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Opdensteinen KD, Rach H, Gruszka P, Schaan L, Adolph D, Pané-Farré CA, Benke C, Dierolf AM, Schneider S, Hechler T. "The mere imagination scares me"-evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain. Pain 2024; 165:621-634. [PMID: 37703402 DOI: 10.1097/j.pain.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/17/2023] [Indexed: 09/15/2023]
Abstract
ABSTRACT According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed. Adolescents (11-18 years) with chronic headache (CH, n = 46) or chronic abdominal pain (CAP, n = 29) and a control group (n = 28) were asked to imagine individualized pain-associated, neutral and standardized fear scripts. During pain-associated compared with neutral imagery, both pain groups showed higher mean HR, with CH also showing higher HR reactivity, while HR acceleration was not observed within control group. In contrast, during pain-associated compared with neutral imagery, startle response magnitude and SCL remained unchanged in all groups. Additionally, overall levels in self-reports were higher during pain-associated compared with neutral imagery, but significantly more pronounced in the pain groups compared with the control group. Results suggest that the mere imagination of pain-associated sensations elicits specific autonomic fear responses accompanied by increased self-reported fear in adolescents with chronic pain. The specific modulation of heart rate shed new light on our understanding of multimodal fear responses in adolescents with chronic pain and may help to refine paradigms to decrease fear of interoceptive sensations in chronic pain.
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Affiliation(s)
- Kim D Opdensteinen
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Hannah Rach
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Piotr Gruszka
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Luca Schaan
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Dirk Adolph
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Christiane A Pané-Farré
- Department of Psychology, Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Christoph Benke
- Department of Psychology, Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Angelika M Dierolf
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Trier University, Trier, Germany
| | - Silvia Schneider
- Department of Clinical Child and Adolescent Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tanja Hechler
- Department of Clinical Psychology for Children and Adolescents, University of Münster, Münster, Germany
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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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3
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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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Salkovskis PM, Sighvatsson MB, Sigurdsson JF. How effective psychological treatments work: mechanisms of change in cognitive behavioural therapy and beyond. Behav Cogn Psychother 2023; 51:595-615. [PMID: 38180111 DOI: 10.1017/s1352465823000590] [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: 01/06/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. AIMS In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. METHOD The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. CONCLUSION Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.
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Affiliation(s)
- Paul M Salkovskis
- University of Oxford Department of Experimental Psychology and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Schultz J, Baumeister A, Schmotz S, Moritz S, Jelinek L. Efficacy of an Internet-based intervention with self-applied exposure therapy in virtual reality for people with panic disorder: study protocol for a randomized controlled trial. Trials 2023; 24:521. [PMID: 37573377 PMCID: PMC10422760 DOI: 10.1186/s13063-023-07536-1] [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: 12/24/2022] [Accepted: 07/25/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is Internet-based psychotherapy, which has been shown particularly effective in guided formats. Still, there remains room for improvement to make these digital therapies more accessible, cost-efficient, and aligned with best practices for in-person interventions (e.g., exposure). The smartphone app "Invirto - Treatment for Anxiety" offers digitally guided, evidence-based treatment of panic disorders including virtual reality (VR) for exposure therapy. The aim present study is to investigate the efficacy, safety, and acceptance of Invirto in comparison to a care-as-usual (CAU) control group. METHODS We plan to conduct a randomized controlled trial with two conditions (intervention vs. CAU), three assessment times via online surveys (t0: baseline; t1: 3 months after baseline; t2: follow-up assessment 6 months after baseline), and a total of 128 participants with a clinical diagnosis of panic disorder (symptoms must be experienced ≥ 1 year). Recruitment will take place via email, phone, and the study website. The primary outcome will be the change in anxiety symptoms as measured by Beck's Anxiety Inventory from t0 to t1. Secondary outcomes will be the change in anxiety symptoms (measured by the Panic and Agoraphobia Scale, PAS; Questionnaire on panic-related Anxieties, Cognitions and Avoidance, ACA), depressive symptoms (measured by the Beck-Depression-Inventory, BDI-II), treatment satisfaction (measured by the Client Satisfaction Questionnaire, CSQ-8; Treatment Adherence Perception Questionnaire, TAPQ-adapt; Positive and Negative Effects of Psychotherapy Scale, PANEPS-I), psychological flexibility (measured by the Acceptance and Action Questionnaire-II, AAQ-II), and dissociation during VR exposure (measured by an adapted version of the Peritraumatic Dissociative Experiences Questionnaire, PDEQ-adapt). Participants in the intervention group will receive access to the intervention (Invirto) right after t0, while the CAU group will receive access to Invirto after t1. We expect a larger change in both the primary and secondary outcomes from t0 to t1 in the intervention group in comparison to the CAU group. DISCUSSION This study is one of the first to evaluate an Internet-based intervention for people with panic disorder that includes self-application of VR exposure therapy. The findings are expected to extend the body of knowledge about effective Internet-based treatment options for people with panic disorder. The empirical and clinical implications and the limitations of the study are discussed. TRIAL REGISTRATION DRKS00027585 ( www.drks.de/drks_web/ ), date of registration: 13 January 2022.
