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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [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] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Kesim IE, Pittig A, Wong AHK. The effect of typicality training on costly safety behavior generalization. PSYCHOLOGICAL RESEARCH 2024; 88:1771-1782. [PMID: 38822864 PMCID: PMC11281986 DOI: 10.1007/s00426-024-01979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Typicality asymmetry in generalization refers to enhanced fear generalization when trained with typical compared to atypical exemplars. Typical exemplars are highly representative of their category, whereas atypical exemplars are less representative. Individual risk factors, such as trait anxiety, attenuate this effect, due to the high level of threat ambiguity of atypical exemplars. Although recent research provided evidence for generalization of safety behavior, it is unclear whether this generalization also follows typicality asymmetry. This study examined (1) whether participants exhibited typicality asymmetry in the generalization of safety behavior and (2) whether this effect would be attenuated by individual risk factors, such as intolerance of uncertainty and trait anxiety. METHODS Participants were trained with either typical (Typical group, n = 53) or atypical (Atypical group, n = 55) exemplars in a fear and avoidance conditioning procedure. Participants acquired differential conditioned fear and costly safety behavior to the threat- and safety-related exemplars. In a following Generalization Test, the degree of safety behavior to novel exemplars of the same categories was tested. RESULTS The Atypical group showed greater differential safety behavior responses compared to the Typical group. Higher trait anxiety was associated with lower differential safety behavior generalization, driven by an increase in generalized responding to novel safety-related exemplars. LIMITATIONS This study used hypothetical cost instead of real cost. CONCLUSIONS Training with atypical exemplars led to greater safety behavior generalization. Moreover, individuals with high trait anxiety show impaired safety behavior generalization.
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Affiliation(s)
- Işık E Kesim
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, Georg-August-Universität Göttingen, Kurze-Geismar-Straße 1, 37073, Göttingen, Germany
| | - Alex H K Wong
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands.
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Butler RM, Christian C, Girard JM, Vanzhula IA, Levinson CA. Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders. Behav Res Ther 2024; 180:104577. [PMID: 38850690 DOI: 10.1016/j.brat.2024.104577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Imaginal exposure is a novel intervention for eating disorders (EDs) that has been investigated as a method for targeting ED symptoms and fears. Research is needed to understand mechanisms of change during imaginal exposure for EDs, including whether within- and between-session distress reduction is related to treatment outcomes. METHOD Study 1 tested four sessions of online imaginal exposure (N = 143). Study 2 examined combined imaginal and in vivo exposure, comprising six imaginal exposure sessions (N = 26). ED symptoms and fears were assessed pre- and posttreatment, and subjective distress and state anxiety were collected during sessions. RESULTS Subjective distress tended to increase within-session in both studies, and within-session reduction was not associated with change in ED symptoms or fears. In Study 1, between-session reduction of distress and state anxiety was associated with greater decreases in ED symptoms and fears pre-to posttreatment. In Study 2, between-session distress reduction occurred but was not related to outcomes. CONCLUSIONS Within-session distress reduction may not promote change during exposure for EDs, whereas between-session distress reduction may be associated with better treatment outcomes. These findings corroborate research on distress reduction during exposure for anxiety disorders. Clinicians might consider approaches to exposure-based treatment that focus on distress tolerance and promote between-session distress reduction.
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Affiliation(s)
- Rachel M Butler
- University of Louisville, Department of Psychological and Brain Sciences, USA.
| | - Caroline Christian
- University of Louisville, Department of Psychological and Brain Sciences, USA
| | | | - Irina A Vanzhula
- Johns Hopkins School of Medicine, Department of Psychiatry & Behavioral Sciences, USA
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, USA
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Müller-Bardorff M, Schulz A, Paersch C, Recher D, Schlup B, Seifritz E, Kolassa IT, Kowatsch T, Fisher A, Galatzer-Levy I, Kleim B. Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e42547. [PMID: 38743473 PMCID: PMC11134235 DOI: 10.2196/42547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. OBJECTIVE This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. METHODS This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. RESULTS The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. CONCLUSIONS The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42547.
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Affiliation(s)
- Miriam Müller-Bardorff
- Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Zurich, Switzerland
| | - Ava Schulz
- Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Zurich, Switzerland
| | - Christina Paersch
- Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Zurich, Switzerland
| | - Dominique Recher
- Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Zurich, Switzerland
| | - Barbara Schlup
- Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Psychiatric University Hospital Zurich, Zurich, Switzerland
| | | | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Aaron Fisher
- Department of Psychology, University of California at Berkeley, Berkeley, CA, United States
| | | | - Birgit Kleim
- Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Zurich, Switzerland
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Trask S, Ferrara NC. Enhancing fear extinction. eLife 2024; 13:e97633. [PMID: 38619041 PMCID: PMC11018348 DOI: 10.7554/elife.97633] [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: 04/16/2024] Open
Abstract
Gradually reducing a source of fear during extinction treatments may weaken negative memories in the long term.
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Affiliation(s)
- Sydney Trask
- Department of Psychological Sciences, Purdue University West LafayetteWest LafayetteUnited States
- Purdue Institute for Integrative Neuroscience, Purdue University West LafayetteWest LafayetteUnited States
| | - Nicole C Ferrara
- Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and ScienceNorth ChicagoUnited States
- Discipline of Physiology and Biophysics, Chicago Medical School, Rosalind Franklin University of Medicine and ScienceNorth ChicagoUnited States
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Boschet-Lange JM, Scherbaum S, Pittig A. Temporal dynamics of costly avoidance in naturalistic fears: Evidence for sequential-sampling of fear and reward information. J Anxiety Disord 2024; 103:102844. [PMID: 38428276 DOI: 10.1016/j.janxdis.2024.102844] [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: 03/14/2023] [Revised: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
Excessive avoidance is characteristic for anxiety disorders, even when approach would lead to positive outcomes. The process of how such approach-avoidance conflicts are resolved is not sufficiently understood. We examined the temporal dynamics of approach-avoidance in intense fear of spiders. Highly fearful and non-fearful participants chose repeatedly between a fixed no spider/low reward and a spider/high reward option with varying fear (probability of spider presentation) and reward information (reward magnitude). By sequentially presenting fear and reward information, we distinguished whether decisions are dynamically driven by both information (sequential-sampling) or whether the impact of fear information is inhibited (cognitive control). Mouse movements were recorded to assess temporal decision dynamics (i.e., how strongly which information impacts decision preference at which timepoint). Highly fearful participants showed stronger avoidance despite lower gains (i.e., costly avoidance). Time-continuous multiple regression of their mouse movements yielded a stronger impact of fear compared to reward information. Importantly, presenting either information first (fear or reward) enhanced its impact during the early decision process. These findings support sequential sampling of fear and reward information, but not inhibitory control. Hence, pathological avoidance may be characterized by biased evidence accumulation rather than altered cognitive control.
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Affiliation(s)
- Juliane M Boschet-Lange
- University of Würzburg, Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Marcusstraße 9-11, 97070 Würzburg, Germany
| | - Stefan Scherbaum
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | - Andre Pittig
- University of Göttingen, Institute of Psychology, Translational Psychotherapy, Göttingen, Germany.
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Kwee CMB, van der Flier FE, Duits P, van Balkom AJLM, Cath DC, Baas JMP. Effects of cannabidiol on fear conditioning in anxiety disorders: decreased threat expectation during retention, but no enhanced fear re-extinction. Psychopharmacology (Berl) 2024; 241:833-847. [PMID: 38044339 DOI: 10.1007/s00213-023-06512-6] [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: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
RATIONALE Preclinical research suggests that pharmacologically elevating cannabinoid levels may attenuate fear memory expression and enhance fear extinction. OBJECTIVES We studied the effects of cannabidiol (CBD) on fear memory expression and fear re-extinction in 69 patients with panic disorder with agoraphobia or with social anxiety disorder. Moderation by sex, diagnosis, and serotonergic antidepressant (AD) use was explored. METHODS A cued fear conditioning paradigm was applied before the first treatment session with 300 mg CBD/placebo augmented exposure therapy. Study medication was administered orally preceding 8 weekly sessions. Fear acquisition and suboptimal extinction took place prior to the first medication ingestion (T0). After the first medication ingestion (T1), we investigated effects on fear memory expression at retention and fear re-extinction. Subjective fear, shock expectancy, skin conductance, and startle responses to conditioned (CS+) and safety stimulus (CS-) were measured. RESULTS Across the sample, CBD reduced shock expectancy at retention under low and ambiguous threat of shock, but fear re-extinction at T1 was unaffected by CBD. However, in AD users, re-extinction of subjective fear was impaired in the CBD condition compared to placebo. In female AD users, CBD interfered with safety learning measured with fear-potentiated startle. CONCLUSIONS The current findings provide no evidence for enhanced fear re-extinction by CBD. However, CBD acutely decreased threat expectation at retention, without affecting other indices of fear. More studies are needed to elucidate possible interactions with AD use and sex, as well as potential effects of CBD on threat expectancies.
