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Wall A, Henriksson M, Nyberg J, Holmgren K, Isgaard J, Lennartsson AK, Svensson J, Danielsson L, Waern M, Åberg M, Åberg ND. Exercise and health-related quality of life and work-related outcomes in primary care patients with anxiety disorders - A randomized controlled study. J Affect Disord 2024; 360:5-14. [PMID: 38777273 DOI: 10.1016/j.jad.2024.05.092] [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: 09/27/2023] [Revised: 04/29/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Exercise interventions show promise in the treatment of anxiety disorders, but effects on health-related quality of life (HR-QoL), work ability, and sick leave are little studied. We investigated these outcomes in a 12-week randomized controlled trial with a 1-year follow-up. METHODS Patients aged 18-65 (n = 222) with anxiety disorders from primary care centers in Gothenburg were randomized to a control group or one of two 12-week exercise intervention groups (low-intensity, [LI] and moderate/high-intensity, [HI]); 148 were evaluated at 12-weeks and 113 completed the 1-year follow-up. The EuroQol 5D (EQ5D; index and the visual analogue scale [VAS]), work ability score (WAS), presenteeism, and self-reported sick leave were assessed at baseline, 12 weeks, and 1 year. Improvements were defined by binary cut-offs for each scale. Binary logistic regression with odds ratios (OR) and 95 % confidence intervals (CI) were reported. RESULTS There were improved scores for EQ5D and WAS in the HI group compared to controls after 12 weeks (EQ5D index: 4.74 [1.91-11.7], EQ5D-VAS 4.00, [1.65-9.72], WAS 3.41 [1.24-7.37]) and 1 year (EQ5D index: 3.05 [1.05-8.81], EQ5D-VAS 3.20 [1.16-8.84], WAS 5.50 [1.85-16.3]). Post-hoc analysis showed higher ORs in participants on antidepressants (n = 75) (12-week EQ5D index: OR 9.95 [2.85-34.8]) and significant improvements in EQ5D scores for both intervention groups after 1 year. There were no between-group differences for presenteeism or sick leave. LIMITATIONS Discontinuation was high, mostly early after randomization (n = 74), as is common for anxiety interventions. CONCLUSIONS HI Exercise improves HR-QoL and work ability in anxiety patients, especially when combined with antidepressants.
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Affiliation(s)
- Alexander Wall
- Region Västra Götaland, Närhälsan, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Malin Henriksson
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jenny Nyberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Neurology Clinic, Gothenburg, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Research, Education, Development & Innovation, Primary Health Care, Sweden
| | - Jörgen Isgaard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Specialist Medicine, Gothenburg, Sweden
| | - Anna-Karin Lennartsson
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Skaraborg Central Hospital, Department of Internal Medicine, Skövde, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Angered Hospital, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - N David Åberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden.
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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 non-human 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)
| | - Laura Watkins
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Natalie Hellman
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | | | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences.
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Zalta AK, Voigt RM, Stevens SK, Held P, Raeisi S, Boley RA, Keshavarzian A, Pollack MH. Brain derived neurotrophic factor and treatment outcomes among veterans attending an intensive treatment program for posttraumatic stress disorder. J Psychiatr Res 2024; 173:1-5. [PMID: 38437783 PMCID: PMC11018453 DOI: 10.1016/j.jpsychires.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
Brain derived neurotrophic factor (BDNF) may play an important role in the success of treatment for posttraumatic stress disorder (PTSD). Pre- and post-treatment blood samples were analyzed for 40 veterans who completed a 3-week intensive outpatient treatment for PTSD. The treatment included Cognitive Processing Therapy, mindfulness, and yoga as core treatment components. PTSD symptoms were assessed at pre-treatment, post-treatment, and 3-month follow-up. Participants reported large decreases in PTSD symptoms from pre-to post-treatment (d = 1.46, p < 0.001) and pre-treatment to 3-month follow-up (d = 0.91, p < 0.001). Unexpectedly, participants demonstrated a decrease in BDNF from pre-to post-treatment (d = 0.64, p < 0.001). Changes in BDNF from pre-to post-treatment were not significantly associated with PTSD symptom improvement. However, higher levels of post-treatment BDNF were significantly associated with lower PTSD symptoms at 3-month follow-up (n = 27, r = -0.57, p = 0.002) and greater improvements in PTSD symptoms from pre-treatment to 3-month follow-up (n = 27, r = 0.50, p = 0.008). Higher levels of post-treatment BDNF may facilitate the long-term success of intensive PTSD treatment. Further research with larger samples is needed to evaluate the processes by which BDNF may affect consolidation of improvements after completion of PTSD treatment.
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Affiliation(s)
- Alyson K Zalta
- Department of Psychological Science, University of California, Irvine, CA, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Robin M Voigt
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA; Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, USA; Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Sarah K Stevens
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Shohreh Raeisi
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, USA
| | - Randy A Boley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Keshavarzian
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA; Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, USA; Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA; Department of Physiology, Rush University Medical Center, Chicago, IL, USA
| | - Mark H Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Matthijssen SJMA, Menses SDF, Huisman-van Dijk HM. The effects of an intensive outpatient treatment for PTSD. Eur J Psychotraumatol 2024; 15:2341548. [PMID: 38665124 PMCID: PMC11057464 DOI: 10.1080/20008066.2024.2341548] [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: 01/04/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction: Research has shown that combining different evidence-based PTSD treatments for patients with PTSD in an intensive inpatient format seems to be a promising approach to enhance efficiency and reduce generally high dropout rates.Objective: To assess the effectiveness of an intensive six-day outpatient trauma-focused treatment for patients with PTSD.Method: Data from 146 patients (89.7% female, mean age = 36.79, SD = 11.31) with PTSD due to multiple traumatization were included in the analyses. The treatment programme consisted of six days of treatment within two weeks, with two daily individual 90-minute trauma-focused sessions (prolonged exposure and eye movement desensitization and reprocessing), one hour of exercise, and one hour of psychoeducation. All participants experienced multiple traumas, and 85.6% reported one or more comorbid psychiatric disorders. PTSD symptoms and diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and self-reported symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5).Results: A significant decline in PTSD symptoms (CAPS-5 and PCL-5) from pretreatment to one-month follow-up (Cohen's d = 1.13 and 1.59) was observed and retained at six-month follow-up (Cohen's d = 1.47 and 1.63). After one month, 52.4% of the patients no longer met the diagnostic criteria for PTSD (CAPS-5). The Reliable Change Index (RCI) shows that 73.9% of patients showed improvement on the CAPS-5 and 77.61% on the PCL-5. Additionally, 21.77% (CAPS-5) and 20.0% (PCL-5) showed no change, while 4.84% (CAPS-5) and 2.96% (PCL-5) showed symptom worsening.Discussion: The results show that an intensive outpatient trauma treatment programme, including two evidence-based trauma-focused treatments, exercise, and psychoeducation, is effective for patients suffering from PTSD as a result of multiple traumatization. Subsequent research should focus on more controlled studies comparing the treatment programme with other intensive trauma treatments and less frequent routine treatment.
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Bernstein EE, Wolfe EC, Huguenel BM, Wilhelm S. Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review. JMIR Mhealth Uhealth 2024; 12:e45860. [PMID: 38488834 PMCID: PMC10981024 DOI: 10.2196/45860] [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: 01/19/2023] [Revised: 09/12/2023] [Accepted: 11/30/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. OBJECTIVE This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. METHODS In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. RESULTS To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. CONCLUSIONS Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.
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Affiliation(s)
- Emily E Bernstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Emma C Wolfe
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Brynn M Huguenel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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6
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Ragsdale KA, Nichols AA, Mehta M, Maples-Keller JL, Yasinski CW, Hyatt CS, Watkins LE, Loucks LA, Carbone E, Rauch SAM, Rothbaum BO. Comorbid treatment of traumatic brain injury and mental health disorders. NeuroRehabilitation 2024:NRE230235. [PMID: 38277308 DOI: 10.3233/nre-230235] [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: 01/28/2024]
Abstract
BACKGROUND The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE This article reviews the EHVP. METHODS The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.
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Affiliation(s)
- Katie A Ragsdale
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anastacia A Nichols
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Mansi Mehta
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Carly W Yasinski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Courtland S Hyatt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura E Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura A Loucks
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Carbone
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, GA, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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Bendau A, Petzold MB, Kaminski J, Plag J, Ströhle A. Exercise as Treatment for "Stress-Related" Mental Disorders. Curr Neuropharmacol 2024; 22:420-436. [PMID: 37779399 PMCID: PMC10845075 DOI: 10.2174/1570159x22666230927103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 10/03/2023] Open
Abstract
The beneficial impact of physical activity on preventing and treating mental disorders has captured growing (research) interest. This article aims to provide a concise overview of essential evidence regarding the effectiveness and underlying mechanisms of physical activity for individuals with mental disorders clustered as "stress-related" conditions. Empirical findings (e.g., longitudinalprospective studies, interventional randomized-controlled-trials, reviews, meta-analyses) regarding the effects of physical activity in the prevention and treatment of stress-related mental disorders are summarized. Furthermore, potential mechanisms underlying these effects are discussed, and recommendations regarding the use of physical activity are outlined. The majority of studies indicate good efficacy of physical activity in prospectively lowering the risk for the incidence of subsequent stress-related mental disorders as well as in the treatment of manifest disorders. Most evidence targets unipolar depressive disorder and, secondly, anxiety disorders. Research regarding posttraumatic stress disorder, obsessive-compulsive disorders, and somatoform disorders is promising but scarce. Physical activity seems to be useful as a stand-alone-treatment as well as in combination with other psychotherapeutic or pharmacological treatments. Multiple intertwined physiological, psychological, and social mechanisms are assumed to mediate the beneficial effects. Recommendations regarding physical activity can orientate on official guidelines but should consider the individual needs and circumstances of each subject. In summary, physical activity seems to be effective in the prevention and treatment of stressrelated mental disorders and, therefore, should be fostered in healthcare-settings. Future studies are needed to clarify partly inconsistent patterns of results and to close research gaps, e.g., concerning somatoform disorders.