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Affiliation(s)
- Josephine Schultz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stella Schmotz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Russman Block S, Norman LJ, Zhang X, Mannella KA, Yang H, Angstadt M, Abelson JL, Himle JA, Taylor SF, Fitzgerald KD. Resting-State Connectivity and Response to Psychotherapy Treatment in Adolescents and Adults With OCD: A Randomized Clinical Trial. Am J Psychiatry 2023; 180:89-99. [PMID: 36475374 PMCID: PMC10956516 DOI: 10.1176/appi.ajp.21111173] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cortical-subcortical hyperconnectivity related to affective-behavioral integration and cortical network hypoconnectivity related to cognitive control have been demonstrated in obsessive-compulsive disorder (OCD); the study objective was to examine whether these connectivity patterns predict treatment response. METHODS Adolescents (ages 12-17) and adults (ages 24-45) were randomly assigned to 12 sessions of exposure and response prevention (ERP) or stress management therapy (SMT), an active control. Before treatment, resting-state connectivity of ventromedial prefrontal cortical (vmPFC), cingulo-opercular, frontoparietal, and subcortical regions was assessed with functional MRI. OCD severity was assessed with the Yale-Brown Obsessive Compulsive Scale before, during, and after treatment. Usable fMRI and longitudinal symptom data were obtained from 116 patients (68 female; 54 adolescents; 60 medicated). RESULTS ERP produced greater decreases in symptom scores than SMT. ERP was selectively associated with less vmPFC-subcortical (caudate and thalamus) connectivity in both age groups and primarily in unmedicated participants. Greater symptom improvement with both ERP and SMT was associated with greater cognitive-control (cingulo-opercular and frontoparietal) and subcortical (putamen) connectivity across age groups. Developmental specificity was observed across ERP and SMT treatments, such that greater improvements with ERP than SMT were associated with greater frontoparietal-subcortical (nucleus accumbens) connectivity in adolescents but greater connectivity between frontoparietal regions in adults. Comparison of response-predictive connections revealed no significant differences compared with a matched healthy control group. CONCLUSIONS The results suggest that less vmPFC-subcortical connectivity related to affect-influenced behavior may be important for ERP engagement, whereas greater cognitive-control and motor circuit connectivity may generally facilitate response to psychotherapy. Finally, neural predictors of treatment response may differ by age.
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Affiliation(s)
- Stefanie Russman Block
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Luke J Norman
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Xiaoxi Zhang
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Kristin A Mannella
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Huan Yang
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Mike Angstadt
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - James L Abelson
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Joseph A Himle
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Stephan F Taylor
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Kate D Fitzgerald
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
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Newsome P, Ruiz SG, Gold AL, Pine DS, Abend R. Fear-potentiated startle reveals diminished threat extinction in pathological anxiety. Int J Psychophysiol 2023; 183:81-91. [PMID: 36442665 PMCID: PMC9812922 DOI: 10.1016/j.ijpsycho.2022.11.011] [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: 02/08/2022] [Revised: 10/13/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Major theories propose that perturbed threat learning is central to pathological anxiety, but empirical support is inconsistent. Failures to detect associations with anxiety may reflect limitations in quantifying conditioned responses to anticipated threat, and hinder translation of theory into empirical work. In prior work, we could not detect threat-specific anxiety effects on states of conditioned threat using psychophysiology in a large sample of patients and healthy comparisons. Here, we examine the utility of an alternative fear potentiated startle (FPS) scoring in revealing associations between anxiety and threat conditioning and extinction in this dataset. Secondary analyses further explored associations among conditioned threat responses, subcortical morphometry, and treatment outcomes. METHODS Youths and adults with anxiety disorders and healthy comparisons (n = 306; 178 female participants; 8-50 years) previously completed a well-validated differential threat learning paradigm. FPS and skin conductance response (SCR) quantified psychophysiological responses during threat conditioning and extinction. In this report, we examined normalizing raw FPS scores to intertrial intervals (ITI) to address challenges in more common approaches to FPS scoring which could mask group effects. Secondary analyses examined associations between FPS and subcortical morphometry and with response to exposure-based cognitive behavioral therapy in a subsample of patients. RESULTS Patients and comparisons showed comparable differential threat conditioning using FPS and SCR. While SCR suggested comparable extinction between groups, FPS revealed stronger retention of threat contingency during extinction in individuals with anxiety disorders. Extinction indexed with FPS was not associated with age, morphometry, or anxiety treatment outcome. CONCLUSION ITI-normalized FPS may have utility in detecting difficulties in extinguishing conditioned threat responses in anxiety. These findings provide support for extinction theories of anxiety and encourage continued research on aberrant extinction in pathological anxiety.
