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Bryant RA, Dawson KS, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, Tran J, Rawson N, Tockar J, Garber B, Keyan D. A pilot study of the role of the BDNF Val66Met polymorphism in response to exercise-augmented exposure therapy for posttraumatic stress disorder. Psychoneuroendocrinology 2024; 167:107106. [PMID: 38943720 DOI: 10.1016/j.psyneuen.2024.107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/01/2024]
Abstract
Brain-Derived Neurotrophic Factor (BDNF) is implicated in extinction learning, which is a primary mechanism of exposure therapy for posttraumatic stress disorder (PTSD). Brief aerobic exercise has been shown to promote BDNF release and augment extinction learning. On the premise that the Val allele of the BDNF Val66Met polymorphism facilitates greater release of BDNF, this study examined the extent to which the Val allele of the BDNF polymorphism predicted treatment response in PTSD patients who underwent exposure therapy combined with aerobic exercise or passive stretching. PTSD patients (N = 85) provided saliva samples in order to extract genomic DNA to identify Val/Val and Met carriers of the BDNF Val66Met genotype, and were assessed for PTSD severity prior to and following a 9-week course of exposure therapy combined with aerobic exercise or stretching. The sample comprised 52 Val/Val carriers and 33 Met carriers. Patients with the BDNF high-expression Val allele display greater reduction of PTSD symptoms at posttreatment than Met carriers. Hierarchical regression analysis indicated that greater PTSD reduction was specifically observed in Val/Val carriers who received exposure therapy in combination with the aerobic exercise. This finding accords with animal and human evidence that the BDNF Val allele promotes greater extinction learning, and that these individuals may benefit more from exercise-augmented extinction. Although preliminary, this result represents a possible avenue for augmented exposure therapy in patients with the BDNF Val allele.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Yang Y, Wang Y, Mao Y, Zhu F, Zhang M, Pan M, Yin T, Xu J, Chen R, Zheng W. Association of life's essential 8 with mortality among the individuals with cardiovascular disease. Sci Rep 2024; 14:18520. [PMID: 39122961 PMCID: PMC11315880 DOI: 10.1038/s41598-024-69603-0] [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: 01/16/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024] Open
Abstract
This study explores the association between LE8 scores and mortality risks among individuals diagnosed with cardiovascular disease (CVD). Utilizing data from the NHANES conducted between 2005 and 2018, survey-weighted multivariable Cox proportional hazards regression models were utilized. Life's Essential 8 (LE8) scores dose-response associations were assessed using restricted cubic spline regression. Sub-analyses were performed for different categories of CVD. The study consisted of 2164 participants diagnosed with CVD, ranging in age from 20 to 80 years (weighted mean [SE] age, 61.47 [0.34] years; The average total LE8 was 64.97 [0.54]. 499 participants experienced mortality, with 350 deaths attributed to CVD. After accounting for potential covariates, LE8 score was found to be associated with a decreased both all-cause mortality (OR 0.34, CI 0.22-0.51) and CVD mortality (OR 0.40, CI 0.23-0.68). A survey-weighted multivariable Cox model with restricted cubic splines identified the lowest all-cause mortality (P < 0.001) and CVD mortality (P < 0.001) risk when LE8 reach at 63.75 (P < 0.001). The results highlight the association between LE8 scores and reduced mortality in CVD patient population. The implementation of comprehensive initiatives that prioritize healthy dietary patterns, will play a crucial role in alleviating the impact of cardiovascular disease and improving cardiovascular health outcomes.
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Affiliation(s)
- Ying Yang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Wang
- Department of Psychiatry, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yanping Mao
- Department of Psychiatry, Zhejiang Cancer Hospital, Hangzhou, China
| | - Feiyun Zhu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Man Zhang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengshan Pan
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tongle Yin
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiamin Xu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Rucheng Chen
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Weijun Zheng
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
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3
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Azar A, Hubert T, Adams TG, Cisler JM, Crombie KM. Exercise and Fear and Safety Learning. Curr Top Behav Neurosci 2024. [PMID: 39039358 DOI: 10.1007/7854_2024_494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Fear conditioning paradigms have been studied for over 100 years and are of great interest to the behavioral and clinical sciences given that several safety learning processes (e.g., extinction learning and recall) are thought to be fundamental to the success of exposure-based therapies for anxiety and related disorders. This chapter provides an overview of preclinical and clinical investigations that examined the effects of exercise on initial fear acquisition, fear extinction learning and consolidation, and return of fear outcomes. This chapter highlights the collective body of evidence suggesting that exercise administered after extinction learning enhances the consolidation and subsequent recall of extinction memories to a greater extent than exercise administered prior to extinction learning. This suggests that the addition of exercise after exposure therapy sessions may improve treatment outcomes for people with anxiety and related disorders. Potential mechanisms are discussed in addition to suggestions for future research to improve our understanding of the effects of exercise on fear conditioning and extinction outcomes.