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Affiliation(s)
- Antonia Bendau
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- HMU Health and Medical University Potsdam, Potsdam, Germany
| | - Moritz Bruno Petzold
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Jan Kaminski
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- HMU Health and Medical University Potsdam, Potsdam, Germany
- Oberberg Fachklinik Potsdam, Potsdam, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
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Antolasic EJ, Jaehne EJ, van den Buuse M. Interaction of Brain-derived Neurotrophic Factor, Exercise, and Fear Extinction: Implications for Post-traumatic Stress Disorder. Curr Neuropharmacol 2024; 22:543-556. [PMID: 37491857 PMCID: PMC10845100 DOI: 10.2174/1570159x21666230724101321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/16/2023] [Accepted: 02/23/2023] [Indexed: 07/27/2023] Open
Abstract
Brain-Derived Neurotrophic Factor (BDNF) plays an important role in brain development, neural plasticity, and learning and memory. The Val66Met single-nucleotide polymorphism is a common genetic variant that results in deficient activity-dependent release of BDNF. This polymorphism and its impact on fear conditioning and extinction, as well as on symptoms of post-traumatic stress disorder (PTSD), have been of increasing research interest over the last two decades. More recently, it has been demonstrated that regular physical activity may ameliorate impairments in fear extinction and alleviate symptoms in individuals with PTSD via an action on BDNF levels and that there are differential responses to exercise between the Val66Met genotypes. This narrative literature review first describes the theoretical underpinnings of the development and persistence of intrusive and hypervigilance symptoms commonly seen in PTSD and their treatment. It then discusses recent literature on the involvement of BDNF and the Val66Met polymorphism in fear conditioning and extinction and its involvement in PTSD diagnosis and severity. Finally, it investigates research on the impact of physical activity on BDNF secretion, the differences between the Val66Met genotypes, and the effect on fear extinction learning and memory and symptoms of PTSD.
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Affiliation(s)
- Emily J. Antolasic
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emily J. Jaehne
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Sep MSC, Geuze E, Joëls M. Impaired learning, memory, and extinction in posttraumatic stress disorder: translational meta-analysis of clinical and preclinical studies. Transl Psychiatry 2023; 13:376. [PMID: 38062029 PMCID: PMC10703817 DOI: 10.1038/s41398-023-02660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Current evidence-based treatments for post-traumatic stress disorder (PTSD) are efficacious in only part of PTSD patients. Therefore, novel neurobiologically informed approaches are urgently needed. Clinical and translational neuroscience point to altered learning and memory processes as key in (models of) PTSD psychopathology. We extended this notion by clarifying at a meta-level (i) the role of information valence, i.e. neutral versus emotional/fearful, and (ii) comparability, as far as applicable, between clinical and preclinical phenotypes. We hypothesized that cross-species, neutral versus emotional/fearful information processing is, respectively, impaired and enhanced in PTSD. This preregistered meta-analysis involved a literature search on PTSD+Learning/Memory+Behavior, performed in PubMed. First, the effect of information valence was estimated with a random-effects meta-regression. The sources of variation were explored with a random forest-based analysis. The analyses included 92 clinical (N = 6732 humans) and 182 preclinical (N = 6834 animals) studies. A general impairment of learning, memory and extinction processes was observed in PTSD patients, regardless of information valence. Impaired neutral learning/memory and fear extinction were also present in animal models of PTSD. Yet, PTSD models enhanced fear/trauma memory in preclinical studies and PTSD impaired emotional memory in patients. Clinical data on fear/trauma memory was limited. Mnemonic phase and valence explained most variation in rodents but not humans. Impaired neutral learning/memory and fear extinction show stable cross-species PTSD phenotypes. These could be targeted for novel PTSD treatments, using information gained from neurobiological animal studies. We argue that apparent cross-species discrepancies in emotional/fearful memory deserve further in-depth study; until then, animal models targeting this phenotype should be applied with utmost care.
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Affiliation(s)
- Milou S C Sep
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands.
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, The Netherlands.
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Jentsch VL, Wolf OT, Otto T, Merz CJ. The impact of physical exercise on the consolidation of fear extinction memories. Psychophysiology 2023; 60:e14373. [PMID: 37350416 DOI: 10.1111/psyp.14373] [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: 01/26/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
Based on the mechanisms of fear extinction, exposure therapy is the most common treatment for anxiety disorders. However, extinguished fear responses can reemerge even after successful treatment. Novel interventions enhancing exposure therapy efficacy are therefore critically needed. Physical exercise improves learning and memory and was also shown to enhance extinction processes. This study tested whether physical exercise following fear extinction training improves the consolidation of extinction memories. Sixty healthy men underwent a differential fearconditioning paradigm with fear acquisition training on day 1 and fear extinction training followed by an exercise or resting control intervention on day 2. On day 3, retrieval and reinstatement were tested including two additional but perceptually similar stimuli to explore the generalization of exercise effects. Exercise significantly increased heart rate, salivary alpha amylase, and cortisol, indicating successful exercise manipulation. Contrary to our expectations, exercise did not enhance but rather impaired extinction memory retrieval on the next day, evidenced by significantly stronger differential skin conductance responses (SCRs) and pupil dilation (PD). Importantly, although conditioned fear responses were successfully acquired, they did not fully extinguish, explaining why exercise might have boosted the consolidation of the original fear memory trace instead. Additionally, stronger differential SCRs and PD toward the novel stimuli suggest that the memory enhancing effects of exercise also generalized to perceptually similar stimuli. Together, these findings indicate that physical exercise can facilitate both the long-term retrievability and generalization of extinction memories, but presumably only when extinction was successful in the first place.
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Affiliation(s)
- Valerie L Jentsch
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tobias Otto
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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12
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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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13
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Caudle MM, Dugas N, Stout DM, Ball TM, Bomyea J. Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety. Psychiatry Res 2023; 327:115416. [PMID: 37604041 DOI: 10.1016/j.psychres.2023.115416] [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: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - D M Stout
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - T M Ball
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305, United States
| | - J Bomyea
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
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14
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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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15
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Dell L, Sbisa AM, Forbes A, O'Donnell M, Bryant R, Hodson S, Morton D, Battersby M, Tuerk PW, Wallace D, Forbes D. Effect of massed v. standard prolonged exposure therapy on PTSD in military personnel and veterans: a non-inferiority randomised controlled trial. Psychol Med 2023; 53:4192-4199. [PMID: 35440345 PMCID: PMC10317798 DOI: 10.1017/s0033291722000927] [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: 02/08/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system. METHODS This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE. RESULTS The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, M = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) -4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE). CONCLUSIONS MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alyssa M. Sbisa
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Meaghan O'Donnell
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie Hodson
- Department of Veteran's Affairs, Canberra, Australian Capital Territory, Australia
| | - David Morton
- Department of Defence, Canberra, Australian Capital Territory, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Peter W. Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Duncan Wallace
- Australian Defence Force Center for Mental Health, Sydney, New South Wales, Australia
| | - David Forbes
- Phoenix Australia – Center for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Jaehne EJ, Antolasic EJ, Creutzberg KC, Begni V, Riva MA, van den Buuse M. Impaired fear memory in a rat model of the Brain-Derived Neurotrophic Factor Val66Met polymorphism is reversed by chronic exercise. Neurobiol Learn Mem 2023; 203:107779. [PMID: 37269900 DOI: 10.1016/j.nlm.2023.107779] [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: 10/25/2022] [Revised: 03/08/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with reduced activity-dependent BDNF release in the brain and has been implicated in fear and anxiety disorders, including post-traumatic stress disorder. Exercise has been shown to have benefits in affective disorders but the role of BDNF Val66Met remains unclear. Male and female BDNF Val66Met rats were housed in automated running-wheel cages from weaning while controls were housed in standard cages. During adulthood, all rats underwent standard three-day fear conditioning testing, with three tone/shock pairings on day 1 (acquisition), and extinction learning and memory (40 tones/session) on day 2 and day 3. Expression of BDNF and stress-related genes were measured in the frontal cortex. Extinction testing on day 2 revealed significantly lower freezing in response to initial cue exposure in control Met/Met rats, reflecting impaired fear memory. This deficit was reversed in both male and female Met/Met rats exposed to exercise. There were no genotype effects on acquisition or extinction of fear, however chronic exercise increased freezing in all groups at every stage of testing. Exercise furthermore led to increased expression of Bdnf in the prefrontal cortex of females and its isoforms in both sexes, as well as increased expression of FK506 binding protein 51 (Fkpb5) in females and decreased expression of Serum/glucocorticoid-regulated kinase (Sgk1) in males independent of genotype. These results show that the Met/Met genotype of the Val66Met polymorphism affects fear memory, and that chronic exercise selectively reverses this genotype effect. Chronic exercise also led to an overall increase in freezing in all genotypes which may contribute to results.
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Affiliation(s)
- Emily J Jaehne
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emily J Antolasic
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kerstin C Creutzberg
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Veronica Begni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Marco A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Biological Psychiatry Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maarten van den Buuse
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Department of Pharmacology, University of Melbourne, Melbourne, Australia.