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Affiliation(s)
- C M B Kwee
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - F E van der Flier
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - P Duits
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands
| | - A J L M van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - D C Cath
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe, Assen, The Netherlands
| | - J M P Baas
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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Wiemer J, Leimeister F, Gamer M, Pauli P. The ventromedial prefrontal cortex in response to threat omission is associated with subsequent explicit safety memory. Sci Rep 2024; 14:7378. [PMID: 38548770 PMCID: PMC10979006 DOI: 10.1038/s41598-024-57432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
In order to memorize and discriminate threatening and safe stimuli, the processing of the actual absence of threat seems crucial. Here, we measured brain activity with fMRI in response to both threat conditioned stimuli and their outcomes by combining threat learning with a subsequent memory paradigm. Participants (N = 38) repeatedly saw a variety of faces, half of which (CS+) were associated with an aversive unconditioned stimulus (US) and half of which were not (CS-). When an association was later remembered, the hippocampus had been more active (than when forgotten). However, the ventromedial prefrontal cortex predicted subsequent memory specifically during safe associations (CS- and US omission responses) and the left dorsolateral prefrontal cortex during outcomes in general (US and US omissions). In exploratory analyses of the theoretically important US omission, we found extended involvement of the medial prefrontal cortex and an enhanced functional connectivity to visual and somatosensory cortices, suggesting a possible function in sustaining sensory information for an integration with semantic memory. Activity in visual and somatosensory cortices together with the inferior frontal gyrus also predicted memory performance one week after learning. The findings imply the importance of a close interplay between prefrontal and sensory areas during the processing of safe outcomes-or 'nothing'-to establish declarative safety memory.
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Affiliation(s)
- Julian Wiemer
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Franziska Leimeister
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Matthias Gamer
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
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Berthail B, Trousselard M, Lecouvey G, Le Roy B, Fraisse F, Peschanski D, Eustache F, Gagnepain P, Dayan J. Differences in predictive factors for post-traumatic stress disorder encompassing partial PTSD and full PTSD: a cross-sectional study among individuals exposed to the November 13, 2015 Paris attacks. Front Psychiatry 2024; 15:1351695. [PMID: 38606406 PMCID: PMC11007703 DOI: 10.3389/fpsyt.2024.1351695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 04/13/2024] Open
Abstract
Background When faced with a surge of physically injured individuals, especially following a traumatic event like an attack, frontline practitioners prioritize early triage. Detecting potential psychological injuries soon after such events remains challenging. Some individuals might develop post-traumatic stress disorder (PTSD) according to DSM-V criteria. Others may exhibit PTSD symptoms without meeting full diagnostic criteria, termed partial or sub-syndromal PTSD, a less-explored area in literature. This study aims to identify predictive factors for both full and partial PTSD. Method In a cohort of victims of the 2015 Paris attacks, multinomial logistic regressions explored predictive factors for partial or full PTSD status 8 to 18 months post-attacks. Analyses considered pre, peri, and posttraumatic factors chosen from literature review and univariate analysis within each group. Results Within the cohort, 50 individuals showed no signs of PTSD, 35 experienced partial PTSD, and 30 presented with full PTSD. After logistic regression, risk factors associated with full PTSD included a history of trauma (OR = 1.30, CI [1.02-1.66], p < 0.05), the intensity of peri-traumatic physical reactions (OR = 1.22, CI [1.09-1.36], p < 0.001), the difficulties in suppressing intrusive thoughts (OR = 1.11, CI [1.02-1.21], p < 0.013). Only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD (OR = 1.13, [CI 1.02-1.24], p < 0.001). Discussion This study revealed that a history of trauma, the intensity of peri-traumatic physical reactions (e.g., tachycardia, trembling, flushes, numbness.), and the difficulties in suppressing intrusive thoughts constitute risk factors for the development of full PTSD. Moreover, the study identified that only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD. These findings seem to underscore the significance of peri-traumatic experiences in influencing the development of post-traumatic stress symptoms. Conclusion This study emphasizes the significance of examining peri-traumatic reactions in PTSD development, suggesting its potential as a straightforward screening tool for post-traumatic stress disorder. It also underscores the influence of prior traumatic experiences, before de novo traumatization, in shaping vulnerability to PTSD and illuminates the crucial role of compromised control of intrusive thoughts that could perpetuate PTSD.
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Affiliation(s)
- Benoit Berthail
- French Military Health Service Academy, Ecole du Val de Grace, 1 Place Alphonse Laveran, Paris, France
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Marion Trousselard
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
- University of Lorraine, Inserm, INSPIIRE UMR 1319, F-54000, Nancy, France
| | - Gregory Lecouvey
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Barbara Le Roy
- Stress Neurophysiology Unit, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Florence Fraisse
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Denis Peschanski
- Paris I Pantheon Sorbonne University, HESAM University , EHESS, CNRS, UMR8209, Paris, France
| | - Francis Eustache
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Pierre Gagnepain
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
| | - Jacques Dayan
- Neuropsychology and Imaging of Human Memory (NIMH) Research Unit, GIP Cyceron, INSERM U1077, Caen University Hospital, PSL, EPHE, Caen University, Caen, France
- Child and Adolescent Psychiatry University Hospital Pole, Guillaume Régnier Hospital Center, Rennes 1 University, 35700 Rennes, France
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van Veen SC, Zbozinek TD, van Dis EAM, Engelhard IM, Craske MG. Positive mood induction does not reduce return of fear: A virtual reality exposure study for public speaking anxiety. Behav Res Ther 2024; 174:104490. [PMID: 38354451 DOI: 10.1016/j.brat.2024.104490] [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: 04/21/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
Previous laboratory work has shown that induction of positive mood prior to fear extinction decreases the negative valence of the conditional stimulus (CS) and reduces reinstatement of fear. Before translating these insights to clinical practice, it is important to test this strategy in anxious individuals. Students with a high fear of public speaking (N = 62) were randomized to either a positive mood induction, a negative mood induction, or no induction control group. All participants performed two weekly sessions of virtual reality exposure and a 1-week follow-up test including a spontaneous recovery test and reinstatement test after a social rejection (unconditional stimulus). We used self-reported fear measures and skin conductance responses. We expected that the positive group, compared to the other groups, would evaluate the CS (i.e., speaking in front of an audience) as less negative following exposure and would show less spontaneous recovery and reinstatement of fear following a social rejection. Although mood was successfully manipulated, there were no group differences in CS valence following exposure. In all conditions, VR exposure successfully reduced public speaking fear, and these effects were stable at follow-up. In contrast with expectations, the positive group showed more spontaneous recovery of CS negative valence than the negative group. To conclude, we found no evidence that positive mood induction prior to exposure optimizes exposure effects for anxious individuals.
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Affiliation(s)
| | - Tomislav D Zbozinek
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
| | - Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, CA, United States
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Natali L, Meregalli V, Rowlands K, Di Pietro J, Treasure J, Collantoni E, Meneguzzo P, Tenconi E, Favaro A, Fontana F, Ceccato E, Sala A, Valmaggia L, Cardi V. Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: A feasibility study. Int J Eat Disord 2024; 57:703-715. [PMID: 38366755 PMCID: PMC11137760 DOI: 10.1002/eat.24155] [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: 10/17/2023] [Revised: 01/20/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food-related anxiety in anorexia nervosa. METHOD One hundred and forty-five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self-report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure. RESULTS Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F(2,141) = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found. DISCUSSION Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa. PUBLIC SIGNIFICANCE This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.