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Affiliation(s)
- Ameera Azar
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Troy Hubert
- Department of Psychology, University of Kentucky, Lexington, KY, UK
| | - Thomas G Adams
- Department of Psychology, University of Kentucky, Lexington, KY, UK
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
- Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Kevin M Crombie
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA.
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL, USA.
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4
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Maples-Keller JL, Watkins L, Hellman N, Phillips NL, Rothbaum BO. Treatment Approaches for Posttraumatic Stress Disorder Derived From Basic Research on Fear Extinction. Biol Psychiatry 2024:S0006-3223(24)01458-6. [PMID: 39032727 DOI: 10.1016/j.biopsych.2024.07.010] [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] [Received: 02/15/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
This brief review article will describe treatment approaches for posttraumatic stress disorder (PTSD) based on findings from basic research. The focus of this review will be fear conditioning and extinction models, which provide a translational model of PTSD that can help translate basic research in nonhuman animals through well-controlled trials confirming the efficacy of treatment approaches in humans with PTSD such as prolonged exposure therapy. Specific cognitive aspects of fear extinction processes, including consolidation and reconsolidation, are reviewed along with behavioral and pharmacological treatment strategies based on basic research in these areas including attempts to prevent the development of PTSD as well as the treatment of chronic PTSD. Pharmacological, behavioral, and device-based augmentation strategies of PTSD treatment based in basic science findings are reviewed, including those that disrupt noradrenergic receptor processes, medications that act on NMDA receptors, physical exercise, cannabinoids, estradiol, dexamethasone, yohimbine, losartan, dopamine, and MDMA, along with the evidence for their efficacy in human clinical samples. While fear extinction provides an exciting translational opportunity to improve PTSD based on basic science findings, we review limitations and challenges of the extant literature as well as future directions.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie Hellman
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Steil R, Maercker A, Jaworski L, Bachem R, Eberle D. [Evidence-based psychotherapy of posttraumatic stress syndrome-An update]. DER NERVENARZT 2024; 95:616-621. [PMID: 38906997 DOI: 10.1007/s00115-024-01694-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). METHODS The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. RESULTS The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. A range of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. DISCUSSION Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. A large selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.
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Affiliation(s)
- Regina Steil
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland.
| | | | - Lena Jaworski
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland
| | - Rahel Bachem
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
| | - David Eberle
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
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Rief W, Asmundson GJG, Bryant RA, Clark DM, Ehlers A, Holmes EA, McNally RJ, Neufeld CB, Wilhelm S, Jaroszewski AC, Berg M, Haberkamp A, Hofmann SG. The future of psychological treatments: The Marburg Declaration. Clin Psychol Rev 2024; 110:102417. [PMID: 38688158 DOI: 10.1016/j.cpr.2024.102417] [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: 09/28/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
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Affiliation(s)
- Winfried Rief
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany.
| | | | - Richard A Bryant
- University of New South Wales, School of Psychology, Sydney, New South Wales, Australia
| | - David M Clark
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Anke Ehlers
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Emily A Holmes
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Solna, Sweden
| | | | - Carmem B Neufeld
- University of São Paulo, Department of Psychology, Ribeirão Preto, SP, Brazil
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Adam C Jaroszewski
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Anke Haberkamp
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Stefan G Hofmann
- Philipps-University of Marburg, Department of Psychology, Translational Clinical Psychology Group, Marburg, Germany
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Vock S, Delker A, Rinderknecht J, Engel F, Wieland S, Beiner E, Friederich HC, Jarero IN, Seidler GH, Tesarz J. Group eye movement desensitization and reprocessing (EMDR) in chronic pain patients. Front Psychol 2024; 15:1264807. [PMID: 38455119 PMCID: PMC10919217 DOI: 10.3389/fpsyg.2024.1264807] [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: 07/21/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
The prevalence of chronic pain is increasing, and conventional pain therapies often have limited efficacy in individuals with high levels of psychological distress and a history of trauma. In this context, the use of Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based psychotherapy approach for the treatment of posttraumatic stress disorder, is becoming increasingly important. EMDR shows promising results, particularly for patients with pain and high levels of emotional distress. Although group therapy is becoming increasingly popular in pain management, EMDR has mainly been studied as an individual treatment. However, a systematic review suggests that group therapy can be an effective tool for improving mental health outcomes, especially when trauma is addressed together. Based on these findings, an outpatient EMDR group program was developed for patients with chronic pain. The program consists of a total of four treatment days with 5-5.5 h therapy sessions each day and provides patients with a supportive environment in which they can learn effective pain management strategies and interact with other patients with similar experiences. Initial pilot evaluations indicate high efficacy and adequate safety for patients with chronic pain.
