated with the percentage of improvement in 17-items Hamilton depression rating scale scores, and FC between the right dAI and left calcarine was negatively associated with the improvement percentage in asthma control test scores. Conclusions: This study in the first time demonstrated that GCBT led to significant improvement of FC between insula subregions and other brain regions. Clinical Trial Registration: An investigation of therapeutic mechanism in asthmatic patients: based on the results of Group Cognitive Behavioral Therapy (Registration number: ChiCTR-COC-15007442) (http://www.chictr.org.cn/usercenter.aspx).
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Affiliation(s)
- Yuqun Zhang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
| | - Yuan Yang
- Department of Respiration, ZhongDa Hospital, Southeast UniversityNanjing, China
| | - Rongrong Bian
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
| | - Yingying Yin
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
| | - Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
| | - Huanxin Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, School of Psychology, Southwest UniversityChongqing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast UniversityNanjing, China.,School of Medicine, Institute of Psychosomatics, Southeast UniversityNanjing, China
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Changing views of emotion regulation and neurobiological models of the mechanism of action of psychotherapy. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2017; 16:571-87. [PMID: 27351671 DOI: 10.3758/s13415-016-0440-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Influential neurobiological models of the mechanism of action of psychotherapy attribute its success to increases of activity in prefrontal areas and decreases in limbic areas, interpreted as the successful and adaptive recruitment of controlled processes to achieve emotion regulation. In this article, we review the behavioral and neuroscientific evidence in support of this model and its applicability to explain the mechanism of action of psychotherapy. Neuroimaging studies of explicit emotion regulation, evidence on the neurobiological substrates of implicit emotion regulation, and meta-analyses of neuroimaging studies of the effect of psychotherapy consistently suggest that areas implicated in coding semantic representations play an important role in emotion regulation not covered by existing models based on controlled processes. We discuss the findings that implicate these same areas in supporting working memory, in encoding preferences and the prospective outcome of actions taken in rewarding or aversive contingencies, and show how these functions may be integrated into process models of emotion regulation that depend on elaborate semantic representations for their effectiveness. These alternative models also appear to be more consistent with internal accounts in the psychotherapeutic literature of how psychotherapy works.
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37
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Peñate W, Fumero A, Viña C, Herrero M, Marrero R, Rivero F. A meta-analytic review of neuroimaging studies of specific phobia to small animals. EUROPEAN JOURNAL OF PSYCHIATRY 2017. [DOI: 10.1016/j.ejpsy.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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38
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Brinkmann L, Poller H, Herrmann MJ, Miltner W, Straube T. Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia. NEUROIMAGE-CLINICAL 2016; 13:320-329. [PMID: 28066706 PMCID: PMC5200881 DOI: 10.1016/j.nicl.2016.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/03/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
Abstract
Blood-injection-injury (BII) phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC), insula, lateral and medial prefrontal cortex (PFC), thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.
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Affiliation(s)
- Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
| | - Hendrik Poller
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Am Steiger 3, D-07743 Jena, Germany
| | - Martin J Herrmann
- Laboratory of Psychophysiology and Functional Imaging, University Hospital Wuerzburg, Fuechsleinstraße 15, D-97080 Wuerzburg, Germany
| | - Wolfgang Miltner
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Am Steiger 3, D-07743 Jena, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany
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39
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Soravia LM, Orosz A, Schwab S, Nakataki M, Wiest R, Federspiel A. CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia. Brain Behav 2016; 6:e00510. [PMID: 27688940 PMCID: PMC5036433 DOI: 10.1002/brb3.510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Imaging studies have provided evidence that cognitive-behavioral therapy (CBT) is able to change brain activation in phobic patients in response to threatening stimuli. The changes occurred in both emotion-generating and modulatory regions. In this study, we use a data-driven approach to explore resting state cerebral blood flow (CBF) measured by arterial spin labeling (ASL), before and after CBT. METHODS Eight female patients with spider phobia were scanned before and 1 month after an exposure-based group therapy for spider phobia. Each MRI session consisted of an ASL resting state measurement acquired before and after a symptom provocation task involving the showing of spider pictures in the scanner. The first ASL acquisition measured anticipatory anxiety and the second measured postprocessing of phobia-relevant stimuli. RESULTS Cognitive-behavioral therapy significantly reduced spider phobic symptoms in all patients. Symptom reduction during anticipatory anxiety was accompanied by reduced bilateral CBF in the parahippocampal gyrus, ventral anterior thalamus, Brodmann area 8, and the anterior cingulate cortex. During postprocessing of phobia-relevant stimuli, patients showed reduced CBF in the bilateral insula, components of the motor cortex, and areas associated with language functions. CONCLUSIONS Longitudinal CBF dynamics following CBT were in concordance with results from several studies using BOLD fMRI to investigate the effects of psychotherapy on brain activity. CBF can be quantified by ASL, with the principal advantage of sensitivity to slow variations in neural activity and task independence. Therefore, ASL may be a suitable method for monitoring and evaluating the efficacy of psychotherapy or pharmacotherapy approaches.