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Affiliation(s)
- Ludovica Natali
- Department of General PsychologyUniversity of PadovaPadovaItaly
| | - Valentina Meregalli
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
| | - Katie Rowlands
- Department of Psychological MedicineInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Jerome Di Pietro
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Janet Treasure
- Department of Psychological MedicineInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Enrico Collantoni
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
- Department of PsychiatryEating Disorders Unit, Padova University HospitalPadovaItaly
| | - Paolo Meneguzzo
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
- Department of PsychiatryEating Disorders Unit, Padova University HospitalPadovaItaly
| | - Elena Tenconi
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
- Department of PsychiatryEating Disorders Unit, Padova University HospitalPadovaItaly
| | - Angela Favaro
- Department of NeuroscienceUniversity of PadovaPadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
- Department of PsychiatryEating Disorders Unit, Padova University HospitalPadovaItaly
| | - Francesca Fontana
- Centro Provinciale di Treviso per i Disturbi del Comportamento Alimentare (Treviso Eating Disorders Unit)ULSS2 Marca TrevigianaTrevisoItaly
| | - Enrico Ceccato
- Centro Provinciale di Vicenza per i Disturbi del Comportamento Alimentare (Vicenza Eating Disorders Unit)ULSS8 BericaVicenzaItaly
| | - Alessandra Sala
- Centro Provinciale di Vicenza per i Disturbi del Comportamento Alimentare (Vicenza Eating Disorders Unit)ULSS8 BericaVicenzaItaly
| | - Lucia Valmaggia
- Department of Psychological MedicineInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- South London and Maudsley NHS Foundation TrustLondonUnited Kingdom
- Department of PsychiatryKU LeuvenLeuvenBelgium
| | - Valentina Cardi
- Department of General PsychologyUniversity of PadovaPadovaItaly
- Department of Psychological MedicineInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- Department of PsychiatryEating Disorders Unit, Padova University HospitalPadovaItaly
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12
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Lewis MW, Bradford DE, Akman E, Frederiks K, Rauch SL, Rosso IM. Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self-reported fearful traits in a PTSD sample. Psychophysiology 2024; 61:e14473. [PMID: 37919832 DOI: 10.1111/psyp.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023]
Abstract
Unconditioned responding (UCR) to a naturally aversive stimulus is associated with defensive responding to a conditioned threat cue (CS+) and a conditioned safety cue (CS-) in trauma-exposed individuals during fear acquisition. However, the relationships of UCR with defensive responses during extinction training, posttraumatic stress disorder (PTSD) symptom severity, and fearful traits in trauma-exposed individuals are not known. In a sample of 100 trauma-exposed adults with a continuum of PTSD severity, we recorded startle responses and skin conductance responses (SCR) during fear acquisition and extinction training using a 140 psi, 250-ms air blast to the larynx as the unconditioned stimulus. We explored dimensional associations of two different measures of UCR (unconditioned startle and unconditioned SCR) with conditioned defensive responding to CS+ and CS-, conditioned fear (CS+ minus CS-), PTSD symptom severity, and a measure of fearful traits (composite of fear survey schedule, anxiety sensitivity index, and Connor-Davidson resilience scale). Unconditioned startle was positively associated with startle potentiation to the threat cue and the safety cue across both learning phases (CS+ Acquisition, CS- Acquisition, CS+ Extinction Training, CS- Extinction Training) and with fearful traits. Unconditioned SCR was positively associated with SCR to the CS+ and CS- and SCR difference score during Acquisition. Neither type of UCR was associated with PTSD symptom severity. Our findings suggest that UCR, particularly unconditioned startle to a naturally aversive stimulus, may inform research on biomarkers and treatment targets for symptoms of pervasive and persistent fear in trauma-exposed individuals.
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Affiliation(s)
- Michael W Lewis
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Bradford
- School of Psychological Science, Oregon State University, Oregon, USA
| | - Eylül Akman
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Kevin Frederiks
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Scott L Rauch
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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13
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Hornstein E, Leschak CJ, Parrish MH, Byrne-Haltom KE, Fanselow MS, Craske MG, Eisenberger NI. Social support and fear-inhibition: an examination of underlying neural mechanisms. Soc Cogn Affect Neurosci 2024; 19:nsae002. [PMID: 38217103 PMCID: PMC10868130 DOI: 10.1093/scan/nsae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
Recent work has demonstrated that reminders of those we are closest to have a unique combination of effects on fear learning and represent a new category of fear inhibitors, termed prepared fear suppressors. Notably, social-support-figure images have been shown to resist becoming associated with fear, suppress conditional-fear-responding and lead to long-term fear reduction. Due to the novelty of this category, understanding the underlying neural mechanisms that support these unique abilities of social-support-reminders has yet to be investigated. Here, we examined the neural correlates that enable social-support-reminders to resist becoming associated with fear during a retardation-of-acquisition test. We found that social-support-figure-images (vs stranger-images) were less readily associated with fear, replicating prior work, and that this effect was associated with decreased amygdala activity and increased ventromedial prefrontal cortex (VMPFC) activity for social-support-figure-images (vs stranger-images), suggesting that social-support-engagement of the VMPFC and consequent inhibition of the amygdala may contribute to unique their inhibitory effects. Connectivity analyses supported this interpretation, showing greater connectivity between the VMPFC and left amygdala for social-support-figure-images (vs stranger-images).
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Affiliation(s)
- E.A Hornstein
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - C J Leschak
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - M H Parrish
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - K E Byrne-Haltom
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - M S Fanselow
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
| | - M G Craske
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
| | - N I Eisenberger
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
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14
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Hearne LJ, Breakspear M, Harrison BJ, Hall CV, Savage HS, Robinson C, Sonkusare S, Savage E, Nott Z, Marcus L, Naze S, Burgher B, Zalesky A, Cocchi L. Revisiting deficits in threat and safety appraisal in obsessive-compulsive disorder. Hum Brain Mapp 2023; 44:6418-6428. [PMID: 37853935 PMCID: PMC10681637 DOI: 10.1002/hbm.26518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
Current behavioural treatment of obsessive-compulsive disorder (OCD) is informed by fear conditioning and involves iteratively re-evaluating previously threatening stimuli as safe. However, there is limited research investigating the neurobiological response to conditioning and reversal of threatening stimuli in individuals with OCD. A clinical sample of individuals with OCD (N = 45) and matched healthy controls (N = 45) underwent functional magnetic resonance imaging. While in the scanner, participants completed a well-validated fear reversal task and a resting-state scan. We found no evidence for group differences in task-evoked brain activation or functional connectivity in OCD. Multivariate analyses encompassing all participants in the clinical and control groups suggested that subjective appraisal of threatening and safe stimuli were associated with a larger difference in brain activity than the contribution of OCD symptoms. In particular, we observed a brain-behaviour continuum whereby heightened affective appraisal was related to increased bilateral insula activation during the task (r = 0.39, pFWE = .001). These findings suggest that changes in conditioned threat-related processes may not be a core neurobiological feature of OCD and encourage further research on the role of subjective experience in fear conditioning.
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Affiliation(s)
- Luke J. Hearne
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Michael Breakspear
- College of Engineering Science and Environment, College of Health and MedicineUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Ben J. Harrison
- Melbourne Neuropsychiatry Centre, Department of PsychiatryThe University of Melbourne & Melbourne HealthMelbourneVictoriaAustralia
| | - Caitlin V. Hall
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Hannah S. Savage
- College of Engineering Science and Environment, College of Health and MedicineUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Conor Robinson
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | | | - Emma Savage
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Zoie Nott
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Leo Marcus
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Sebastien Naze
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Bjorn Burgher
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of PsychiatryThe University of Melbourne & Melbourne HealthMelbourneVictoriaAustralia
| | - Luca Cocchi
- QIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
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15
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Roesmann K, Leehr EJ, Böhnlein J, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Dannlowski U, Lueken U. Mechanisms of action underlying virtual reality exposure treatment in spider phobia: Pivotal role of within-session fear reduction. J Anxiety Disord 2023; 100:102790. [PMID: 37879242 DOI: 10.1016/j.janxdis.2023.102790] [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: 11/07/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Although virtual-reality exposure treatment (VRET) for anxiety disorders is an efficient treatment option for specific phobia, mechanisms of action for immediate and sustained treatment response need to be elucidated. Towards this aim, core therapy process variables were assessed as predictors for short- and long-term VR treatment outcomes. In a bi-centric study, n = 186 patients with spider phobia completed a baseline-assessment, a one-session VRET, a post-therapy assessment, and a 6-month-follow-up assessment (ClinicalTrials.gov, ID: NCT03208400). Short- and long-term outcomes regarding self-reported symptoms in the spider phobia questionnaire (SPQ) and final patient-spider distance in the behavioral avoidance test (BAT) were predicted via logistic regression models with the corresponding baseline score, age, initial fear activation, within-session fear reduction and fear expectancy violation as predictors. To predict long-term remission status at 6-month-follow-up, dimensional short-term changes in the SPQ and BAT were additionally included. Higher within-session fear reductions predicted better treatment outcomes (long-term SPQ; short- and long-term BAT). Lower initial fear activation tended to be associated with better long-term outcomes (SPQ), while fear expectancy violation was not associated with any outcome measure. Short-term change in the SPQ predicted remission status. Findings highlight that in VRET for spider phobia, the experience of fear reduction is central for short- and long-term treatment success and should be focused by therapists.
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Affiliation(s)
- Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Psychology, Unit for Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany.