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Affiliation(s)
- Stephanie Vock
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Anna Delker
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Janna Rinderknecht
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Sebastian Wieland
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Eva Beiner
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | | | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
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8
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Whitworth JW, Checko ER, Rosenbaum S. Editorial: Lifestyle interventions for traumatic stress (LIFTS). Front Psychol 2024; 15:1367344. [PMID: 38328378 PMCID: PMC10848493 DOI: 10.3389/fpsyg.2024.1367344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- James W. Whitworth
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Erica R. Checko
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Lüder CC, Michael T, Lass-Hennemann J, Schanz CG, Venhorst A, Meyer T, Equit M. Moderate-intensity aerobic exercise training as an adjunct to trauma-focused psychotherapy in traumatized refugees and asylum seekers: study protocol of a randomized controlled trial. Eur J Psychotraumatol 2023; 14:2251777. [PMID: 37860859 PMCID: PMC10591536 DOI: 10.1080/20008066.2023.2251777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Refugees with exposure to multiple traumatic events are at high risk for developing posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an effective treatment for the core symptoms of PTSD, but it does not reliably reduce depressive symptoms. Endurance exercise on the other hand was consistently found to be effective in treating depression making it a promising adjunct to NET. Up to date, no studies exist investigating the combination of NET and endurance exercise in a sample of refugees with PTSD and comorbid depression.Objectives: In the proposed randomized controlled trial, we aim to investigate whether a combination of NET and moderate-intensity aerobic exercise training (MAET) enhances treatment outcome for refugees with PTSD and comorbid depressive symptoms. We expect a greater improvement in psychopathology in participants who receive the combined treatment.Methods and analysis: 68 refugees and asylum seekers with PTSD and clinically relevant depressive symptoms will be recruited in the proposed study. Participants will be randomly assigned to receive either NET only (NET-group) or NET plus MAET (NET+-group). All participants will receive 10 NET sessions. Participants in the NET+-group will additionally take part in MAET. Primary (PTSD, depression) and secondary (general mental distress, agoraphobia and somatoform complaints, sleep quality) outcome measures will be assessed before treatment, after treatment, and at six-month follow-up. The hypotheses will be tested with multiple 2 × 3 mixed ANOVA's.Trial registration: German Clinical Trials Register identifier: DRKS00022145.
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Affiliation(s)
- Charina C. Lüder
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Christian G. Schanz
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Andreas Venhorst
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Monika Equit
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
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Crombie KM, Azar A, Botsford C, Heilicher M, Hiser J, Moughrabi N, Gruichich TS, Schomaker CM, Cisler JM. The influence of aerobic exercise on model-based decision making in women with posttraumatic stress disorder. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100015. [PMID: 37593142 PMCID: PMC10433398 DOI: 10.1016/j.xjmad.2023.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Individuals with PTSD often exhibit deficits in executive functioning. An unexplored aspect of neurocognitive functions associated with PTSD is the type of learning system engaged in during decision-making. A model-free (MF) system is habitual in nature and involves trial-and-error learning that is often updated based on the most recent experience (e.g., repeat action if rewarded). A model-based (MB) system is goal-directed in nature and involves the development of an abstract representation of the environment to facilitate decisions (e.g., choose sequence of actions according to current contextual state and predicted outcomes). The existing neurocognitive literature on PTSD suggests the hypothesis of greater reliance on MF vs MB learning strategies when navigating their environment. While MF systems may be more cognitively efficient, they do not afford flexibility when making prospective predictions about likely outcomes of different decision-tree branches. Emerging research suggests that an acute bout of aerobic exercise improves certain aspects of neurocognition, and thereby could promote the utilization of MB over MF systems during decision making, although prior research has not yet tested this hypothesis. Accordingly, the current study administered a lab-based two-stage Markov decision-making task capable of discriminating MF vs MB decision making, in order to determine if moderate-intensity aerobic exercise (either shortly after or 30-minutes after the exercise bout has ended) promotes greater engagement in MB behavioral strategies compared to light-intensity aerobic exercise in adult women with and without PTSD (N=61). Results revealed that control women generally displayed higher levels of MB behavior that was further increased following immediate exercise, particularly moderate-intensity exercise. By contrast, the PTSD group generally displayed lower levels of MB behavior, and exhibited greater MB behavior when completing the task following moderate-intensity aerobic exercise compared to light-intensity aerobic exercise regardless of whether there was a short or long delay between exercise and the task. Additionally, women with PTSD demonstrated less impairment in MB decision-making compared to controls following moderate-intensity aerobic exercise. These results suggest that an acute bout of moderate-intensity aerobic exercise boosts MB behavior in women with PTSD, and suggests that aerobic exercise may play an important role in enhancing cognitive outcomes for PTSD.