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17
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Teckchandani T, Krakauer RL, Andrews KL, Neary JP, Nisbet J, Shields RE, Maguire KQ, Jamshidi L, Afifi TO, Lix LM, Sauer-Zavala S, Asmundson GJG, Krätzig GP, Carleton RN. Prophylactic relationship between mental health disorder symptoms and physical activity of Royal Canadian Mounted Police Cadets during the cadet training program. Front Psychol 2023; 14:1145184. [PMID: 37260953 PMCID: PMC10229095 DOI: 10.3389/fpsyg.2023.1145184] [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: 01/15/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Objective Royal Canadian Mounted Police report experiencing extremely frequent potentially psychologically traumatic events (PPTE). In a recent study, approximately half of participating RCMP screened positive for one or more mental disorders, which is approximately five times the diagnostic proportion for the general Canadian population. Increased reporting of mental health symptoms been linked to PPTE exposures. Programs promoting physical activity may be useful interventions to supplement or pair with mental health interventions, providing anxiolytic, antidepressant, and stress-buffering effects. The current study was designed to assess the relationship between physical activity behaviors and reported mental health disorder symptoms of cadets during the Royal Mounted Canadian Police (RCMP) Cadet Training Program (CTP). The current study also examined the relationship between exercise and mental health disorder symptoms of cadets during the CTP. Methods The study included data from 394 cadets (76.1% male). An analysis of variance (ANOVA) and a series of t-tests were used to assess several differences across sociodemographic groups. Bivariate Spearman's Rank correlations were performed between the average number of active calories burned per day, as recorded by Apple Watches, and changes in self-reported mental health disorder symptoms (i.e., Generalized Anxiety Disorder [GAD], Major Depressive Disorder [MDD], Posttraumatic Stress Disorder [PTSD], Social Anxiety Disorder [SAD]. Alcohol Use Disorders [AUD], Panic Disorder [PD]) from pre-training (starting the CTP) to pre-deployment (completing the CTP) 26 weeks later. Results There were statistically significant correlations between physical activity and self-reported mental health disorder symptom scores during CTP. Cadets who performed more physical activity from pre-training to pre-deployment had statistically significantly greater decreases in symptoms of GAD (ρ = -0.472, p < 0.001), MDD (ρ = -0.307, p < 0.001), PTSD (ρ = -0.343, p < 0.001), and AUD (ρ = -0.085, p < 0.05). There was no statistically significant relationship between physical activity and changes in PD symptoms (ρ = -0.037, p > 0.05). There were also no statistically significant relationships between pre-CTP mental health disorder symptom scores and the volume of physical activity performed during CTP. Conclusion There was evidence of a significant relationship between reductions in mental health disorder symptom scores and physical activity during the 26-week CTP. The results highlight the role that exercise can play as an important tool for reducing mental health disorder symptoms, considering there was no relationship between pre-CTP baseline mental health scores and physical activity performed during CTP. Further research is needed to understand differences in physical activity behaviours among cadets and serving RCMP.
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Affiliation(s)
- Taylor Teckchandani
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Rachel L. Krakauer
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, SK, Canada
| | - Katie L. Andrews
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Kirby Q. Maguire
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Gordon J. G. Asmundson
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, SK, Canada
| | | | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment-Institut Canadien de recherche et de traitement en sécurité publique (CIPSRT-ICRTSP), University of Regina/Université de Regina, Regina, SK, Canada
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, SK, Canada
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18
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Legrand FD, Chaouloff F, Ginoux C, Ninot G, Polidori G, Beaumont F, Murer S, Jeandet P, Pelissolo A. [Exercise for the promotion of mental health II: Putative mechanisms, recommendations, and scientific challenges]. L'ENCEPHALE 2023; 49:296-303. [PMID: 37105781 DOI: 10.1016/j.encep.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023]
Abstract
The idea of applying various forms of physical activity for the betterment of physical health and the reduction of chronic medical conditions is ubiquitous. Despite evidence of successful applications of physical activity for improvement of mental health dating back to antiquity, it has until recent years remained unconventional to consider exercise as an intervention strategy for various mental health conditions. The past two decades, however, have seen a relative explosion of interest in understanding and applying various programs and forms of exercise to improve mental health. Here, our purpose is to provide a comprehensive and updated overview of the application of exercise as a strategy for improving mental health. In the present paper we first summarize contemporary research regarding short- and long-term impacts of exercise on mental health. Then an overview of the putative mechanisms and neurobiological bases underpinning the beneficial effects of exercise is provided. Finally, we suggest directions for future research as well as a series of concrete recommendations for clinicians who wish to prescribe physical activity as part of patient mental health management.
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Affiliation(s)
- Fabien D Legrand
- Université de Reims Champagne Ardenne, laboratoire cognition santé société (EA 6291), Reims, France.
| | | | - Clément Ginoux
- Université de Grenoble-Alpes, laboratoire sport en environnement social (SENS), Grenoble-Alpes, France
| | - Gregory Ninot
- Université de Montpellier, institut Debrest d'épidémiologie et de santé publique - Inserm, Montpellier, France
| | | | - Fabien Beaumont
- Université de Reims Champagne Ardenne, laboratoire MATIM, Reims, France
| | - Sébastien Murer
- Université de Reims Champagne Ardenne, laboratoire MATIM, Reims, France
| | - Philippe Jeandet
- Université de Reims Champagne Ardenne, laboratoire résistance induite et bio-protection des plantes (USC INRAE 1488), Reims, France
| | - Antoine Pelissolo
- Service de psychiatrie sectorisée, Assistance Publique-Hôpitaux de Paris, GHU Mondor, université Paris Est Créteil, Créteil, France
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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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Wang Z, Jiang B, Wang X, Li Z, Wang D, Xue H, Wang D. Relationship between physical activity and individual mental health after traumatic events: a systematic review. Eur J Psychotraumatol 2023; 14:2205667. [PMID: 37134018 PMCID: PMC10158556 DOI: 10.1080/20008066.2023.2205667] [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] [Indexed: 05/04/2023] Open
Abstract
Background: Traumatic events can cause social tension, anxiety, panic and other psychological crises, and can even cause post-traumatic stress disorder (PTSD) and suicide. Physical activity has a good role in promoting mental health, and has a great application prospect in individual psychological intervention after traumatic events. However, no systematic review of the relationship between physical activity and individual mental health after traumatic events affecting many people has been published so far, which makes it impossible for people to understand the research status in this field from a holistic perspective.Objective: This review explores the relationship between physical activity and individual psychology, physiology, subjective quality of life and well-being after traumatic events, so as to provide some valuable clues or enlightenment for individual psychological intervention after traumatic events.Method: Relevant literature was searched in five databases, summarised, sorted and studied.Results: Thirty-three study papers were included in this review, the main study findings include: (1) Physical activity is positively correlated with individual mental resilience and subjective well-being after traumatic events, and negatively correlated with anxiety, depression, tension and PTSD. (2) Individuals with higher levels of physical activity have better mental health status after traumatic events than those who do not regularly engage in physical activity. (3) Physical activity can promote sleep quality, self-efficacy, subjective quality of life and various physiological functions of those experiencing traumatic events. (4) Physical activity (including exercise) is regarded as one of the preferred nursing measures to buffer against mental stress and maintain physical and mental health for those experiencing traumatic events.Conclusion: The level of physical activity is positively correlated with individual physical and mental health before and after traumatic events. Physical activity can be used as one of the effective measures to improve individual mental health after traumatic events.
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Affiliation(s)
- ZhiFeng Wang
- Department of Physical Education, Xi'an Polytechnic University, Shaanxi, People's Republic of China
| | - Bing Jiang
- Department of Physical Education, Xi'an Polytechnic University, Shaanxi, People's Republic of China
| | - Xingtong Wang
- Department of General Education, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, People's Republic of China
| | - Zhixiang Li
- Department of Physical Education, Xi'an Polytechnic University, Shaanxi, People's Republic of China
| | - Dongxu Wang
- Department of Physical Education, Xinyang University, Xinyang, People's Republic of China
| | - HaiHong Xue
- Department of Physical Education, Xi'an Polytechnic University, Shaanxi, People's Republic of China
| | - Dongmei Wang
- College of Sports Medicine and Rehabilitation, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, People's Republic of China
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21
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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. Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomised clinical trial. Lancet Psychiatry 2023; 10:21-29. [PMID: 36436532 DOI: 10.1016/s2215-0366(22)00368-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exposure therapy is central in most front-line psychotherapies of post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. We aimed to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD. METHODS We did a single-blind, parallel, randomised controlled trial in Sydney, NSW, Australia. We included adults (aged ≥18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting suicidal plan), presence of psychosis or substance dependence, history of moderate-to-severe traumatic brain injury, or presence of a physical disorder or impairment that might be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine 90-min weekly sessions of exposure therapy for PTSD with 10 min aerobic exercise or to the control group of exposure therapy with 10 min passive stretching. The primary outcome was PTSD severity measured by the clinician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week after treatment, and 6 months after treatment (primary outcome timepoint). FINDINGS Between Dec 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores relative to those in the exposure therapy with stretching group (mean difference 12·1 [95% CI 2·4-21·8]; p=0·023), which resulted in a moderate effect size of 0·6 (0·1-1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864. INTERPRETATION Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD, which accords with evidence from studies in animals and humans on the role of exercise in modulating the extinction learning processes. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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22
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Ma R, Romano E, Vancampfort D, Firth J, Stubbs B, Koyanagi A. Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries. J Affect Disord 2023; 320:544-551. [PMID: 36209777 PMCID: PMC10166713 DOI: 10.1016/j.jad.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs. METHODS Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category. RESULTS 237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01). CONCLUSION Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK.