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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16
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Kirchner L, Kube T, D'Astolfo L, Strahler J, Herbstreit R, Rief W. How to modify expectations of social rejection? An experimental study using a false-feedback paradigm. J Behav Ther Exp Psychiatry 2023; 81:101859. [PMID: 37182428 DOI: 10.1016/j.jbtep.2023.101859] [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: 03/31/2022] [Revised: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Negative expectations (NEs) are fundamental to various mental disorders. Finding ways to modulate NEs would help to improve clinical treatment. The present study investigated how previously formed expectations of social rejection are revised in the context of novel positive social experiences, and whether their revision can be modulated by differentially shifting participants' attentional focus. METHODS Our sample of 124 healthy participants was randomly assigned to four experimental conditions and received manipulated social feedback in multiple alleged webcam conferences. All groups went through three experimental phases that began with predominantly negative social feedback, then either transitioned to predominantly positive social feedback or continued to predominantly negative social feedback, and ultimately transitioning to a phase with no explicit social feedback. The experimental conditions differed in what they were instructed to focus on when receiving positive social feedback. RESULTS Receiving novel positive social feedback led to substantial changes in social expectations, but this effect was not modulated by the instructions the participants were given. Descriptive trends revealed that both instructions improved NE modification, although this effect was not robust to extinction in one condition. LIMITATIONS To prevent our cover story from being compromised, we could not perform an immediate manipulation check of the instructions given. Nevertheless, some of the sample seemed suspicious about the cover story. CONCLUSION Our results suggest that established expectations of social rejection can be revised when unexpectedly experiencing social acceptance. Nevertheless, more research is needed on potential instructions that could be used to optimize the modification of NEs.
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Affiliation(s)
- Lukas Kirchner
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Tobias Kube
- University of Koblenz-Landau, Ostbahnstraße 10, 76829, Landau, Germany
| | - Lisa D'Astolfo
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jana Strahler
- Albert-Ludwigs-University of Freiburg, Sandfangweg 4, 79102, Freiburg, Germany
| | - René Herbstreit
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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17
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Bustamante J, Soto M, Miguez G, Quezada-Scholz VE, Angulo R, Laborda MA. Extinction in multiple contexts reduces the return of extinguished responses: A multilevel meta-analysis. Learn Behav 2023:10.3758/s13420-023-00609-w. [PMID: 38010486 DOI: 10.3758/s13420-023-00609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/29/2023]
Abstract
Extinguished responses have been shown to reappear under several circumstances, and this reappearance is considered to model behaviors such as relapse after exposure therapy. Conducting extinction in multiple contexts has been explored as a technique to decrease the recovery of extinguished responses. The present meta-analysis aimed to examine whether extinction in multiple contexts can consistently reduce the recovery of extinguished responses. After searching in several databases, experiments were included in the analysis if they presented extinction in multiple contexts, an experimental design, and an adequate statistical report. Cohen's d was obtained for each critical comparison and weighted to obtain the sample's average weighted effect size. Analyses were then performed using a multilevel meta-analytic approach. Twenty-five studies were included, with a total sample of 37 experiments or critical comparisons. The analyses showed a large effect size for the sample, moderated by the length of conditioned stimulus exposure, type of experimental subject, and type of recovery. The robust effect of extinction in multiple contexts on relapse should encourage clinicians to consider extinction in multiple contexts as a useful technique in therapy and research.
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Affiliation(s)
- Javier Bustamante
- Institute of Social Sciences, Universidad de O'Higgins, Av. Libertador Bernardo O'Higgins 611, Rancagua, Chile
| | - Marcela Soto
- School of Psychology, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago, Chile
| | - Gonzalo Miguez
- Department of Psychology, Universidad de Chile, Av. Ignacio Carrera Pinto 1045, Ñuñoa, 7800284, Santiago, Chile
| | - Vanetza E Quezada-Scholz
- Department of Psychology, Universidad de Chile, Av. Ignacio Carrera Pinto 1045, Ñuñoa, 7800284, Santiago, Chile
| | - Rocío Angulo
- Institute of Social Sciences, Universidad de O'Higgins, Av. Libertador Bernardo O'Higgins 611, Rancagua, Chile
| | - Mario A Laborda
- Department of Psychology, Universidad de Chile, Av. Ignacio Carrera Pinto 1045, Ñuñoa, 7800284, Santiago, Chile.
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18
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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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19
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Cox WR, Woelk M, de Vries OT, Krypotos AM, Kindt M, Engelhard IM, Sevenster D, van Ast VA. Context reexposure to bolster contextual dependency of emotional episodic memory. Sci Rep 2023; 13:17792. [PMID: 37853027 PMCID: PMC10584942 DOI: 10.1038/s41598-023-40982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/19/2023] [Indexed: 10/20/2023] Open
Abstract
Contextual overgeneralization of emotional memory is a core aspect of anxiety disorders. Identifying methods to enhance contextual dependency of emotional memory is therefore of significant clinical interest. Animal research points to a promising approach: reexposure to the context in which fear is acquired reduces generalization to other contexts. However, the exact conditions for this effect are unknown, complicating translation to effective interventions. Most notably, exposure to a context that resembles-but is not identical to-the learning context may diminish contextual dependency of memory by integration of additional contextual cues. Here, we therefore assessed in a large-scale study (N = 180) whether context reexposure enhances contextual dependency of emotional episodic memory whereas exposure to a similar context impairs it. We also tested whether relatively strong memory retrieval during context (re)exposure amplifies these effects. We replicated prior research showing that correct recognition depends on context and contextual dependency is lower for emotional than neutral memories. However, exposure to the encoding context or a similar context did not affect contextual dependency of memory, and retrieval strength did not interact with such effects. Thorough insight into factors underlying the effects of context (re)exposure on contextual dependency seems key to eventually attain a memory recontextualization intervention.
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Affiliation(s)
- Wouter R Cox
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Mandy Woelk
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Leuven, Belgium
| | - Olivier T de Vries
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Merel Kindt
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Dieuwke Sevenster
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Vanessa A van Ast
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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20
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Samson DR, Clerget A, Abbas N, Senese J, Sarma MS, Lew-Levy S, Mabulla IA, Mabulla AZP, Miegakanda V, Borghese F, Henckaerts P, Schwartz S, Sterpenich V, Gettler LT, Boyette A, Crittenden AN, Perogamvros L. Evidence for an emotional adaptive function of dreams: a cross-cultural study. Sci Rep 2023; 13:16530. [PMID: 37783728 PMCID: PMC10545663 DOI: 10.1038/s41598-023-43319-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
The function of dreams is a longstanding scientific research question. Simulation theories of dream function, which are based on the premise that dreams represent evolutionary past selective pressures and fitness improvement through modified states of consciousness, have yet to be tested in cross-cultural populations that include small-scale forager societies. Here, we analyze dream content with cross-cultural comparisons between the BaYaka (Rep. of Congo) and Hadza (Tanzania) foraging groups and Global North populations, to test the hypothesis that dreams in forager groups serve a more effective emotion regulation function due to their strong social norms and high interpersonal support. Using a linear mixed effects model we analyzed 896 dreams from 234 individuals across these populations, recorded using dream diaries. Dream texts were processed into four psychosocial constructs using the Linguistic Inquiry and Word Count (LIWC-22) dictionary. The BaYaka displayed greater community-oriented dream content. Both the BaYaka and Hadza exhibited heightened threat dream content, while, at the same time, the Hadza demonstrated low negative emotions in their dreams. The Global North Nightmare Disorder group had increased negative emotion content, and the Canadian student sample during the COVID-19 pandemic displayed the highest anxiety dream content. In conclusion, this study supports the notion that dreams in non-clinical populations can effectively regulate emotions by linking potential threats with non-fearful contexts, reducing anxiety and negative emotions through emotional release or catharsis. Overall, this work contributes to our understanding of the evolutionary significance of this altered state of consciousness.
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Affiliation(s)
- David R Samson
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada.
- Department of Anthropology, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada.
| | - Alice Clerget
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Noor Abbas
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada
| | - Jeffrey Senese
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada
| | - Mallika S Sarma
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sheina Lew-Levy
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Ibrahim A Mabulla
- Department of Archaeology and Heritage, Institute of Resource Assessment, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Audax Z P Mabulla
- Department of Archaeology and Heritage, Institute of Resource Assessment, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Valchy Miegakanda
- Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Francesca Borghese
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Pauline Henckaerts
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Virginie Sterpenich
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, Notre Dame, IN, USA
| | - Adam Boyette
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Lampros Perogamvros
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland.
- Department of Psychiatry, Center for Sleep Medicine, University Hospitals of Geneva, Geneva, Switzerland.
- Department of Psychiatry, Center for Sleep Medicine, 2 Chemin du Petit-Bel-Air, 1226 Thônex, Switzerland.
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Andreatta M, Jongerling J, Wieser MJ. Context-Dependent Responses to the Spread of COVID-19 Among National and International Students During the First Lockdown: An Online Survey. Disaster Med Public Health Prep 2023; 17:e485. [PMID: 37680189 DOI: 10.1017/dmp.2023.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Restrictions to minimize social contact was necessary to prevent the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus but may have impacted individuals' mental well-being. Emotional responses are modulated by contextual information. Living abroad during the coronavirus disease 2019 (COVID-19) pandemic may have boosted the feeling of isolation as the context is unfamiliar. OBJECTIVES This study compared the psychological impact of social distancing in national students (living in a familiar context) versus international students (living in an unfamiliar context). METHODS During March/April 2020 (first lockdown in the Netherlands), 850 university students completed an online survey. Structural equation modeling (SEM) was conducted to compare how students' responses to the virus were predicted by health anxiety, emotional distress, and personal traits. RESULTS Compared with national students, international students showed higher levels in 4 identified factors (COVID-19-related worry, perceived risk of infection, distance from possibly contaminated objects, distance from social situations). The factors were mainly predicted by health anxiety across international students, while emotional distress and individual traits (eg, intolerance of uncertainty) played a role across national students. CONCLUSIONS In the familiar context, individual characteristics (traits) predicted the responses to the virus, while the unfamiliar context drove individuals' health-focused responses. Living in a foreign country is associated with psychological burdens and this should be considered by universities for more pronounced social support and clear references to health-related institutions.