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Affiliation(s)
- Leila M Soravia
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Ariane Orosz
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Simon Schwab
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
| | - Masahito Nakataki
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland; Department of Psychiatry University of Tokushima 3-18-15 Kuramoto-cho Tokushima 770-8503 Japan
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology Inselspital University Hospital of Bern Freiburgstrasse 4 3010 Bern Switzerland
| | - Andrea Federspiel
- Division of Systems Neuroscience of Psychopathology University Hospital of Psychiatry University of Bern Bolligenstrasse 111 3000 Bern Switzerland
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40
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Psychotherapy and its Role in Psychiatric Practice: A Position Paper. I. Psychiatry as a Psychobiological Discipline. J Psychiatr Pract 2016; 22:221-31. [PMID: 27123801 DOI: 10.1097/pra.0000000000000159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Economic, political, and ideological landscapes have impacted the practice of psychiatry throughout its evolution as a medical discipline. Despite enormous scientific advances over the course of the past century, many psychiatrists continue to operate with a split Cartesian picture of mind versus brain and entrenched ideological positions ranging from biological "chemical imbalance" to rigidly followed manualized psychotherapy approaches, both of which frequently result in fractured clinical care. With the impact of systemic economic and political pressures in Canada and the United States, the attention to the doctor-patient relationship has taken a back seat to high-volume practices, computerized assessment tools, and the focus on evidence-based treatments for behaviorally defined syndromes in the Diagnostic and Statistical Manual of Mental Disorders that often come at the expense of the patient's experience of his or her illness. We spend much time teaching the next generation of psychiatrists what to prescribe versus how to prescribe; what manualized treatments to administer versus questioning why our patients engage in dysfunctional patterns of thinking, feeling, and relating to others, and what impact these patterns may have on their interaction with us in the here-and-now of the treatment setting. In this paper, we propose an integrative psychobiological model, in which biological interventions carry personal meanings, and relational transactions in the treatment setting are a form of learning that results in lasting physiological changes in the brain. Psychiatry needs to reconnect with its roots as a science of attachment and meaning, in which attention to the objective, subjective, and relational domains of the patient-provider experience is equally foundational for any successful treatment outcome.
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41
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Straube T. Effects of Psychotherapy on Brain Activation Patterns in Anxiety Disorders. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Psychotherapy is an effective treatment for most mental disorders, including anxiety disorders. Successful psychotherapy implies new learning experiences and therefore neural alterations. With the increasing availability of functional neuroimaging methods, it has become possible to investigate psychotherapeutically induced neuronal plasticity across the whole brain in controlled studies. However, the detectable effects strongly depend on neuroscientific methods, experimental paradigms, analytical strategies, and sample characteristics. This article summarizes the state of the art, discusses current theoretical and methodological issues, and suggests future directions of the research on the neurobiology of psychotherapy in anxiety disorders.