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven 3000, Belgium; University Psychiatric Centre KU Leuven, Kortenberg 3000, Belgium
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK; NICM Health Research Institute, Western Sydney University, Westmead 2751, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, ISCIII, 08830 Barcelona, Spain; Institució Catalana de Recerca i Estudis Avancats (ICREA), Pg. Lluis Companys 23, 08010 Barcelona, Spain
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23
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Provencher J, Cernik R, Marin MF. Impact of Stress and Exercise on Fear Extinction. Curr Top Behav Neurosci 2023; 64:157-178. [PMID: 37498495 DOI: 10.1007/7854_2023_432] [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: 07/28/2023]
Abstract
This chapter reviews the literature on the impact of stress and exercise on fear extinction. Given that key brain regions of the fear circuitry (e.g., hippocampus, amygdala and frontal cortex) can be modulated by stress hormones, it is important to investigate how stress influences this process. Laboratory-based studies performed in healthy adults have yielded mixed results, which are most likely attributable to various methodological factors. Among these factors, inter-individual differences modulating the stress response and timing of stressor administration with respect to the task may contribute to this heterogeneity. Given that fear is a core manifestation of various psychopathologies and that exposure-based therapy relies on fear extinction principles, several studies have attempted to assess the role of stress hormones on exposure-based therapy in patients suffering from post-traumatic stress disorder or anxiety disorders. These studies tend to suggest a beneficial impact of stress hormones (through either natural endogenous variations or synthetic administration) on exposure-based therapy as assessed mostly by subjective fear measures. Similar to stress, exercise can have an impact on many physiological and biological systems in humans. Of note, exercise modulates biomarkers such as brain-derived neurotrophic factor (BDNF) and anandamide (EAE) that act on brain regions implicated in the fear circuitry, supporting the importance of studying the impact of exercise on fear extinction. Overall, the results converge and indicate that fear extinction (tested in the laboratory or via exposure-based therapy in clinical populations) can be enhanced with exercise. Further research is needed to understand the mechanisms by which stress and exercise modulate fear learning and extinction processes, as well as to maximize the applicability to clinical contexts.
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Affiliation(s)
- Jessie Provencher
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
- Research Centre of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Rebecca Cernik
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
- Research Centre of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.
- Research Centre of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
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24
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Zeibig JM, Seiffer B, Frei AK, Takano K, Sudeck G, Rösel I, Hautzinger M, Wolf S. Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102340. [PMID: 37665821 DOI: 10.1016/j.psychsport.2022.102340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects. METHODS Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling. RESULTS From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042). CONCLUSIONS The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.
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Affiliation(s)
- Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki, 305-8560, Japan
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Inka Rösel
- Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tuebingen, 72074, Tuebingen, Germany
| | - Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
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25
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Saraiya TC, Jarnecke AM, Rothbaum AO, Wangelin B, McTeague LM, Acierno R, Brown DG, Bristol E, Feigl H, Reese M, Cobb AR, Harley B, Adams RJ, Back SE. Technology-enhanced in vivo exposures in Prolonged Exposure for PTSD: A pilot randomized controlled trial. J Psychiatr Res 2022; 156:467-475. [PMID: 36347106 PMCID: PMC9811583 DOI: 10.1016/j.jpsychires.2022.10.056] [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: 08/07/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
In vivo exposures (IVEs) are a key component of exposure-based treatments, during which patients approach fear-provoking, yet safe, situations in "real life." This pilot study assessed the use of a wearable technology (Bio Ware) during IVEs to enhance Prolonged Exposure (PE) therapy for PTSD. Bio Ware provides a clinician dashboard with real-time physiological and subjective data for clinicians to use for virtually guided IVEs. Participants (N = 40) were randomized to a Guided group that received standard PE and virtual, clinician-guided IVEs with the Bio Ware device, or a Non-Guided group that received standard PE and used the Bio Ware device on their own for IVEs. Multilevel linear models with bootstrapping were completed on the intent-to-treat (ITT; N = 39) and per-protocol samples (PP; n = 23), defined as completing at least eight sessions of PE and using the Bio Ware system during ≥ 1 IVEs. In the PP sample, there were significant effects of treatment condition (b = -14.55, SE = 1.47, 95% CI [-17.58, -11.78], p < .001) and time (b = -1.98, SE = 0.25, 95% CI [-2.47, -1.48], p < .001). While both groups showed reductions in PTSD symptoms, the Guided group evidenced significantly greater reductions than the Non-Guided group. These findings demonstrate the feasibility and safety of leveraging Bio Ware for virtual, clinician-guided IVEs during PE therapy for PTSD and suggest that virtual, clinician-guided exposures may enhance treatment outcomes. CLINICAL TRIAL REGISTRATION: NCT04471207.
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Affiliation(s)
- Tanya C. Saraiya
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick,Corresponding Author: Tanya C. Saraiya, Ph.D., Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Suite 217-C, Piscataway, NJ 08854.
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Alex O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Research and Outcomes, Skyland Trail
| | - Bethany Wangelin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Lisa M. McTeague
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Ron Acierno
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas
| | - Delisa G. Brown
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Emily Bristol
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Hayley Feigl
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | | | - Adam R. Cobb
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Research and Outcomes, Skyland Trail,Department of Psychology, Institute for Mental Health Research, University of Texas-Austin
| | | | - Robert J Adams
- Zeriscope, Inc,Department of Neurology, Medical University of South Carolina
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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26
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Vancampfort D, Heissel A, Waclawovsky A, Stubbs B, Firth J, McGrath RL, Van Damme T, Schuch FB. Precision-based exercise in people with anxiety and stress related disorders: Are there interindividual differences in anxiolytic effects? An ancillary meta-analysis of randomized controlled trials. Psychiatry Res 2022; 317:114803. [PMID: 36027821 DOI: 10.1016/j.psychres.2022.114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022]
Abstract
Interest in the individualized responses to exercise has been growing within mental health care and psychiatry. This meta-analysis examined if true interindividual differences (IIDs) in anxiolytic effects of exercise exist among adults with anxiety- and stress-related disorders. Data were extracted from a previous meta-analysis of randomized controlled trials (RCTs) and searches in CINAHL, Embase and Medline were updated (8 arms from 7 original studies, n participants=322). Change outcome standard deviations treated as point estimates for anxiety were extracted to calculate true IIDs. Inverse variance heterogeneity and restricted maximum likelihood models were used. Aerobic exercise and resistance training showed significant anxiolytic effects. No significant pooled IIDs were found for aerobic exercise nor resistance training demonstrating that there is currently a lack of convincing evidence to support the notion that true IIDs exist for the anxiolytic effects of exercise among adults with anxiety- and stress-related disorders. Consequently, clinical practice can focus on general population physical activity guidelines for patients with anxiety- and stress-related disorders rather than aiming for highly specific, individualized recommendations. Future research could prioritize investigating how to motivate patients with anxiety- and stress-related disorders to meet general population physical activity guidelines.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium.
| | - Andreas Heissel
- Social and Preventive Medicine, Department of Exercise and Health Sciences, Intra-faculty unit Cognitive Sciences, Faculty of Human Science and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health University of Potsdam, Potsdam, Germany
| | - Aline Waclawovsky
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, NSW, Australia
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
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27
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Souza RR, Powers MB, Rennaker RL, McIntyre CK, Hays SA, Kilgard MP. Timing of vagus nerve stimulation during fear extinction determines efficacy in a rat model of PTSD. Sci Rep 2022; 12:16526. [PMID: 36192564 PMCID: PMC9530175 DOI: 10.1038/s41598-022-20301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Studies have indicated that vagus nerve stimulation (VNS) enhances extinction learning in rodent models. Here, we investigated if pairing VNS with the conditioned stimulus is required for the enhancing effects of VNS. Adult Sprague-Dawley rats were exposed to intense stress followed by fear conditioning training to produce resistant fear. Rats were then implanted with a cuff electrode around the left vagus. After recovery, rats underwent extinction training paired with VNS (0.5 s, 0.8 mA, 100 µs, and 30 Hz) or with Sham VNS (0 mA). VNS rats were randomized into the following subgroups: During VNS (delivered during presentations of the conditioned stimulus, CS), Between VNS (delivered between CS presentations), Continuous VNS (delivered during the entire extinction session), and Dispersed VNS (delivered at longer inter-stimulation intervals across the extinction session). Sham VNS rats failed to extinguish the conditioned fear response over 5 days of repeated exposure to the CS. Rats that received Between or Dispersed VNS showed modest improvement in conditioned fear at the retention test. During and Continuous VNS groups displayed the greatest reduction in conditioned fear. These findings indicate that delivering VNS paired precisely with CS presentations or continuously throughout extinction promotes the maximum enhancement in extinction learning.
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Affiliation(s)
- Rimenez R Souza
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA.
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA.
| | - Mark B Powers
- Baylor University Medical Center, Dallas, TX, 75246, USA
| | - Robert L Rennaker
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Christa K McIntyre
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
| | - Seth A Hays
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Michael P Kilgard
- Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, 75080, USA
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Bioengineering and Sciences Building, 14.506, 800 West Campbell Road, Richardson, TX, 75080, USA
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28
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Ainamani HE, Gumisiriza N, Bamwerinde WM, Rukundo GZ. Gardening activity and its relationship to mental health: Understudied and untapped in low-and middle-income countries. Prev Med Rep 2022; 29:101946. [PMID: 35991326 PMCID: PMC9389296 DOI: 10.1016/j.pmedr.2022.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 11/01/2022] Open
Abstract
There is increasing awareness among researchers and health practitioners from high income countries about the potential mental health benefits of participating in gardening activities and spending substantial time in green spaces. However, this phenomenon is not well established in low- and middle-income countries. In this commentary, we discuss the evidence base surrounding the potential mental health benefits of participating in gardening activity and spending substantial time in a green space. We hope to stimulate discourse about incorporating these activities into mental health prevention in low- and middle-income countries.