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Affiliation(s)
- Marta Andreatta
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Netherlands
| | - Joran Jongerling
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Science, Tilburg, Netherlands
| | - Matthias J Wieser
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Netherlands
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McGregor T, Purves KL, Barry T, Constantinou E, Craske MG, Breen G, Young KS, Eley TC. Introducing the Fear Learning and Anxiety Response (FLARe) app and web portal for the remote delivery of fear conditioning experiments. Behav Res Methods 2023; 55:3164-3178. [PMID: 36070129 PMCID: PMC10556157 DOI: 10.3758/s13428-022-01952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/08/2022]
Abstract
Experimental paradigms measuring key psychological constructs can enhance our understanding of mechanisms underlying human psychological well-being and mental health. Delivering such paradigms remotely affords opportunities to reach larger, more representative samples than is typically possible with in-person research. The efficiency gained from remote delivery makes it easier to test replication of previously established effects in well-powered samples. There are several challenges to the successful development and delivery of remote experimental paradigms, including use of an appropriate delivery platform, identifying feasible outcome measures, and metrics of participant compliance. In this paper, we present FLARe (Fear Learning and Anxiety Response), open-source software in the form of a smartphone app and web portal for the creation and delivery of remote fear conditioning experiments. We describe the benefits and challenges associated with the creation of a remote delivery platform for fear conditioning, before presenting in detail the resultant software suite, and one instance of deploying this using the FLARe Research infrastructure. We provide examples of the application of FLARe to several research questions which illustrate the benefits of the remote approach to experiment delivery. The FLARe smartphone app and web portal are available for use by other researchers and have been designed to be user-friendly and intuitive. We hope that FLARe will be a useful tool for those interested in conducting well-powered fear conditioning studies to inform our understanding of the development and treatment of anxiety disorders.
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Affiliation(s)
- T. McGregor
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - K. L. Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - T. Barry
- Experimental Psychopathology Lab, Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong
| | - E. Constantinou
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - M. G. Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA USA
| | - G. Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - K. S. Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - T. C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
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23
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Craske MG, Meuret AE, Echiverri-Cohen A, Rosenfield D, Ritz T. Positive affect treatment targets reward sensitivity: A randomized controlled trial. J Consult Clin Psychol 2023; 91:350-366. [PMID: 36892884 PMCID: PMC10213148 DOI: 10.1037/ccp0000805] [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] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Determine whether a novel psychosocial treatment for positive affect improves clinical status and reward sensitivity more than a form of cognitive behavioral therapy that targets negative affect and whether improvements in reward sensitivity correlate with improvements in clinical status. METHOD In this assessor-blinded, parallel-group, multisite, two-arm randomized controlled clinical superiority trial, 85 treatment-seeking adults with severely low positive affect, moderate-to-severe depression or anxiety, and functional impairment received 15 weekly individual therapy sessions of positive affect treatment (PAT) or negative affect treatment (NAT). Clinical status measures were self-reported positive affect, interviewer-rated anhedonia, and self-reported depression and anxiety. Target measures were eleven physiological, behavioral, cognitive, and self-report measures of reward anticipation-motivation, response to reward attainment, and reward learning. All analyses were intent-to-treat. RESULTS Compared to NAT, individuals receiving PAT achieved superior improvements in the multivariate clinical status measures at posttreatment, b = .37, 95% CI [.15, .59], t(109) = 3.34, p = .001, q = .004, d = .64. Compared to NAT, individuals receiving PAT also achieved higher multivariate reward anticipation-motivation, b = .21, 95% CI [.05, .37], t(268) = 2.61, p = .010, q = .020, d = .32, and higher multivariate response to reward attainment, b = .24, 95% CI [.02, .45], t(266) = 2.17, p = .031, q = .041, d = .25, at posttreatment. Measures of reward learning did not differ between the two groups. Improvements in reward anticipation-motivation and in response to reward attainment correlated with improvements in the clinical status measures. CONCLUSIONS Targeting positive affect results in superior improvements in clinical status and reward sensitivity than targeting negative affect. This is the first demonstration of differential target engagement across two psychological interventions for anxious or depressed individuals with low positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Michelle G. Craske
- Department of Psychology, UCLA
- Department of Psychiatry and Biobehavioral Sciences, UCLA
| | | | | | | | - Thomas Ritz
- Department of Psychology, Southern Methodist University
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Keller NE, Cooper SE, McClay M, Dunsmoor JE. Counterconditioning reduces contextual renewal in a novel context but not in the acquisition context. Neurobiol Learn Mem 2023; 201:107749. [PMID: 36990311 PMCID: PMC10648400 DOI: 10.1016/j.nlm.2023.107749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023]
Abstract
As extinction is a context-dependent form of learning, conditioned responses tend to return when the conditioned stimulus (CS) is encountered outside the extinction context, known as contextual renewal. Counterconditioning is a technique that may lead to a more persistent reduction of the conditioned response. However, the effects of aversive-to-appetitive counterconditioning on contextual renewal in rodent studies are mixed. Further, research in humans is sparse, particularly direct statistical comparisons between counterconditioning and standard extinction techniques within the same study. Using a causal associative learning framework (the allergist task) implemented online, we compared the effectiveness of counterconditioning to standard extinction in preventing the renewal of judgements on the allergic properties of different food items (CSs). In a between-subjects design, 328 participants first learned that particular food items (CSs) lead to an allergic reaction in a specific restaurant (context A). Next, one CS was extinguished (no allergic reaction) while another CS was counterconditioned (positive outcome) in restaurant B. Causal judgements of the allergic properties of food items occurred in either the response acquisition context (ABA group, N = 112), the response reduction context where extinction and counterconditioning had occurred (ABB group, N = 107), or a novel context (ABC group, N = 109). Results showed that counterconditioning, compared to extinction, diminished the renewal of causal judgements to the CS in a novel context (ABC group). Still, casual judgements returned for both counter-conditioned and extinguished CSs in the response acquisition context (ABA group). Counterconditioning and extinction were similarly effective at preventing recovery of causal judgements in the response reduction context (ABB group); however, only in context B did participants choose the counter-conditioned CS as less likely to cause an allergic reaction in comparison to the extinguished CS. These findings indicate scenarios in which counterconditioning is more effective than standard extinction at diminishing the return of threat associations, with implications for improving the generalization of safety learning.
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Affiliation(s)
- Nicole E Keller
- Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA
| | - Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Mason McClay
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph E Dunsmoor
- Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA; Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Department of Neuroscience, University of Texas at Austin, Austin, TX, USA.
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25
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Verhage ML, Tharner A, Duschinsky R, Bosmans G, Fearon RMP. Editorial Perspective: On the need for clarity about attachment terminology. J Child Psychol Psychiatry 2023; 64:839-843. [PMID: 35916428 PMCID: PMC10953320 DOI: 10.1111/jcpp.13675] [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] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Abstract
Part of the appeal of attachment language is that it feels near to our everyday experience, as terms like 'attachment', 'security' or 'disorganisation' feel readily recognisable. Yet, not one of these terms is used by academic attachment researchers in line with ordinary language. This has hindered the evidence-based use of attachment in practice, the feedback loop from practice to research and the dialogue between attachment researchers in developmental psychology and in social psychology. This paper pinpoints the difficulties arising from the existence of multiple versions of 'attachment theory' that use exactly the same terms, held by communities that assume that they are referring to the same thing and with little infrastructure to help them discover otherwise. When we talk past one another, the different communities with a stake in knowledge of attachment are obstructed from genuinely learning from one another, drawing on their respective strengths and pursuing collaborations. One factor contributing to this situation has been the use of attachment terminology with technical meanings, but often without setting out clear definitions. We here introduce a guide to attachment terminology used by the academic community, which has recently been published on the website of the Society for Emotion and Attachment Studies. The guide is meant for researchers, clinicians and everyone concerned with attachment to increase understanding of the technical meaning of important terminology used by researchers, and support the quality of discussions between researchers, and between researchers and clinicians and other publics.