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Affiliation(s)
- Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
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42
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Greco JA, Liberzon I. Neuroimaging of Fear-Associated Learning. Neuropsychopharmacology 2016; 41:320-34. [PMID: 26294108 PMCID: PMC4677141 DOI: 10.1038/npp.2015.255] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/14/2015] [Accepted: 08/16/2015] [Indexed: 01/08/2023]
Abstract
Fear conditioning has been commonly used as a model of emotional learning in animals and, with the introduction of functional neuroimaging techniques, has proven useful in establishing the neurocircuitry of emotional learning in humans. Studies of fear acquisition suggest that regions such as amygdala, insula, anterior cingulate cortex, and hippocampus play an important role in acquisition of fear, whereas studies of fear extinction suggest that the amygdala is also crucial for safety learning. Extinction retention testing points to the ventromedial prefrontal cortex as an essential region in the recall of the safety trace, and explicit learning of fear and safety associations recruits additional cortical and subcortical regions. Importantly, many of these findings have implications in our understanding of the pathophysiology of psychiatric disease. Recent studies using clinical populations have lent insight into the changes in regional activity in specific disorders, and treatment studies have shown how pharmaceutical and other therapeutic interventions modulate brain activation during emotional learning. Finally, research investigating individual differences in neurotransmitter receptor genotypes has highlighted the contribution of these systems in fear-associated learning.
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Affiliation(s)
- John A Greco
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Israel Liberzon
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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43
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Howells FM, Baldwin DS, Kingdon DG. Can cognitive behaviour therapy beneficially influence arousal mechanisms in psychosis? Hum Psychopharmacol 2016; 31:64-9. [PMID: 26270489 DOI: 10.1002/hup.2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/07/2022]
Abstract
Cognitive behavioural therapy for psychosis (CBTp) is an approved adjunct therapy for patients with psychotic disorders; however, we do not fully understand the neurobiological effects that this therapy may exert. Arousal, as measured by electroencephalography (EEG), provides a useful electrophysiological marker for assessing psychotic disorders. EEG studies may therefore serve as a useful measure for assessing the underlying effects of CBTp in psychotic disorders.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David S Baldwin
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry, University of Southampton, Southampton, UK
| | - David G Kingdon
- Department of Psychiatry, University of Southampton, Southampton, UK
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44
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Haller SPW, Cohen Kadosh K, Scerif G, Lau JYF. Social anxiety disorder in adolescence: How developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology. Dev Cogn Neurosci 2015; 13:11-20. [PMID: 25818181 PMCID: PMC6989773 DOI: 10.1016/j.dcn.2015.02.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/26/2022] Open
Abstract
Social anxiety disorder represents a debilitating condition that has large adverse effects on the quality of social connections, educational achievement and wellbeing. Age-of-onset data suggests that early adolescence is a developmentally sensitive juncture for the onset of social anxiety. In this review, we highlight the potential of using a developmental cognitive neuroscience approach to understand (i) why there are normative increases in social worries in adolescence and (ii) how adolescence-associated changes may 'bring out' neuro-cognitive risk factors for social anxiety in a subset of individuals during this developmental period. We also speculate on how changes that occur in learning and plasticity may allow for optimal acquisition of more adaptive neurocognitive strategies through external interventions. Hence, for the minority of individuals who require external interventions to target their social fears, this enhanced flexibility could result in more powerful and longer-lasting therapeutic effects. We will review two novel interventions that target information-processing biases and their neural substrates via cognitive training and visual feedback of neural activity measured through functional magnetic resonance imaging.
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Affiliation(s)
- Simone P W Haller
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | | | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Department of Psychology, Institute of Psychiatry, King's College London, London, UK
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45
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Lipp I, Evans CJ, Lewis C, Murphy K, Wise RG, Caseras X. The relationship between fearfulness, GABA+, and fear-related BOLD responses in the insula. PLoS One 2015; 10:e0120101. [PMID: 25811453 PMCID: PMC4374765 DOI: 10.1371/journal.pone.0120101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 12/18/2022] Open
Abstract
The inhibitory neurotransmitter GABA plays a crucial role in anxiety and fear, but its relationship to brain activation during fear reactions is not clear. Previous studies suggest that GABA agonists lead to an attenuation of emotion-processing related BOLD signals in the insula. The aim of this study was to investigate the relationship between GABA concentration and fear-related BOLD responses in this region. In 44 female participants with different levels of fearfulness, GABA concentration in the left insula was measured using a GABA+ MRS acquisition during rest; additionally, BOLD signals were obtained during performance of a fear provocation paradigm. Fearfulness was not associated with GABA+ in the left insula, but could predict fear-related BOLD responses in a cluster in the left anterior insula. The BOLD signal change in this cluster did not correlate with GABA+ concentration. However, we found a significant positive correlation between GABA+ concentration and fear-related BOLD responses in a different cluster that included parts of the left insula, amygdala and putamen. Our findings indicate that low insular GABA concentration is not a predisposition for fearfulness, and that several factors influence whether a correlation between GABA and BOLD can be found.