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Affiliation(s)
- Herbert E Ainamani
- Department of Mental Health, Kabale University School of Medicine, P. O. Box 317, Kabale, Uganda
| | - Nolbert Gumisiriza
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Wilson M Bamwerinde
- Department of Environment and Natural Resources, Kabale University, Kabale, Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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29
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Jadhakhan F, Lambert N, Middlebrook N, Evans DW, Falla D. Is exercise/physical activity effective at reducing symptoms of post-traumatic stress disorder in adults — A systematic review. Front Psychol 2022; 13:943479. [PMID: 36033016 PMCID: PMC9412746 DOI: 10.3389/fpsyg.2022.943479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundExercise has been used to manage symptoms of post-traumatic stress disorder (PTSD). The effect of exercise on PTSD outcomes has been previously explored in several studies. However, it still remains unclear what type of exercise/physical activity, intensity and duration is most effective for reducing symptoms of PTSD. A systematic review was conducted to determine which forms of exercise or physical activity have the greatest effect on PTSD outcome scores including an evaluation of exercise frequency and volume.MethodsThe following electronic databases were systematically searched from January 1980 to June 2021: MEDLINE, PsycINFO, PubMed and Web of Science. Inclusion criteria were studies investigating adults aged 18 or over, reporting the effect of exercise and physical activities on PTSD symptom outcome scores. Two reviewers independently extracted information on study characteristics, exposure and outcomes. In total of 3,217 articles were screened and 23 full text articles further assessed, with 13 RCT's included in the review, covering seven exercise/physical activity interventions. The study protocol was registered prospectively with PROSPERO (CRD42021255131).ResultsThirteen studies from four countries involving a total of 531 patients were selected for inclusion. Individual forms of exercise/physical activity examined showed some effect on reducing PTSD symptoms but combined exercises (resistance training, aerobic, strength and yoga) administered over a 12 week period, three times a week for 30–60 min showed greater effects on PTSD symptoms.ConclusionThe limited evidence suggests that a combined exercise intervention has the best evidence for a having a beneficial effect on PTSD symptoms.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255131.
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Affiliation(s)
- Ferozkhan Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Nichola Lambert
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola Middlebrook
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Deborah Falla
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Levinson DB, Halverson TF, Wilson SM, Fu R. Less dropout from prolonged exposure sessions prescribed at least twice weekly: A meta-analysis and systematic review of randomized controlled trials. J Trauma Stress 2022; 35:1047-1059. [PMID: 35278229 DOI: 10.1002/jts.22822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
Trauma-focused psychotherapies, such as prolonged exposure (PE), are strongly recommended to treat posttraumatic stress disorder due to their effects in reducing symptoms. However, such therapies may also suffer from high dropout rates. To investigate how clients might benefit from trauma-focused therapy while minimizing dropout, we conducted a meta-analysis of 1,508 adults from 35 randomized controlled trials (RCTs) of outpatient PE programs to evaluate treatment frequency as a predictor of dropout. When an RCT prescribed PE sessions at least twice weekly compared to less frequently, the dropout rate was significantly lower at 21.0%, 95% CI [13.9%, 30.4%], compared to 34.0%, 95% CI [28.9%, 39.4%], OR = 0.52, 95% CI [0.30, 0.89], p = .018. It was not possible to draw causal conclusions, as only one RCT compared two PE treatment frequencies head-to-head. Nonetheless, the findings remained significant after controlling for study characteristics. These data invite reconsideration of the common practice of weekly psychotherapy in favor of twice-weekly sessions in standard outpatient treatment.
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Affiliation(s)
| | - Tate F Halverson
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Sarah M Wilson
- Durham VA Health Care System, Durham, North Carolina, USA
- Division of Behavioral Medicine and Neurosciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rongwei Fu
- School of Public Health, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
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Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise. Prog Cardiovasc Dis 2022; 70:84-93. [DOI: 10.1016/j.pcad.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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Young-McCaughan S, Peterson AL, Mintz J, Hale WJ, Dondanville KA, Borah EV, Blount TH, Blankenship AE, Fina BA, Hall-Clark BN, Hernandez AM, Jacoby VM, Malach SL, Williams JM, Compton KE, Bingham MO, Vriend CA, Inman AW, Brundige A, Arzola SM, Lapiz-Bluhm MD, Williamson DE, Litz BT, Hembree EA, Roache JD, Taylor DJ, Pruiksma KE, Borah AM, Yarvis JS. Testing the role of aerobic exercise in the treatment of posttraumatic stress disorder (PTSD) symptoms in U.S. active duty military personnel: a pilot study. Cogn Behav Ther 2022; 51:309-325. [PMID: 35001842 DOI: 10.1080/16506073.2021.2001689] [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: 11/03/2022]
Abstract
The purpose of this pilot study was to determine if the efficacy of imaginal exposure for symptoms of posttraumatic stress disorder (PTSD) could be improved by adding aerobic exercise. We hypothesized that aerobic exercise would enhance the efficacy of exposure therapy. Active duty service members with clinically significant symptoms of posttraumatic stress (PTSD Checklist-Stressor-Specific Version, [PCL-S], ≥25) were randomized into one of four conditions: exercise only; imaginal exposure only; imaginal exposure plus exercise; no exercise/no exposure therapy (control). Participants (N = 72) were primarily male, Army, noncommissioned officers ranging in age from 22 to 52. PTSD symptom severity decreased over time (p < .0001); however, there were no significant differences between the experimental conditions. The prediction that imaginal exposure augmented with aerobic exercise would be superior to either imaginal exposure alone or aerobic exercise alone was not supported, suggesting that engaging in exercise and imaginal exposure simultaneously may not be any better than engaging in either activity alone. A better understanding of individually administered and combined exercise and exposure therapy interventions for PTSD is warranted.
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Affiliation(s)
- Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Willie J Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Elisa V Borah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Steve Hicks School of Social Work, the University of Texas at Austin, Austin, TX, USA
| | - Tabatha H Blount
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abby E Blankenship
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brooke A Fina
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brittany N Hall-Clark
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ann Marie Hernandez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Valiant Mental Health PLLC, San Antonio, TX, USA
| | - Vanessa M Jacoby
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Steffany L Malach
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Primary Care, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Jacob M Williams
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Psychology/Neuropsychology, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Katherine E Compton
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mona O Bingham
- Department of Nursing, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Catherine A Vriend
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Alice W Inman
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Antoinette Brundige
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - M Danet Lapiz-Bluhm
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Douglas E Williamson
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry and Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | | | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Adam M Borah
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA.,Department of Behavioral Medicine and Health Services, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Jeffrey S Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA.,Department of Social Work, Texas A&M University - Central Texas, Killeen, TX, USA
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Voorendonk EM, Sanches SA, Tollenaar MS, De Jongh A, Van Minnen A. Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial). Eur J Psychotraumatol 2022; 13:2016219. [PMID: 35126881 PMCID: PMC8812732 DOI: 10.1080/20008198.2021.2016219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. OBJECTIVES This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. METHODS Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. CONCLUSIONS This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register (Trial NL9120).
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Affiliation(s)
- E M Voorendonk
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - S A Sanches
- Phrenos Centre of Expertise for Severe Mental Illness, Utrecht, The Netherlands
| | - M S Tollenaar
- Clinical Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - A De Jongh
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.,School of Psychology, Queen's University, Belfast, Northern Ireland.,Institute of Health and Society, University of Worcester, Worcester, UK
| | - A Van Minnen
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
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Bichler CS, Niedermeier M, Hüfner K, Gálffy M, Sperner-Unterweger B, Kopp M. Affective Responses to Both Climbing and Nordic Walking Exercise Are Associated With Intermediate-Term Increases in Physical Activity in Patients With Anxiety and Posttraumatic Stress Disorder - A Randomized Longitudinal Controlled Clinical Pilot Trial. Front Psychiatry 2022; 13:856730. [PMID: 35757205 PMCID: PMC9218791 DOI: 10.3389/fpsyt.2022.856730] [Citation(s) in RCA: 3] [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: 01/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exercise programs have shown anxiolytic effects in psychiatric patients. Adherence to exercise programs and subsequent long-term lifestyle change is influenced by acute affective responses of the exercise programs. This research aimed to assess acute affective responses of two different exercise modalities compared to a non-exercise control program and its effects on persisting physical activity behavior change. METHODS Sixty-six outpatients diagnosed with an anxiety disorder or posttraumatic stress disorder were randomly allocated to one of three groups in a randomized longitudinal controlled clinical pilot trial: climbing (n = 26), nordic walking (n = 19), social contact control (n = 21). Affective responses were assessed pre, during, and post activity. General physical activity behavior was recorded prior to participation in the program, post program, and at follow-ups three and six months after the program. RESULTS Multilevel modeling analyzes of 1,066 individual data points revealed increases in affective valence in the exercise sessions compared to the social contact sessions. State anxiety decreased in the climbing group compared to the social contact group. Physical activity behavior was increased immediately following the program as well as at six months follow-up in both exercise groups. A larger increase in affective valence during and after the sessions was associated with higher physical activity post program. CONCLUSIONS Climbing and conventional nordic walking exercise sessions revealed positive affective changes in outpatients indicating therapeutic potential of both modalities for acute emotion regulation. In accordance with theoretical models of human behavior change, it was judged that the experience of a more pleasant affective state following the exercise sessions induced more persisting effects on physical activity behavior after the exercise programs. TRIAL REGISTRATION https://www.clinicaltrials.gov/ct2/show/NCT03758599, identifier: NCT03758599.