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Affiliation(s)
- Marije L. Verhage
- Clinical Child and Family StudiesVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anne Tharner
- Clinical Child and Family StudiesVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Robbie Duschinsky
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | | | - R. M. Pasco Fearon
- Centre for Family Research, Department of PsychologyUniversity of CambridgeCambridgeUK
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26
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Kvist J, Bengtsson J, Lundqvist C. The experience and influence of fear after anterior cruciate ligament reconstruction: an interview study with young athletes. BMC Sports Sci Med Rehabil 2023; 15:50. [PMID: 37013605 PMCID: PMC10068218 DOI: 10.1186/s13102-023-00659-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Despite good physical function, many athletes do not return to sports after an anterior cruciate ligament reconstruction (ACLR). One important reason for this is fear of new injury. The aim of this study was to investigate young athletes' experiences of knee-related fear after an ACLR and how they perceive this fear to affect them in their sporting and everyday life. METHODS A qualitative interview study was conducted, using semi-structured interviews. Athletes who were active in contact or pivoting sport before an ACL injury, with the goal of returning to the same sport and who scored highly on fear of new injury at six months post-ACLR, were asked to participate. Ten athletes (six women and four men, aged 17-25 years), were interviewed by an independent researcher, 7-9 months after ACLR. Content analysis employing an abductive approach was used. RESULTS The analysis resulted in three categories with associated subcategories: 1. The expressions of fear; (i) reason for fear, (ii) changes in fear over time, and (iii) injury situation. 2. Reactions, consequences, and adaptations; (i) reactions, (ii) behavioural adaptation and influence on rehabilitation and daily life, (iii) present consequences, and (iv) consequences for the future. 3. Fear and adaptations related to returning to sports; (i) fear related to returning to sports and, (ii) adaptations in sports and life due to fear. Fear was described in broad and complex ways, with fear of a new injury being expressed as one of several aspects. Various reasons (e.g., seeing others getting injured in the past, previous experience of injury, failed rehabilitation, perceived knee instability) were given to explain the fear, and athletes reacted both physically and mentally to fear. Both positive and negative adaptations to fear were described, in both daily life and sports. CONCLUSION The results contribute to an increased understanding of fear as an essential psychological factor to consider during rehabilitation and leaves the way open for research to investigate how physiotherapists can work to manage fear better among ACLR patients.
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Affiliation(s)
- Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, 581 85, Sweden.
- Stockholm Sports Trauma Research Centre, Karolinska Institute, Stockholm, Sweden.
| | - Johanna Bengtsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, 581 85, Sweden
| | - Carolina Lundqvist
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Linkoping University, Sweden
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27
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Luck CC, Patterson RR, Lipp OV. The influence of cross unconditional stimulus reinstatement on electrodermal responding and conditional stimulus valence in differential fear conditioning. Psychophysiology 2023:e14278. [PMID: 36929597 DOI: 10.1111/psyp.14278] [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: 02/04/2022] [Revised: 10/25/2022] [Accepted: 01/17/2023] [Indexed: 03/17/2023]
Abstract
We examined whether the inhibitory Conditional Stimulus (CS)-no Unconditional Stimulus (US) association formed during extinction can be triggered by a novel US during the reinstatement of conditional electrodermal responding and self-reported CS valence in human differential fear conditioning. Participants were trained with either a shock or an aversive scream US before undergoing extinction. Participants then received either the same (i.e., shock_shock or scream_scream) or a different US during reinstatement (i.e., shock_scream, scream_shock). Differential conditioning across all indices was stronger when a shock US was used during acquisition. After reinstatement, electrodermal responding to both the CS+ and the CS- increased regardless of the type of US used during reinstatement (non-differential reinstatement). Differential CS valence evaluations were larger after reinstatement in the groups that received the same US during acquisition and reinstatement (differential reinstatement), but differential evaluations did not increase in the groups receiving a different US at reinstatement. This dissociation suggests that the reinstatement of negative stimulus valence and the reinstatement of expectancy learning may differ.
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Affiliation(s)
- Camilla C Luck
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rachel R Patterson
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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28
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Crimmins BE, Lingawi NW, Chieng BC, Leung BK, Maren S, Laurent V. Basal forebrain cholinergic signaling in the basolateral amygdala promotes strength and durability of fear memories. Neuropsychopharmacology 2023; 48:605-614. [PMID: 36056107 PMCID: PMC9938249 DOI: 10.1038/s41386-022-01427-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022]
Abstract
The basolateral amygdala (BLA) complex receives dense cholinergic projections from the nucleus basalis of Meynert (NBM) and the horizontal limb of the diagonal band of Broca (HDB). The present experiments examined whether these projections regulate the formation, extinction, and renewal of fear memories. This was achieved by employing a Pavlovian fear conditioning protocol and optogenetics in transgenic rats. Silencing NBM projections during fear conditioning weakened the fear memory produced by that conditioning and abolished its renewal after extinction. By contrast, silencing HDB projections during fear conditioning had no effect. Silencing NBM or HDB projections during extinction enhanced the loss of fear produced by extinction, but only HDB silencing prevented renewal. Next, we found that systemic blockade of nicotinic acetylcholine receptors during fear conditioning mimicked the effects produced by silencing NBM projections during fear conditioning. However, this blockade had no effect when given during extinction. These findings indicate that basal forebrain cholinergic signaling in the BLA plays a critical role in fear regulation by promoting strength and durability of fear memories. We concluded that cholinergic compounds may improve treatments for post-traumatic stress disorder by durably stripping fear memories from their fear-eliciting capacity.
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Affiliation(s)
- Byron E. Crimmins
- grid.1005.40000 0004 4902 0432Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Nura W. Lingawi
- grid.1005.40000 0004 4902 0432Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Billy C. Chieng
- grid.1005.40000 0004 4902 0432Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Beatrice K. Leung
- grid.1005.40000 0004 4902 0432Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW Australia
| | - Stephen Maren
- grid.264756.40000 0004 4687 2082Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX USA
| | - Vincent Laurent
- Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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Ginat-Frolich R, Kara-Ivanov A, Strauss AY, Myers A, Huppert JD. Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study. Cogn Behav Ther 2023; 52:132-145. [PMID: 36217830 DOI: 10.1080/16506073.2022.2109511] [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: 01/12/2023]
Abstract
Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.
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Affiliation(s)
| | - Anna Kara-Ivanov
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayelet Myers
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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30
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Beckers T, Hermans D, Lange I, Luyten L, Scheveneels S, Vervliet B. Understanding clinical fear and anxiety through the lens of human fear conditioning. NATURE REVIEWS PSYCHOLOGY 2023; 2:233-245. [PMID: 36811021 PMCID: PMC9933844 DOI: 10.1038/s44159-023-00156-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
Fear is an adaptive emotion that mobilizes defensive resources upon confrontation with danger. However, fear becomes maladaptive and can give rise to the development of clinical anxiety when it exceeds the degree of threat, generalizes broadly across stimuli and contexts, persists after the danger is gone or promotes excessive avoidance behaviour. Pavlovian fear conditioning has been the prime research instrument that has led to substantial progress in understanding the multi-faceted psychological and neurobiological mechanisms of fear in past decades. In this Perspective, we suggest that fruitful use of Pavlovian fear conditioning as a laboratory model of clinical anxiety requires moving beyond the study of fear acquisition to associated fear conditioning phenomena: fear extinction, generalization of conditioned fear and fearful avoidance. Understanding individual differences in each of these phenomena, not only in isolation but also in how they interact, will further strengthen the external validity of the fear conditioning model as a tool with which to study maladaptive fear as it manifests in clinical anxiety.
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Affiliation(s)
- Tom Beckers
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Iris Lange
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Laura Luyten
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Sara Scheveneels
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Bram Vervliet
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Friesen E, Sopp MR, Cordi MJ, Rasch B, Michael T. Sleep-Directed Hypnosis Improves Subjective Sleep Quality but not Extinction Memory After Exposure to Analog Trauma. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-022-10345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Evidence-based treatments of posttraumatic stress disorder (PTSD) aim to promote fear extinction learning. Post-learning sleep, particularly slow wave sleep (SWS), promotes memory consolidation and recall. Thus, boosting SWS might strengthen extinction recall. The current study investigated whether sleep-directed hypnosis designed to increase SWS and sleep quality improves extinction recall and reduces analog PTSD symptoms.
Method
In two subsamples (remote/laboratory), 211 healthy individuals underwent fear conditioning with a traumatic film clip. On the next evening, they underwent extinction training. Thereafter, the experimental group received sleep-directed hypnosis, whereas the control group listened to a control text. Extinction recall and generalization and film-related intrusions and rumination were assessed on the following morning.
Results
Subjective sleep quality declined following exposure to an aversive film. No group differences were found in SWS though exploratory analyses indicated less rapid eye movement sleep after hypnosis. After hypnosis, the experimental group reported improved sleep quality, whereas the control group showed a further deterioration. Hypnosis had no effects on extinction retention and generalization nor on analog intrusions and rumination.
Conclusion
The current results indicate that sleep-directed hypnosis may be beneficial for improving subjective sleep quality after trauma but not for enhancing extinction memory and reducing analog PTSD symptoms.