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Affiliation(s)
- Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - C. John Evans
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Caroline Lewis
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Richard G. Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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46
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Mobbs D, Hagan CC, Dalgleish T, Silston B, Prévost C. The ecology of human fear: survival optimization and the nervous system. Front Neurosci 2015; 9:55. [PMID: 25852451 PMCID: PMC4364301 DOI: 10.3389/fnins.2015.00055] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/07/2015] [Indexed: 01/04/2023] Open
Abstract
We propose a Survival Optimization System (SOS) to account for the strategies that humans and other animals use to defend against recurring and novel threats. The SOS attempts to merge ecological models that define a repertoire of contextually relevant threat induced survival behaviors with contemporary approaches to human affective science. We first propose that the goal of the nervous system is to reduce surprise and optimize actions by (i) predicting the sensory landscape by simulating possible encounters with threat and selecting the appropriate pre-encounter action and (ii) prevention strategies in which the organism manufactures safe environments. When a potential threat is encountered the (iii) threat orienting system is engaged to determine whether the organism ignores the stimulus or switches into a process of (iv) threat assessment, where the organism monitors the stimulus, weighs the threat value, predicts the actions of the threat, searches for safety, and guides behavioral actions crucial to directed escape. When under imminent attack, (v) defensive systems evoke fast reflexive indirect escape behaviors (i.e., fight or flight). This cascade of responses to threat of increasing magnitude are underwritten by an interconnected neural architecture that extends from cortical and hippocampal circuits, to attention, action and threat systems including the amygdala, striatum, and hard-wired defensive systems in the midbrain. The SOS also includes a modulatory feature consisting of cognitive appraisal systems that flexibly guide perception, risk and action. Moreover, personal and vicarious threat encounters fine-tune avoidance behaviors via model-based learning, with higher organisms bridging data to reduce face-to-face encounters with predators. Our model attempts to unify the divergent field of human affective science, proposing a highly integrated nervous system that has evolved to increase the organism's chances of survival.
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Affiliation(s)
- Dean Mobbs
- Department of Psychology, Columbia University New York, NY, USA
| | - Cindy C Hagan
- Department of Psychology, Columbia University New York, NY, USA
| | - Tim Dalgleish
- Medical Research Council-Cognition and Brain Sciences Unit Cambridge, UK
| | - Brian Silston
- Department of Psychology, Columbia University New York, NY, USA
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47
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Abstract
Lines of evidence coming from many branches of neuroscience indicate that anxiety disorders arise from a dysfunction in the modulation of brain circuits which regulate emotional responses to potentially threatening stimuli. The concept of anxiety disorders as a disturbance of emotional response regulation is a useful one as it allows anxiety to be explained in terms of a more general model of aberrant salience and also because it identifies avenues for developing psychological, behavioral, and pharmacological strategies for the treatment of anxiety disorder. These circuits involve bottom-up activity from the amygdala, indicating the presence of potentially threatening stimuli, and top-down control mechanisms originating in the prefrontal cortex, signaling the emotional salience of stimuli. Understanding the factors that control cortical mechanisms may open the way to identification of more effective cognitive behavioral strategies for managing anxiety disorders. The brain circuits in the amygdala are thought to comprise inhibitory networks of γ-aminobutyric acid-ergic (GABAergic) interneurons and this neurotransmitter thus plays a key role in the modulation of anxiety responses both in the normal and pathological state. The presence of allosteric sites on the GABAA receptor allows the level of inhibition of neurons in the amygdala to be regulated with exquisite precision, and these sites are the molecular targets of the principal classes of anxiolytic drugs. Changes in the levels of endogenous modulators of these allosteric sites as well as changes in the subunit composition of the GABAA receptor may represent mechanisms whereby the level of neuronal inhibition is downregulated in pathological anxiety states. Neurosteroids are synthesized in the brain and act as allosteric modulators of the GABAA receptor. Since their synthesis is itself regulated by stress and by anxiogenic stimuli, targeting the neurosteroid-GABAA receptor axis represents an attractive target for the modulation of anxiety.