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Affiliation(s)
- Carina S Bichler
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Innsbruck, Austria
| | - Mátyás Gálffy
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Meyer JD, Perkins SL, Brower CS, Lansing JE, Slocum JA, Thomas EBK, Murray TA, Lee DC, Wade NG. Feasibility of an Exercise and CBT Intervention for Treatment of Depression: A Pilot Randomized Controlled Trial. Front Psychiatry 2022; 13:799600. [PMID: 35599775 PMCID: PMC9115753 DOI: 10.3389/fpsyt.2022.799600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Depression (DEP) is prevalent and current treatments are ineffective for many people. This pilot study's purpose was to assess the feasibility, acceptability, and plausible efficacy of an 8-week intervention employing 30 min of prescribed moderate intensity exercise ("ActiveCBT") compared to 30 min of usual activities ("CalmCBT") immediately prior to weekly online CBT sessions. Ten adults with DSM-5-diagnosed current DEP were randomized to groups and completed: an intake assessment, eight weekly CBT sessions, final assessment, and 3-month follow-up. ActiveCBT participants were prescribed 30-min of moderate exercise immediately prior to each standardized 50-min CBT session. CalmCBT participants continued with normal activities for 30 min before therapy. Questionnaires regarding DEP symptom severity (Patient Health Questionnaire-9 [PHQ-9]), between-session effectiveness (Behavioral Activation for Depression Survey [BADS], Automatic Thoughts Questionnaire [ATQ]), in-session effectiveness (Working Alliance Inventory-Short Revised [WAI]), and state anhedonia (Dimension Analog Rating Scale [DARS], Visual Analog Scale [VAS]; assessed 3 times: before Active/Calm condition, after, and after therapy) were completed each week. Therapy fidelity ratings were independently coded via a standardized codebook. The Structured Clinical Interview for DSM-5 (SCID) and Hamilton Rating Scale for Depression (HAMD) were used to assess DEP at intake, final, and 3-month follow-up. We found strong feasibility and acceptability (100% adherence, 100% retention at final visit, 74.6% therapy fidelity, and high patient satisfaction ratings). Differences between groups favoring ActiveCBT in anhedonia (DARS, Hedges' g = 0.92; VAS, g = 3.16), within- (WAI, g = 0.1.10), and between-session effectiveness (ATQ g = -0.65; BADS g = -1.40), suggest plausible efficacy of ActiveCBT for enhancing CBT. DEP rates were reduced in both groups from baseline to final (60% MDD SCID remission) and at follow up (Active: 40%; Calm: 25%). Larger and potentially quicker symptom improvement was found favoring the Active condition to the final visit (HAMD, between-group changes g = -1.33; PHQ-9, g = -0.62), with small differences remaining at follow-up (HAMD, g = -0.45; PHQ-9, g = -0.19). Exercise priming appears acceptable and plausibly efficacious for enhancing mechanisms of CBT and overall outcomes, though the present small sample precludes efficacy determinations. It appears feasible to conduct a randomized controlled trial comparing ActiveCBT to CalmCBT. Future trials evaluating this potentially promising treatment approach and mediating mechanisms are warranted.
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Affiliation(s)
- Jacob D Meyer
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Seana L Perkins
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Cassandra S Brower
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Jeni E Lansing
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Julia A Slocum
- Department of Kinesiology, Iowa State University, Ames, IA, United States.,Department of Psychology, Iowa State University, Ames, IA, United States
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Thomas A Murray
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Duck-Chul Lee
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Nathaniel G Wade
- Department of Psychology, Iowa State University, Ames, IA, United States
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Maoz I, Zubedat S, Dolev T, Aga-Mizrachi S, Bloch B, Michaeli Y, Eshed Y, Grinstein D, Avital A. Dog training alleviates PTSD symptomatology by emotional and attentional regulation. Eur J Psychotraumatol 2021; 12:1995264. [PMID: 34868486 PMCID: PMC8635621 DOI: 10.1080/20008198.2021.1995264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background Post-Traumatic Stress Disorder (PTSD) symptoms include re-experiencing, avoidance, hyperarousal, and cognitive deficits, reflecting both emotional and cognitive dysregulation. In recent years, non-pharmacological approaches and specifically animal-assisted therapy have been shown to be beneficial for a variety of disorders such as Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and PTSD. However, little is mentioned in the literature about the reciprocal effects of the animal-human interaction. Objective To evaluate the effects of a one-year dog training programme on PTSD symptomatology in youngsters with PTSD and on dogs' behaviour. Methods Fifty-three adolescents, previously exposed to interpersonal trauma, were clinically diagnosed with PTSD and assigned to a dog-training programme group (n = 30) and a control group (n = 23) that engaged in other training programmes (e.g. cooking, hairstyling, etc.). Both groups were evaluated at baseline and following 12-months by The Clinician-Administered PTSD Scale for DSM-5 in Children and Adolescents (CAPS-CA-5) and Beck-Depression Inventory (BDI). Additionally, we physiologically measured both emotional and attention dysregulation. Results Post-12-months training, a significant alleviation of PTSD symptomatology accompanied by lower depression severity was observed in the dog-training group, compared with a insignificant recovery in the control group. Furthermore, improved emotional and attentional regulation was observed in the dog-training group. Measuring the dogs' behaviour revealed increased anxiety and decreased selective attention performance, which was inversely correlated with the beneficial effects observed in the dog-training programme group. Conclusions Our findings emphasize the role of emotional and attentional regulations on the dog-handler interface, as evidence-based support for the beneficial effects of the dog-training programme, as either a non-pharmacological intervention or as complementary to anti-depressants treatment of PTSD. Though pharmacological treatments increase the patients' well-being by treating certain PTSD symptoms, our suggested dog-training programme seems to influence the PTSD diagnostic status, thus may be implemented in civilians and veterans with PTSD.
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Affiliation(s)
- Inon Maoz
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Salman Zubedat
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Talya Dolev
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Shlomit Aga-Mizrachi
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
- Nursing Department, Jerusalem College of Technology, Jerusalem, Israel
| | - Boaz Bloch
- Department of Psychiatry, Emek Medical Center, Afula, Israel
| | - Yuval Michaeli
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Yuval Eshed
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Dan Grinstein
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Avi Avital
- Behavioral Neurobiology Lab, Department of Occupational Therapy, University of Haifa, Haifa, Israel
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Bauer LL, Frei AK, Studnitz T, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, El-Kurd N, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial. BMC Psychiatry 2021; 21:540. [PMID: 34717567 PMCID: PMC8556805 DOI: 10.1186/s12888-021-03541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). METHODS This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. DISCUSSION Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany.
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
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Crombie KM, Sartin-Tarm A, Sellnow K, Ahrenholtz R, Lee S, Matalamaki M, Almassi NE, Hillard CJ, Koltyn KF, Adams TG, Cisler JM. Exercise-induced increases in Anandamide and BDNF during extinction consolidation contribute to reduced threat following reinstatement: Preliminary evidence from a randomized controlled trial. Psychoneuroendocrinology 2021; 132:105355. [PMID: 34280820 PMCID: PMC8487992 DOI: 10.1016/j.psyneuen.2021.105355] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We recently demonstrated that moderate-intensity aerobic exercise delivered during the consolidation of fear extinction learning reduced threat expectancy during a test of extinction recall among women with posttraumatic stress disorder (PTSD). These findings suggest that exercise may be a potential candidate for improving the efficacy of exposure-based therapies, which are hypothesized to work via the mechanisms of fear extinction learning. The purpose of this secondary analysis was to examine whether exercise-induced increases in circulating concentrations of candidate biomarkers: endocannabinoids (anandamide [AEA]; 2-arachidonoylglycerol [2-AG], brain-derived neurotrophic factor (BDNF), and homovanillic acid (HVA), mediate the effects of exercise on extinction recall. METHODS Participants (N = 35) completed a 3-day fear acquisition (day 1), extinction (day 2), and extinction recall (day 3) protocol, in which participants were randomly assigned to complete either moderate-intensity aerobic exercise (EX) or a light-intensity control (CON) condition following extinction training (day 2). Blood was obtained prior to and following EX or CON. Threat expectancy ratings during tests of extinction recall (i.e., initial fear recall and fear recall following reinstatement) were obtained 24 h following EX or CON. Mediation was tested using linear-mixed effects models and bootstrapping of the indirect effect. RESULTS Circulating concentrations of AEA and BDNF (but not 2-AG and HVA) were found to mediate the relationship between moderate-intensity aerobic exercise and reduced threat expectancy ratings following reinstatement (AEA 95% CI: -0.623 to -0.005; BDNF 95% CI: -0.941 to -0.005). CONCLUSIONS Exercise-induced increases in peripheral AEA and BDNF appear to play a role in enhancing consolidation of fear extinction learning, thereby leading to reduced threat expectancies following reinstatement among women with PTSD. Future mechanistic research examining these and other biomarkers (e.g., brain-based biomarkers) is warranted.