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Almaguer-Azpeitia M, Nieto J, Bernal-Gamboa R. ABC renewal is reduced by a focused attention intervention. LEARNING AND MOTIVATION 2023. [DOI: 10.1016/j.lmot.2023.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Salloum A, Palantekin S, Claudio Torres AM, Holley R, Storch EA. Stepping Together in Stepped Care Trauma-Focused Cognitive Behavioral Therapy: Case Report of Core Components. J Cogn Psychother 2023; 37:7-25. [PMID: 36787998 DOI: 10.1891/jcpsy-d-20-00060] [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: 02/16/2023]
Abstract
New service delivery systems are needed to expand the reach of evidence-based practices for childhood trauma. Cognitive behavioral therapy is an effective approach for treating -childhood trauma, yet treatment barriers remain. Stepped care models that incorporate parent-led -treatment with therapist assistance may be one approach to improve access. This case study highlights the core components of a parent-led therapist-assisted treatment called Stepping Together that serves as a Step 1 treatment within a stepped care model. The components and structure of Stepping Together are described, along with excerpts from therapy sessions to illustrate the therapist's implementation of the model. Results of the case, in which improvements occurred, are presented. Stepping Together, a parent-led therapist-assisted first-line treatment within stepped care trauma-focused cognitive behavioral therapy, may be an effective treatment for some children after trauma and their caregivers, although more research is needed.
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Affiliation(s)
- Alison Salloum
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | | | | | - Robb Holley
- School of Social Work, University of South Florida, Tampa, Florida, USA
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Chowdhury N, Khandoker AH. The gold-standard treatment for social anxiety disorder: A roadmap for the future. Front Psychol 2023; 13:1070975. [PMID: 36755980 PMCID: PMC9901528 DOI: 10.3389/fpsyg.2022.1070975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 01/19/2023] Open
Abstract
Exposure therapy (ET), which follows the Pavlovian extinction model, is regarded as the gold-standard treatment for social anxiety disorder (SAD). The prospect of virtual reality in lieu of a traditional laboratory setting for the treatment of SAD has not been rigorously explored. The aim of the review was to summarize, find gaps in the current literature, and formulate future research direction by identifying two broad research questions: the comparative efficacy between in vivo ET and virtual reality exposure therapy (VRET) and the effectiveness of the Pavlovian extinction model in treating SAD. The criteria for effectiveness were effect size, relapse prevention, attrition rate and ecological validity. A literature search on recent randomized controlled trials yielded a total of 6 original studies (N=358), excluding duplication and overlapping participants. All studies supported that VRET was as effective as in vivo ET. Behavioral therapy that follows classical conditioning principles has a high attrition and relapse rate. Comparisons were drawn between the efficacy of the Pavlovian extinction model and other existing models, including third-wave approaches. The neural markers are suggested to be included as efficacy measures in treating SAD. The gold-standard treatment for SAD requires a paradigm shift through rigorous longitudinal comparative studies.
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Affiliation(s)
- Nayeefa Chowdhury
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,*Correspondence: Nayeefa Chowdhury, ✉
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
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Wang YX, Yin B. A new understanding of the cognitive reappraisal technique: an extension based on the schema theory. Front Behav Neurosci 2023; 17:1174585. [PMID: 37138662 PMCID: PMC10149752 DOI: 10.3389/fnbeh.2023.1174585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Cognitive reappraisal is a widely utilized emotion regulation strategy that involves altering the personal meaning of an emotional event to enhance attention to emotional responses. Despite its common use, individual differences in cognitive reappraisal techniques and the spontaneous recovery, renewal, and reinstatement of negative responses across varying contexts may limit its effectiveness. Furthermore, detached reappraisal could cause distress for clients. According to Gross's theory, cognitive reappraisal is an effortless process that can occur spontaneously. When guided language triggers cognitive reappraisal as an emotion regulation strategy in laboratory or counseling settings, clients experience improved emotional states, but this induced strategy may not necessarily guide them in regulating emotions in similar future situations. Therefore, effectively applying cognitive reappraisal techniques in clinical practice to help clients alleviate emotional distress in daily life remains a significant concern. Exploring the mechanism of cognitive reappraisal reveals that reconstructing stimulus meaning is akin to extinction learning, which entails fostering cognitive contingency that the original stimulus provoking negative emotions will no longer result in negative outcomes in the current context. However, extinction learning is a new learning process rather than an elimination process. The activation of new learning relies on the presentation of critical cues, with contextual cues often playing a vital role, such as a safe laboratory or consulting room environment. We propose a new understanding of cognitive reappraisal based on the schema theory and the dual-system theory, emphasizing the significance of environmental interaction and feedback in constructing new experiences and updating schemata. This approach ultimately enriches the schema during training and integrates the new schema into long-term memory. Bottom-up behavioral experiences as schema enrichment training provide the foundation for top-down regulation to function. This method can assist clients in activating more suitable schemata probabilistically when encountering stimuli in real life, forming stable emotions, and achieving transfer and application across diverse contexts.
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Affiliation(s)
- Ya-Xin Wang
- Laboratory of Learning and Behavioral Sciences, School of Psychology, Fujian Normal University, Fuzhou, Fujian, China
| | - Bin Yin
- Laboratory of Learning and Behavioral Sciences, School of Psychology, Fujian Normal University, Fuzhou, Fujian, China
- Department of Applied Psychology, School of Psychology, Fujian Normal University, Fuzhou, Fujian, China
- *Correspondence: Bin Yin,
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Cain CK. Beyond Fear, Extinction, and Freezing: Strategies for Improving the Translational Value of Animal Conditioning Research. Curr Top Behav Neurosci 2023; 64:19-57. [PMID: 37532965 PMCID: PMC10840073 DOI: 10.1007/7854_2023_434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Translational neuroscience for anxiety has had limited success despite great progress in understanding the neurobiology of Pavlovian fear conditioning and extinction. This chapter explores the idea that conditioning paradigms have had a modest impact on translation because studies in animals and humans are misaligned in important ways. For instance, animal conditioning studies typically use imminent threats to assess short-duration fear states with single behavioral measures (e.g., freezing), whereas human studies typically assess weaker or more prolonged anxiety states with physiological (e.g., skin conductance) and self-report measures. A path forward may be more animal research on conditioned anxiety phenomena measuring dynamic behavioral and physiological responses in more complex environments. Exploring transitions between defensive brain states during extinction, looming threats, and post-threat recovery may be particularly informative. If care is taken to align paradigms, threat levels, and measures, this strategy may reveal stable patterns of non-conscious defense in animals and humans that correlate better with conscious anxiety. This shift in focus is also warranted because anxiety is a bigger problem than fear, even in disorders defined by dysfunctional fear or panic reactions.
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Affiliation(s)
- Christopher K Cain
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA.
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Maples-Keller JL, Sherrill A, Reddi P, Norrholm SD, Rothbaum BO. Extinction-Based Exposure Therapies Using Virtual Reality. Curr Top Behav Neurosci 2023; 64:335-352. [PMID: 37566312 DOI: 10.1007/7854_2023_437] [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: 08/12/2023]
Abstract
The focus of this chapter is an overview of integrating virtual reality (VR) technology within the context of exposure therapy for anxiety disorders, a gold standard treatment, with a focus on how VR can help facilitate extinction learning processes integral to these interventions. The chapter will include an overview of advantages of incorporating VR within exposure therapy, and benefits specifically within an inhibitory learning approach for extinction training. A review of the empirical literature on the effectiveness of VR exposure therapy for specific phobia and PTSD will be provided, as well as practical overview of how to effectively incorporate VR within exposure therapy.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrew Sherrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Preethi Reddi
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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38
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Webler RD, Oathes DJ, van Rooij SJH, Gewirtz JC, Nahas Z, Lissek SM, Widge AS. Causally mapping human threat extinction relevant circuits with depolarizing brain stimulation methods. Neurosci Biobehav Rev 2023; 144:105005. [PMID: 36549377 DOI: 10.1016/j.neubiorev.2022.105005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Laboratory threat extinction paradigms and exposure-based therapy both involve repeated, safe confrontation with stimuli previously experienced as threatening. This fundamental procedural overlap supports laboratory threat extinction as a compelling analogue of exposure-based therapy. Threat extinction impairments have been detected in clinical anxiety and may contribute to exposure-based therapy non-response and relapse. However, efforts to improve exposure outcomes using techniques that boost extinction - primarily rodent extinction - have largely failed to date, potentially due to fundamental differences between rodent and human neurobiology. In this review, we articulate a comprehensive pre-clinical human research agenda designed to overcome these failures. We describe how connectivity guided depolarizing brain stimulation methods (i.e., TMS and DBS) can be applied concurrently with threat extinction and dual threat reconsolidation-extinction paradigms to causally map human extinction relevant circuits and inform the optimal integration of these methods with exposure-based therapy. We highlight candidate targets including the amygdala, hippocampus, ventromedial prefrontal cortex, dorsal anterior cingulate cortex, and mesolimbic structures, and propose hypotheses about how stimulation delivered at specific learning phases could strengthen threat extinction.