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Affiliation(s)
- Philippe Nuss
- Department of Psychiatry, Hôpital St Antoine, AP-HP, Paris, France ; UMR 7203, INSERM ERL 1057 - Bioactive Molecules Laboratory, Pierre and Marie Curie University, Paris, France
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48
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Psychotherapy Outcome Research and Neuroimaging. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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49
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Abstract
It has been long established that psychological interventions can markedly alter patients' thinking patterns, beliefs, attitudes, emotional states, and behaviors. Little was known about the neural mechanisms mediating such alterations before the advent of functional neuroimaging techniques. Since the turn of the new millenium, several functional neuroimaging studies have been conducted to tackle this important issue. Some of these studies have explored the neural impact of various forms of psychotherapy in individuals with major depressive disorder. Other neuroimaging studies have investigated the effects of psychological interventions for anxiety disorders. I review these studies in the present article, and discuss the putative neural mechanisms of change in psychotherapy. The findings of these studies suggest that mental and behavioral changes occurring during psychotherapeutic interventions can lead to a normalization of functional brain activity at a global level.
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Affiliation(s)
- Mario Beauregard
- Laboratory for Advances in Consciousness and Health, Department of Psychology, The University of Arizona, Tucson, Arizona, USA
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50
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Lipka J, Hoffmann M, Miltner WHR, Straube T. Effects of cognitive-behavioral therapy on brain responses to subliminal and supraliminal threat and their functional significance in specific phobia. Biol Psychiatry 2014; 76:869-77. [PMID: 24393393 DOI: 10.1016/j.biopsych.2013.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/21/2013] [Accepted: 11/04/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neurocircuitry models of anxiety disorders suggest dysregulated mechanisms encompassing both automatic and elaborate threat processing. However, the extent to which these processes might be differentially modified by psychotherapy and the neural basis of such changes are unknown. We examined the effects of cognitive-behavioral therapy (CBT) in patients with anxiety disorder on brain responses to subliminal and supraliminal threat. METHODS 3-Tesla functional magnetic resonance imaging was used to assess neural responses to disorder-related stimuli, presented during two backward-masking conditions employed to manipulate stimulus awareness. In 28 spider-phobic patients randomly assigned to a therapy group or a waiting-list control group scanning was performed before and after completing CBT or a waiting period. Scanning was performed one time in 16 healthy control subjects. Self-report and behavioral measures were used to relate CBT-mediated brain activation changes with symptom improvement. RESULTS Untreated patients demonstrated abnormal hyperactivation in the amygdala, fusiform gyrus, insula, anterior cingulate cortex, and dorsomedial prefrontal cortex. Successful CBT was reflected in an overall downregulation in these fear circuitry structures, especially in the right amygdala and anterior cingulate cortex, with reductions in amygdala responsiveness associated with self-reported symptom improvement. However, subliminal threat induced a pattern of right-lateralized hyperactivation in the amygdala and fusiform gyrus that was subject to intersession habituation across groups without showing significant sensitivity to CBT. CONCLUSIONS These results challenge prevailing models that emphasize a role for amygdala automaticity in the maintenance of anxiety. Our results suggest CBT-related changes in neural activation associated with fear responses to consciously perceived threat.
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Affiliation(s)
- Judith Lipka
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Jena.
| | - Marius Hoffmann
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Jena; Institute of Medical Psychology and Systems Neuroscience, University Hospital Muenster, Muenster, Germany
| | - Wolfgang H R Miltner
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Jena
| | - Thomas Straube
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University Jena, Jena; Institute of Medical Psychology and Systems Neuroscience, University Hospital Muenster, Muenster, Germany
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