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Affiliation(s)
- Kevin M. Crombie
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Anneliis Sartin-Tarm
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Kyrie Sellnow
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Rachel Ahrenholtz
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Sierra Lee
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Megan Matalamaki
- University of Wisconsin, Department of Psychiatry, 6001
Research Park Boulevard, Madison, Wisconsin, United States of America,
53719-1176
| | - Neda E. Almassi
- University of Wisconsin, Department of Kinesiology, 285 Med
Sci, 1300 University Ave, Madison, WI, United States of America, 53706-1121
| | - Cecilia J. Hillard
- Medical College of Wisconsin, Neuroscience Research Center,
Department of Pharmacology and, Toxicology, 8701 Watertown Plank Rd., Milwaukee, WI
53226
| | - Kelli F. Koltyn
- University of Wisconsin, Department of Kinesiology, 285 Med
Sci, 1300 University Ave, Madison, WI, United States of America, 53706-1121
| | - Tom G. Adams
- University of Kentucky, Department of Psychology, 105
Kastle Hill, Lexington, Kentucky, United States of America, 40506-0044,Yale School of Medicine, Department of Psychiatry, 300
George St., New Haven, CT, United States of America, 06511,National Center for PTSD, Clinical Neurosciences Division,
VA CT Healthcare System, 950 Campbell Avenue, West Haven, CT, United States of
America, 06516
| | - Josh M. Cisler
- University of Texas at Austin, Department of Psychiatry and
Behavioral Sciences, 1601 Trinity St, Bldg B, Austin, TX, United States of America,
78712
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39
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Piotrkowicz M, Janoska-Jazdzik M, Koweszko T, Szulc A. The Influence of Psychotherapy on Peripheral Brain-Derived Neurotrophic Factor Concentration Levels and Gene Methylation Status: A Systematic Review. J Clin Med 2021; 10:4424. [PMID: 34640441 PMCID: PMC8509187 DOI: 10.3390/jcm10194424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/02/2023] Open
Abstract
Psychotherapy is a well-established method of treating many mental disorders. It has been proven that psychotherapy leads to structural and functional changes in the brain; however, knowledge about the molecular and cellular mechanisms of these changes is limited. Neuroplasticity and one of its mediators, brain-derived neurotrophic factor (BDNF), are potential research targets in this field. To define the role of BDNF concentration in serum, or in plasma, and BDNF promoter gene methylation in saliva or leucocytes, in psychotherapy, an extensive literature search was conducted in the PubMed and Web of Science databases. The literature review was conducted based on papers published up until May 2021 that included pre and post psychotherapy measurements of either BDNF concentration levels or promoter gene methylation status. Ten studies were indicated as eligible for analysis: eight studies that investigated peripheral BDNF concentration levels, one study that investigated methylation status, and one study that included an evaluation of both subject matters. Patients underwent cognitive behavioral therapy or interpersonal psychotherapy. Patients were diagnosed with borderline personality disorder, major depressive disorder, anorexia nervosa, bulimia nervosa, or post-traumatic stress disorder. There were only three of the nine studies that showed statistically significant increases in BDNF concentration levels after psychotherapy. The two studies that involved BDNF gene methylation status showed a decrease in methylation after dialectical behavioral therapy of borderline patients.
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Affiliation(s)
- Michal Piotrkowicz
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Partyzantow 2/4, 05-802 Pruszkow, Poland; (M.J.-J.); (T.K.); (A.S.)
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40
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Littman AJ, Bratman GN, Lehavot K, Engel CC, Fortney JC, Peterson A, Jones A, Klassen C, Brandon J, Frumkin H. Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA. BMJ Open 2021; 11:e051885. [PMID: 34556516 PMCID: PMC8461737 DOI: 10.1136/bmjopen-2021-051885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD). DESIGN AND SETTING A pilot randomised controlled trial conducted in the US Pacific Northwest. PARTICIPANTS Veterans with PTSD due to any cause. INTERVENTIONS Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13). PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up. RESULTS Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group. CONCLUSIONS This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes. TRIAL REGISTRATION NUMBER NCT03997344.
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Affiliation(s)
- Alyson J Littman
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, Washington, USA
| | - Keren Lehavot
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Charles C Engel
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C Fortney
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander Peterson
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Alex Jones
- Outdoors for All, Seattle, Washington, USA
| | - Carolyn Klassen
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Howard Frumkin
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
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Voorendonk EM, Meyer T, Duken SB, van Ast VA. Cardiorespiratory fitness as protection against the development of memory intrusions: A prospective trauma analogue study. Biol Psychol 2021; 165:108189. [PMID: 34517067 DOI: 10.1016/j.biopsycho.2021.108189] [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: 02/06/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Intrusive and distressing memories are at the core of post-traumatic stress disorder (PTSD). Since cardiorespiratory fitness (CRF) has been linked with improved mental health, emotion regulation, and memory function, CRF may, by promoting these capabilities, protect against the development of intrusions after trauma. We investigated the CRF-intrusion relationship and its potential mediators in 115 healthy individuals, using a trauma film to induce intrusions. As potential mediators, we assessed indices of pre-trauma mental health such as heart rate variability, subjective and psychobiological peri-traumatic responses, and memory. Critically, results showed that higher CRF was related to fewer intrusions, but no mediators emerged for the CRF-intrusion relationship. These results indicate that individuals displaying higher CRF are less prone to develop traumatic memory intrusions. Future studies may want to investigate whether promoting fitness prior to possible trauma exposure can boost resilience against the development of debilitating re-experiencing symptoms of PTSD.
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Affiliation(s)
- Eline M Voorendonk
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research Department, PSYTREC, Bilthoven, The Netherlands; Radboud University Nijmegen, Behavioural Science Institute (BSI), The Netherlands.
| | - Thomas Meyer
- Institute of Psychology, University of Münster, Münster, Germany
| | - Sascha B Duken
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Vanessa A van Ast
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Tryon SC, Sakamoto IM, Kellis DM, Kaigler KF, Wilson MA. Individual Differences in Conditioned Fear and Extinction in Female Rats. Front Behav Neurosci 2021; 15:740313. [PMID: 34489657 PMCID: PMC8418198 DOI: 10.3389/fnbeh.2021.740313] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
The inability to extinguish a traumatic memory is a key aspect of post-traumatic stress disorder (PTSD). While PTSD affects 10–20% of individuals who experience a trauma, women are particularly susceptible to developing the disorder. Despite this notable female vulnerability, few studies have investigated this particular resistance to fear extinction observed in females. Similar to humans, rodent models of Pavlovian fear learning and extinction show a wide range of individual differences in fear learning and extinction, although female rodents are considerably understudied. Therefore, the present study examined individual differences in fear responses, including freezing behavior and ultrasonic vocalizations (USVs), of female Long–Evans rats during acquisition of fear conditioning and cued fear extinction. Similar to prior studies in males, female rats displayed individual variation in freezing during cued fear extinction and were divided into extinction competent (EC) and extinction resistant (ER) phenotypes. Differences in freezing between ER and EC females were accompanied by shifts in rearing during extinction, but no darting was seen in any trial. Freezing behavior during fear learning did not differ between the EC and ER females. Vocalizations emitted in the 22 and 50 kHz ranges during fear learning and extinction were also examined. Unlike vocalizations seen in previous studies in males, very few 22 kHz distress vocalizations were emitted by female rats during fear acquisition and extinction, with no difference between ER and EC groups. Interestingly, all female rats produced significant levels of 50 kHz USVs, and EC females emitted significantly more 50 kHz USVs than ER rats. This difference in 50 kHz USVs was most apparent during initial exposure to the testing environment. These results suggest that like males, female rodents show individual differences in both freezing and USVs during fear extinction, although females appear to vocalize more in the 50 kHz range, especially during initial periods of exposure to the testing environment, and emit very few of the 22 kHz distress calls that are typically observed in males during fear learning or extinction paradigms. Overall, these findings show that female rodents display fear behavior repertoires divergent from males.
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Affiliation(s)
- Sarah C Tryon
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Iris M Sakamoto
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Devin M Kellis
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Kris F Kaigler
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Marlene A Wilson
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States.,Columbia VA Health Care System, Columbia, SC, United States
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Pebole M, Gobin RL, Hall KS. Trauma-informed exercise for women survivors of sexual violence. Transl Behav Med 2021; 11:686-691. [PMID: 32535635 DOI: 10.1093/tbm/ibaa043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Compared to their male counterparts, women experience alarmingly high rates of sexual violence (SV). Nearly 20% of women in the USA have been victims of SV, and prevalence of sexual assault among female service members is reported to be even higher, up to 50%. SV results in negative health outcomes like posttraumatic stress disorder, depression, obesity, poor body image, and pain-related disability. Exercise has been shown to positively impact both mental and physical health outcomes in populations experiencing posttraumatic symptoms, yet women survivors of SV are often excluded from exercise trials in trauma-affected populations. The purpose of this paper is to comment on the importance of incorporating women-specific trauma-informed principles in the content and delivery of exercise interventions in trauma-affected populations, particularly as it relates to SV. Researchers discuss the implications of female-specific and trauma-informed exercise considerations for SV survivors. This commentary highlights the need for trauma-informed implementation efforts and outcome measurements in exercise interventions involving women affected by SV. Researchers call for (a) increased qualitative work on trauma-specific implementation efforts across exercise intervention domains and (b) increased assessment of trauma-specific outcomes in exercise trials.
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Affiliation(s)
- Michelle Pebole
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
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Ramos-Sanchez CP, Schuch FB, Seedat S, Louw QA, Stubbs B, Rosenbaum S, Firth J, van Winkel R, Vancampfort D. The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence. Psychiatry Res 2021; 302:114046. [PMID: 34126464 DOI: 10.1016/j.psychres.2021.114046] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/30/2021] [Indexed: 12/20/2022]
Abstract
Exercise as a treatment option for people with mental disorders is a field of growing interest. The increased number of published randomized controlled trials (RCTs) evaluating the effects of exercise in the treatment of anxiety and related disorders in recent years calls for an update of the available meta-analytic evidence. Electronic databases (PubMed, CINAHL, PSYCArticles, and Embase) were searched up to 17.2.2021, for RCTs evaluating the effects of exercise on anxiety and stress symptoms in adults with anxiety and related disorders. A random effects meta-analysis was conducted. A total of 13 RCTs comprising 731 adult participants (exercise n=376; control n=355) were included. Exercise had a small, bordering medium, but statistically significant effect on decreasing anxiety symptoms compared to control condition (standardized mean difference=-0.425, 95%CI -0.67 to -0.17; I2 = 47.9%) in people with anxiety and related disorders. Our meta-analysis updates the existing evidence supporting exercise as an efficacious intervention for anxiety and related disorders. Although the updated meta-analytic evidence is less heterogenous than previously reported, future research is still needed to explore the factors moderating the effects of exercise on outcome such as frequency, intensity, duration of the sessions, and type of exercise and qualification of the provider in more detail.
