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Harvanek ZM, Kudinova AY, Wong SA, Xu K, Brick L, Daniels TE, Marsit C, Burt A, Sinha R, Tyrka AR. Childhood adversity, accelerated GrimAge, and associated health consequences. J Behav Med 2024:10.1007/s10865-024-00496-0. [PMID: 38762606 DOI: 10.1007/s10865-024-00496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects.
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Affiliation(s)
- Zachary M Harvanek
- Department of Psychiatry, Yale University, New Haven, CT, USA.
- Yale Stress Center, Yale University, New Haven, CT, USA.
| | - Anastacia Y Kudinova
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley Hospital, Providence, RI, USA
| | - Samantha A Wong
- New York University Grossman School of Medicine, New York, USA
| | - Ke Xu
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry, Connecticut Veteran Healthcare System, West Haven, CT, USA
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Teresa E Daniels
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley Hospital, Providence, RI, USA
- Initiative for Stress, Trauma, and Resilience, Alpert Medical School of Brown University, Providence, RI, USA
- Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amber Burt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Stress Center, Yale University, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Child Study Center, Yale University, New Haven, CT, USA
| | - Audrey R Tyrka
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Initiative for Stress, Trauma, and Resilience, Alpert Medical School of Brown University, Providence, RI, USA
- Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
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Fuhr K, Bender A, Wiegand A, Janouch P, Drujan M, Cyrny B, Schweizer C, Kreifelts B, Nieratschker V, Batra A. Hypnotherapy for agoraphobia-Feasibility and efficacy investigated in a pilot study. Front Psychol 2023; 14:1213792. [PMID: 37637902 PMCID: PMC10448829 DOI: 10.3389/fpsyg.2023.1213792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
A number of case studies describing hypnotherapy in the treatment of anxiety disorder patients have already been published. Only a few randomized controlled trials (RCTs) investigated the efficacy of hypnotherapy but focused mainly on symptoms rather than specific mental disorders. The goal of this study was to investigate whether hypnotherapy (HT) was superior to a waitlist control group (WL) in the reduction of agoraphobia-related symptoms. Further goals were to report the feasibility of hypnotherapy as well as attrition and completion rates and detect (epi-)genetic variables, which might play a role in treatment outcome. This pilot study was based on a monocentric two-armed randomized controlled rater-blind clinical trial that was conducted between 2018 and 2020 with a waitlist control group. A total of 36 patients diagnosed with agoraphobia were randomized to either HT or WL. Patients in HT received individual outpatient treatment with hypnotherapy with 8 to 12 sessions for a period of 3 months. Patients in WL received HT after 3 months. Agoraphobia-related symptoms were assessed at baseline, after the treatment, and 3 months later in both groups with a clinician rating. The primary hypothesis concerning the difference between groups in the individual percentage symptom reduction could be confirmed in the intention-to-treat, not the per-protocol sample. Additionally, we applied repeated-measures analyses of variance and found a higher symptom decrease in HT compared with WL patients in three of the five imputed datasets. The dropout rate was low, and satisfaction with the treatment was high. HT patients experienced a strong symptom reduction after receiving hypnotherapy. WL patients improved slightly during the waiting period. The COMT Val108/158Met genotype had an effect on the agoraphobia-related symptoms as well as on COMT DNA methylation levels. This is the first study to indicate that hypnotherapy performed better than a waitlist control group regarding the reduction in anxiety symptoms in an RCT. Future studies should confirm the efficacy of hypnotherapy and compare the treatment with a standard treatment for anxiety disorders in a larger trial. Future studies should also investigate whether hypnotic susceptibility is associated with COMT Val108/158Met genotype and could predict treatment success for HT. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT03684577, identifier: NCT03684577.
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Affiliation(s)
- Kristina Fuhr
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Annika Bender
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- Max Planck Fellow Group Precision Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Paul Janouch
- Outpatient Psychotherapy Practice, Bad Salzuflen, Germany
| | - Marta Drujan
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Barbara Cyrny
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Cornelie Schweizer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Benjamin Kreifelts
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital of Tübingen, Tübingen, Germany
- German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit), University Hospital of Tübingen, Tübingen, Germany
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Bellinger D, Wehrmann K, Rohde A, Schuppert M, Störk S, Flohr-Jost M, Gall D, Pauli P, Deckert J, Herrmann MJ, Erhardt-Lehmann A. The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study. BMC Psychiatry 2023; 23:555. [PMID: 37528410 PMCID: PMC10394851 DOI: 10.1186/s12888-023-05040-z] [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: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. METHODS This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. DISCUSSION The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. TRIAL REGISTRATION This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).
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Affiliation(s)
- Daniel Bellinger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany.
| | - Kristin Wehrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Anna Rohde
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | | | - Stefan Störk
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Michael Flohr-Jost
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Dominik Gall
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Angelika Erhardt-Lehmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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