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Affiliation(s)
- Kevin M. Crombie
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
- The University of Alabama, Department of Kinesiology, 1003 Wade Hall, Tuscaloosa, Alabama, United States of America 35487
| | - Ameera Azar
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
| | - Chloe Botsford
- University of Wisconsin – Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America 53719
| | - Mickela Heilicher
- University of Wisconsin – Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America 53719
| | - Jaryd Hiser
- University of Wisconsin – Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America 53719
- The Ohio State University, Department of Psychiatry and Behavioral Health, 1670 Upham Drive, Suite 130, Columbus, Ohio, United States of America 43210
| | - Nicole Moughrabi
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
| | - Tijana Sagorac Gruichich
- University of Wisconsin – Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America 53719
| | - Chloe M. Schomaker
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
| | - Josh M. Cisler
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
- Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, Texas, United States of America 78712
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11
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Voorendonk EM, Sanches SA, Tollenaar MS, Hoogendoorn EA, de Jongh A, van Minnen A. Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial. Front Psychol 2023; 14:1215250. [PMID: 37546473 PMCID: PMC10400339 DOI: 10.3389/fpsyg.2023.1215250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration Trialregister.nl Identifier: Trial NL9120.
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Affiliation(s)
- Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Sarita A. Sanches
- Phrenos Centre of Expertise for Severe Mental Illness, Utrecht, Netherlands
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands
| | - Marieke S. Tollenaar
- Institute of Psychology, Department of Clinical Psychology and the Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | | | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
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Crombie KM, Adams TG, Dunsmoor JE, Greenwood BN, Smits JA, Nemeroff CB, Cisler JM. Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. J Anxiety Disord 2023; 94:102680. [PMID: 36773486 PMCID: PMC10084922 DOI: 10.1016/j.janxdis.2023.102680] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with heightened emotional responding, avoidance of trauma related stimuli, and physical health concerns (e.g., metabolic syndrome, type 2 diabetes, cardiovascular disease). Existing treatments such as exposure-based therapies (e.g., prolonged exposure) aim to reduce anxiety symptoms triggered by trauma reminders, and are hypothesized to work via mechanisms of extinction learning. However, these conventional gold standard psychotherapies do not address physical health concerns frequently presented in PTSD. In addition to widely documented physical and mental health benefits of exercise, emerging preclinical and clinical evidence supports the hypothesis that precisely timed administration of aerobic exercise can enhance the consolidation and subsequent recall of fear extinction learning. These findings suggest that aerobic exercise may be a promising adjunctive strategy for simultaneously improving physical health while enhancing the effects of exposure therapies, which is desirable given the suboptimal efficacy and remission rates. Accordingly, this review 1) encompasses an overview of preclinical and clinical exercise and fear conditioning studies which form the basis for this claim; 2) discusses several plausible mechanisms for enhanced consolidation of fear extinction memories following exercise, and 3) provides suggestions for future research that could advance the understanding of the potential importance of incorporating exercise into the treatment of PTSD.
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Affiliation(s)
- Kevin M Crombie
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America.
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY 40506-0044, United States of America; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, United States of America
| | - Joseph E Dunsmoor
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Benjamin N Greenwood
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO 80217-3364, United States of America
| | - Jasper A Smits
- The University of Texas at Austin, Department of Psychology, 108 E Dean Keeton St., Austin, TX 78712, United States of America
| | - Charles B Nemeroff
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Josh M Cisler
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
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13
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Bryant RA. Is Fear Extinction Impairment Central to Psychopathology? Curr Top Behav Neurosci 2023; 64:195-212. [PMID: 37668874 DOI: 10.1007/7854_2023_439] [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] [Indexed: 09/06/2023]
Abstract
As discussed in this chapter, there have been enormous advances in our understanding of how anxiety disorders develop, are maintained, and can be treated. Many of these advances have been the result of translational studies using fear conditioning and extinction models. Despite these successes, we recognize, as a field, that there are important limitations in the extent to which extinction can explain how anxiety disorders and behaviors remit. Clinically speaking, the outstanding challenge for treatment of anxiety disorders is to improve the current suboptimal success rates. Over the past 30 years, we have not improved our treatment success rates despite employing many pharmacological and pharmacological strategies. While extinction and related fear circuitry mechanisms most certainly appear to play a role in treatment of anxiety disorders, they are also apparently insufficient to fully accommodate the varied responses individuals exhibit with this treatment approach. Increasingly diverse and innovative approaches are needed that accommodate the multitude of change mechanisms involved in treating anxiety. However, this is not to suggest ignoring the key role that extinction and memory updating processes play in overcoming anxiety.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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14
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Niemeyer H. Interventions focusing on the body in recovery from post-traumatic stress disorder. Lancet Psychiatry 2023; 10:2-3. [PMID: 36436533 DOI: 10.1016/s2215-0366(22)00382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Helen Niemeyer
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, 12163 Berlin, Germany.
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