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Affiliation(s)
| | - Felipe Barreto Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South-Africa
| | - Quinette Abegail Louw
- Department of Health and rehabilitation Sciences, Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South-Africa
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom; NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Ruud van Winkel
- University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium
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Abstract
OBJECTIVE There is growing evidence that higher levels of physical activity are associated with better mental health. Furthermore, interventional studies have shown that exercise may improve symptoms in a number of psychiatric conditions. Despite this evidence, relatively little information is available about how these findings have been translated into clinical practice. The goal of this study was to characterize the exercise prescribing practices of health care providers from different subspecialties and evaluate factors that may influence their prescribing practices. METHODS We conducted a cross-sectional survey among faculty and staff from a large academic tertiary care medical center in the southeastern United States. Participants were invited to complete the survey via email or departmental newsletters. Descriptive statistics were used to characterize the sample and ordered logistic regression was used to analyze practices about exercise as a therapy for psychiatric illness. RESULTS A total of 185 respondents completed the survey. More than half of the providers (58%) reported that they regularly recommend exercise as part of the treatment for patients with psychiatric conditions; however, few providers offered specific exercise instructions (24%) or followed national guidelines (30%). Depression (84.9%) and anxiety (69.2%) were the most common indications for exercise prescription, while insufficient knowledge or training was the most common barrier to prescribing exercise. We also found significant differences in prescription practices depending on the providers' formal clinical degree and their reported personal exercise habits. CONCLUSIONS Exercise is recognized by most clinicians as a therapeutic option for psychiatric conditions. Despite this recognition, only a small proportion provide recommendations consistent with national guidelines or empirical research.
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McInerney J, Brown P, Bird JC, Nickless A, Brown G, Freeman D. Does raising heart rate prior to a behavioural test enhance learning in cognitive therapy for anxiety? An experimental test for the treatment of fear of heights using virtual reality. Behav Res Ther 2021; 144:103928. [PMID: 34246887 DOI: 10.1016/j.brat.2021.103928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests. METHODS Sixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief. RESULTS Heart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56). DISCUSSION An increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.
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Affiliation(s)
- Josephine McInerney
- Royal Holloway, University of London, UK; Broadmoor Hospital, West London NHS Trust, UK.
| | - Poppy Brown
- Department of Psychiatry, University of Oxford, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | | | - Gary Brown
- Royal Holloway, University of London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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47
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Zeibig JM, Seiffer B, Sudeck G, Rösel I, Hautzinger M, Wolf S. Transdiagnostic efficacy of a group exercise intervention for outpatients with heterogenous psychiatric disorders: a randomized controlled trial. BMC Psychiatry 2021; 21:313. [PMID: 34158000 PMCID: PMC8218400 DOI: 10.1186/s12888-021-03307-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Exercise efficaciously reduces disorder-specific symptoms of psychiatric disorders. The current study aimed to examine the efficacy of a group exercise intervention on global symptom severity and disorder-specific symptoms among a mixed outpatient sample. METHODS Groups of inactive outpatients, waiting for psychotherapy, with depressive disorders, anxiety disorders, insomnia, and attention-deficit/hyperactivity disorders were randomized to a manualized 12-week exercise intervention, combining moderate to vigorous aerobic exercise with techniques for sustainable exercise behaviour change (n = 38, female = 71.1% (n = 27), Mage = 36.66), or a passive control group (n = 36, female = 75.0% (n = 27), Mage = 34.33). Primary outcomes were global symptom severity and disorder-specific symptoms, measured with the Symptom Checklist-90-Revised and Pittsburgh Sleep Quality Index pre- and post-treatment. Secondary outcome was the self-reported amount of exercise (Physical Activity, Exercise, and Sport Questionnaire), measured pre-treatment, intermediate-, and post-treatment. Intention-to-treat analyses were conducted using linear mixed models. Linear regressions were conducted to examine the effect of the change of exercise behaviour on the change of symptoms. RESULTS The intervention significantly improved global symptom severity (d = 0.77, p = .007), depression (d = 0.68, p = .015), anxiety (d = 0.87, p = .002), sleep quality (d = 0.88, p = .001), and increased the amount of exercise (d = 0.82, p < .001), compared to the control group. Post-treatment differences between groups were significant for depression (d = 0.63, p = .031), sleep quality (d = 0.61, p = .035) and the amount of exercise (d = 1.45, p < .001). Across both groups, the reduction of global symptom severity was significantly predicted by an increase of exercise (b = .35, p = .012). CONCLUSIONS The exercise intervention showed transdiagnostic efficacy among a heterogeneous clinical sample in a realistic outpatient setting and led to sustained exercise behaviour change. Exercise may serve as an efficacious and feasible transdiagnostic treatment option improving the existing treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (ID: NCT03542396 , 25/04/2018).
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Affiliation(s)
- Johanna-Marie Zeibig
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany.
| | - Britta Seiffer
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany
| | - Gorden Sudeck
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany
| | - Inka Rösel
- Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074, Tuebingen, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, Faculty of Science, Psychological Institute, University of Tuebingen, 72074, Tuebingen, Germany
| | - Sebastian Wolf
- Department of Education & Health Research, Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tuebingen, 72074, Tuebingen, Germany.,Department of Clinical Psychology and Psychotherapy, Faculty of Science, Psychological Institute, University of Tuebingen, 72074, Tuebingen, Germany
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48
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Akhtar A, Pilkhwal Sah S. Advances in the pharmacotherapeutic management of post-traumatic stress disorder. Expert Opin Pharmacother 2021; 22:1919-1930. [PMID: 34124975 DOI: 10.1080/14656566.2021.1935871] [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: 10/21/2022]
Abstract
Introduction: Post-traumatic stress disorder (PTSD), a mental disorder, is associated with anxiety, depression, and social awkwardness resulting from past traumatic episodes like natural disasters, accidents, terrorist attacks, war, rape, and sexual violence. It affects primarily the amygdala, cortex, and hippocampus where neurochemical changes result in altered behavior. PTSD patients display impaired fear extinction, and past events keep haunting them. The topic presents relevant sections like PTSD pharmacotherapy, associated challenges, and the novel targets and drugs for future research and therapy.Areas covered: The authors discuss the current pharmacotherapy like SSRIs, NDRIs, SNRIs, anticonvulsants, antidepressants, and benzodiazepines, used to attenuate the associated symptoms. However, the primary focus being the novel and potential targets which can be explored better to understand possible future research and advanced therapy in PTSD. For the same, an account of both preclinical and clinical studies has been covered.Expert opinion: Excessive adverse effects, limited efficacy, and lower patient compliance are some of the major challenges with conventional drugs. Moreover, they correct only fewer symptoms without halting the disease progression. Several agents are investigated in different preclinical and clinical phases, which can potentially overcome the pitfalls and limitations associated with conventional therapies.
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Affiliation(s)
- Ansab Akhtar
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Sangeeta Pilkhwal Sah
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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49
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van Gelderen MJ, Nijdam MJ, Haagen JFG, Vermetten E. Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:215-227. [PMID: 32203971 DOI: 10.1159/000505977] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. OBJECTIVE To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. METHOD In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. RESULTS The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. CONCLUSIONS In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).
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Affiliation(s)
- Marieke J van Gelderen
- ARQ Centrum'45, Diemen, The Netherlands, .,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,
| | - Mirjam J Nijdam
- ARQ Centrum'45, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Military Mental Health Research, Ministry of Defense, Utrecht, The Netherlands
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50
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Crombie KM, Sartin-Tarm A, Sellnow K, Ahrenholtz R, Lee S, Matalamaki M, Adams TG, Cisler JM. Aerobic exercise and consolidation of fear extinction learning among women with posttraumatic stress disorder. Behav Res Ther 2021; 142:103867. [PMID: 34020153 DOI: 10.1016/j.brat.2021.103867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/21/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022]
Abstract
This study tested whether aerobic exercise delivered during the consolidation window following fear extinction learning reduces the return of fear among women with posttraumatic stress disorder (PTSD). Participants (n=35) completed an initial clinical assessment followed by a 3-day fear acquisition, extinction, and recall protocol. On day 1, participants completed a fear acquisition training task in which one geometric shape (conditioning stimulus; CS+) was paired (with 50% probability) with a mild electric shock (unconditioned stimulus; US), while a different shape (CS-) was never paired with the US. On day 2 (24 h later), participants completed a fear extinction training task in which the CS+ no longer predicted administration of the US. Shortly following extinction, participants were randomly assigned to complete either moderate-intensity aerobic exercise (EX) or a light-intensity exercise control (CON) condition. On day 3 (24 h later), participants completed fear recall tests assessing the return of fear (spontaneous recovery, renewal, and reinstatement). Fear responding was assessed via threat expectancy ratings and skin conductance responses (SCR). In the threat expectancy ratings, there were no significant differences between groups in spontaneous recovery; however, EX significantly (p=.02) reduced threat expectancy ratings following reinstatement relative to CON. In SCR measures, there were no significant differences between groups in spontaneous recovery, renewal, or reinstatement. These results support a role for moderate-intensity aerobic exercise during the consolidation window in reducing threat expectations following reinstatement in women with PTSD. Research should continue to examine exercise as a potential method for improving the efficacy of exposure-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04113798.
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Affiliation(s)
- Kevin M Crombie
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
| | - Anneliis Sartin-Tarm
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Kyrie Sellnow
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Rachel Ahrenholtz
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Sierra Lee
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Megan Matalamaki
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY, 40506-0044, USA; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT, 06511, USA; National Center for PTSD, Clinical Neurosciences Division, VA CT Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Josh M Cisler
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
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