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Affiliation(s)
- Ryan D Webler
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Desmond J Oathes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan C Gewirtz
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA; Department of Psychology, Arizona State University, AZ, USA
| | - Ziad Nahas
- Department of Psychology, Arizona State University, AZ, USA
| | - Shmuel M Lissek
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Alik S Widge
- Department of Psychiatry and Medical Discovery Team on Addictions, University of Minnesota Medical School, MN, USA
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39
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Carpenter JK, Moskow DM, Hofmann SG. Enhanced Mental Reinstatement of Exposure to Improve Extinction Generalization: A Study on Claustrophobia and MRI Fear. Behav Ther 2023; 54:156-169. [PMID: 36608973 DOI: 10.1016/j.beth.2022.08.002] [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: 04/07/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
Fear of enclosed spaces prevents many people from receiving magnetic resonance imaging (MRI) scans. Although exposure therapy can effectively treat such fears, reductions in fear during exposure often do not generalize beyond the context in which they took place. This study tested a strategy designed to increase generalization, which involved revisiting the memory of a prior exposure to enhance retrieval of extinction learning. Forty-five participants with claustrophobia that included fear of MRI scans underwent a series of exposures lying inside a narrow cabinet. One week later, participants were randomly assigned to enhanced mental reinstatement (EMR) or control procedures. Prior to entering a mock MRI scanner, EMR participants recalled the memory of exposure training and listened to an audio recording of themselves describing what they learned, whereas control participants recalled a neutral memory. Compared to the control condition, EMR led to significantly reduced heart rate reactivity in the mock MRI scanner, but not self-reported fear or avoidance. There were no differences between conditions in claustrophobia symptoms or MRI fear at 1-month follow-up. Results suggest some benefits of mental reinstatement for improving generalization of gains following exposure training for claustrophobia, with measures of subjective fear and physiological arousal showing discordant outcomes.
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Affiliation(s)
- Joseph K Carpenter
- Boston University; National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division; VA Boston Healthcare System
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40
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Stenson AF, France JM, Jovanovic T. Getting Better with Age? A Review of Psychophysiological Studies of Fear Extinction Learning Across Development. Curr Top Behav Neurosci 2023; 64:213-236. [PMID: 37651043 DOI: 10.1007/7854_2023_441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
A critical developmental task is learning what constitutes reliable threat and safety signals in the environment. In humans, atypical fear learning processes are implicated in many mental health conditions, particularly fear and anxiety disorders, pointing to the potential for laboratory measures of fear learning to facilitate early identification of at-risk individuals. This chapter reviews studies of fear learning and extinction learning that incorporate peripheral measures of psychophysiological response and include a developmental sample. Broadly, these studies indicate substantial consistency in differential learning and extinction across development, as assessed with multiple paradigms, across physiological indices. Importantly, though, response coherence across measures (e.g., physiological, neural, and behavioral) was inconsistent across studies. There was also less consistency in results from studies that probed associations between anxiety and fear learning processes. These mixed findings highlight the need for additional examination of when and why there is variability, both across development and in relation to individual differences factors, including mental health, childhood adversity, and sex. In addition, there remains a need for studies that test for developmental change in extinction recall learning and whether stimulus type impacts learning across development. Longitudinal studies designed to address these questions could provide novel insight into the developmental trajectory of fear learning and extinction.
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Affiliation(s)
- Anaïs F Stenson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - John M France
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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41
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Ponomareva OY, Fenster RJ, Ressler KJ. Enhancing Fear Extinction: Pharmacological Approaches. Curr Top Behav Neurosci 2023; 64:289-305. [PMID: 37584834 DOI: 10.1007/7854_2023_443] [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: 08/17/2023]
Abstract
Extinction is the process by which the memory of a learned conditioned association decreases over time and with introduction of new associations. It is a vital part of fear learning, and it is critical to recovery in multiple fear-related disorders, including Specific and Social Phobias, Panic Disorder, Obsessive Compulsive Disorder (OCD), and Posttraumatic Stress Disorder (PTSD). The process of extinction is also the underlying mechanism for recovery in gold-standard therapies for PTSD, including prolonged exposure, cognitive processing therapy, eye movement desensitization and procession, as well as other empirically-based paradigms. Pharmacological modulators of extinction are thus promising targets for treatment of fear-related disorders. We focus here on emerging psychopharmacological treatments to facilitate extinction: D-cycloserine, scopolamine, losartan, ketamine, and 3,4-methylenedioxymethamphetamine. We also provide an overview of recent advances in molecular pathways that show promise as targets for extincion and inhibitory learning, including pathways related to cannabinoid, brain-derived neurotrophic factor, hypothalamic-pituitary-adrenal signaling, and promising work in neurosteroid compounds.
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42
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LaBar KS. Neuroimaging of Fear Extinction. Curr Top Behav Neurosci 2023; 64:79-101. [PMID: 37455302 DOI: 10.1007/7854_2023_429] [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: 07/18/2023]
Abstract
Extinguishing fear and defensive responses to environmental threats when they are no longer warranted is a critical learning ability that can promote healthy self-regulation and, ultimately, reduce susceptibility to or maintenance of affective-, trauma-, stressor-,and anxiety-related disorders. Neuroimaging tools provide an important means to uncover the neural mechanisms of effective extinction learning that, in turn, can abate the return of fear. Here I review the promises and pitfalls of functional neuroimaging as a method to investigate fear extinction circuitry in the healthy human brain. I discuss the extent to which neuroimaging has validated the core circuits implicated in rodent models and has expanded the scope of the brain regions implicated in extinction processes. Finally, I present new advances made possible by multivariate data analysis tools that yield more refined insights into the brain-behavior relationships involved.
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Affiliation(s)
- Kevin S LaBar
- Center for Cognitive Neuroscience, Duke University, Durham, NC, USA.
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43
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Smits JAJ, Monfils MH, Otto MW, Telch MJ, Shumake J, Feinstein JS, Khalsa SS, Cobb AR, Parsons EM, Long LJ, McSpadden B, Johnson D, Greenberg A. CO 2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC Psychiatry 2022; 22:831. [PMID: 36575425 PMCID: PMC9793569 DOI: 10.1186/s12888-022-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
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Affiliation(s)
- Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Marie-H. Monfils
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Michael W. Otto
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Michael J. Telch
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Jason Shumake
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Justin S. Feinstein
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Adam R. Cobb
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Ralph H. Johnson VAHCS, 67 President Street MSC 862, Charleston, SC 29425 USA
| | - E. Marie Parsons
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Laura J. Long
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Bryan McSpadden
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - David Johnson
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Alma Greenberg
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
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Exposure to Promote Healthy Eating. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Christian C, Levinson CA. An integrated review of fear and avoidance learning in anxiety disorders and application to eating disorders. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Using expectation violation models to improve the outcome of psychological treatments. Clin Psychol Rev 2022; 98:102212. [PMID: 36371900 DOI: 10.1016/j.cpr.2022.102212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.
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47
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Reply to Quintner. Pain 2022; 163:e1217-e1219. [DOI: 10.1097/j.pain.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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48
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Winkler CD, Koval P, Phillips LJ, Felmingham KL. Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol. Front Psychiatry 2022; 13:1000686. [PMID: 37082515 PMCID: PMC10111196 DOI: 10.3389/fpsyt.2022.1000686] [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: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.
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Affiliation(s)
- Christopher D. Winkler
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Schwartz S, Clerget A, Perogamvros L. Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Curr Biol 2022; 32:4808-4816.e4. [PMID: 36306786 DOI: 10.1016/j.cub.2022.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
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Affiliation(s)
- Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland
| | - Alice Clerget
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; Center for Sleep Medicine, Geneva University Hospitals, 1225 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospitals, 1225 Geneva, Switzerland.
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Graham BM. The impact of hormonal contraceptives on anxiety treatments: From preclinical models to clinical settings. Front Neuroendocrinol 2022; 67:101030. [PMID: 35995079 DOI: 10.1016/j.yfrne.2022.101030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
Exposure therapy is a central component of the first-line treatment for anxiety disorders, a common mental health condition that is twice as prevalent in women relative to men. A key underlying mechanism of exposure therapy is fear extinction, which is an active learning process supported by a neural circuitry that is highly regulated by ovarian hormones. This review synthesises research examining the impact of hormonal contraceptives on laboratory fear extinction tasks in female rats and women, and on exposure therapy in women with anxiety disorders. The evidence indicates that hormonal contraceptives have a detrimental impact on fear extinction and exposure therapy that is consistent across species, and from laboratory to clinical settings. Candidate pathways by which hormonal contraceptives impede fear extinction and exposure therapy include suppression of endogenous ovarian hormones and glucocorticoids, and downregulation of signalling pathways that support extinction learning. Key areas of focus for future research are discussed.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, Australia.
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