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Affiliation(s)
- Philip Newsome
- Emotion and Development Branch, National Institute of Mental Health (NIMH), National Institutes of Health, Bethesda, MD, USA
| | - Sonia G Ruiz
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health (NIMH), National Institutes of Health, Bethesda, MD, USA
| | - Rany Abend
- Baruch Ivcher School of Psychology, Reichman University, Israel.
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8
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Schamong I, D'Astolfo L, Bollmann S, Brakemeier E, Kube T. How expectations and therapeutic style influence counselling outcome. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Isabel Schamong
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Lisa D'Astolfo
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Simon Bollmann
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Eva‐Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
- Department of Clinical Psychology and Psychotherapy University of Greifswald Greifswald Germany
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
- Department of Clinical Psychology and Psychotherapy University of Landau Landau Germany
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9
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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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10
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Hoppe JM, Vegelius J, Gingnell M, Björkstrand J, Frick A. Internet-delivered approach-avoidance conflict task shows temporal stability and relation to trait anxiety. LEARNING AND MOTIVATION 2022. [DOI: 10.1016/j.lmot.2022.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Schrammen E, Roesmann K, Rosenbaum D, Redlich R, Harenbrock J, Dannlowski U, Leehr EJ. Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies. Neurosci Biobehav Rev 2022; 142:104895. [PMID: 36179918 DOI: 10.1016/j.neubiorev.2022.104895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/12/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in effortful cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.
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Affiliation(s)
| | - Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen
| | | | - Jana Harenbrock
- Institute for Translational Psychiatry, University of Münster
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster
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Miegel F, Bücker L, Kühn S, Mostajeran F, Moritz S, Baumeister A, Lohse L, Blömer J, Grzella K, Jelinek L. Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series. Psychiatr Q 2022; 93:861-882. [PMID: 35779165 DOI: 10.1007/s11126-022-09992-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany
| | - Fariba Mostajeran
- Department of Informatics, University of Hamburg, Vogt-Kölln-Strasse 30, 22527, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jannik Blömer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karsten Grzella
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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13
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Future-oriented imagery rescripting facilitates conducting behavioral experiments in social anxiety. Behav Res Ther 2022; 155:104130. [DOI: 10.1016/j.brat.2022.104130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/18/2022]
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15
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Quezada-Scholz VE, Laborda MA, San Martín C, Miguez G, Alfaro F, Mallea J, Díaz F. Cued fear conditioning in humans using immersive Virtual Reality. LEARNING AND MOTIVATION 2022. [DOI: 10.1016/j.lmot.2022.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Nishikawa Y, Fracalanza K, Rector NA, Laposa JM. Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play? J Clin Psychol 2022; 78:2513-2524. [PMID: 35435997 DOI: 10.1002/jclp.23363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively. METHOD One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events. RESULTS Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity. CONCLUSION Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.
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Affiliation(s)
- Yasunori Nishikawa
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katie Fracalanza
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Neil A Rector
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Judith M Laposa
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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17
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Zinbarg RE, Williams AL, Mineka S. A Current Learning Theory Approach to the Etiology and Course of Anxiety and Related Disorders. Annu Rev Clin Psychol 2022; 18:233-258. [PMID: 35134320 DOI: 10.1146/annurev-clinpsy-072220-021010] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors describe how contemporary learning theory and research provide the basis for models of the etiology and maintenance of anxiety and related disorders. They argue that contemporary learning theory accounts for much of the complexity associated with individual differences in the development and course of these disorders. These insights from modern research on learning overcome the limitations of earlier behavioral approaches, which were overly simplistic and have been justifiably criticized. The authors show how considerations of early learning histories and temperamental vulnerabilities affect the short- and long-term likelihood that experiences with stressful events will lead to the development of anxiety disorders. They also discuss how contextual variables during and after stressful learning experiences influence the maintenance of anxiety disorder symptoms. Thus, contemporary learning models provide a rich and nuanced understanding of the etiology and course of anxiety and related disorders. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois, USA; .,The Family Institute at Northwestern University, Evanston, Illinois, USA
| | | | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, Illinois, USA;
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18
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von Mücke-Heim IA, Walter I, Nischwitz S, Erhardt A. Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report. Front Psychiatry 2022; 13:915058. [PMID: 35903630 PMCID: PMC9314666 DOI: 10.3389/fpsyt.2022.915058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most frequent mental disorders. Among the different subtypes, specific phobias are the commonest. Due to the ongoing SARS-CoV-19 pandemic, blood-injury-injection phobia (BII) has gained wider attention in the context of large-scale vaccination campaigns and public health. In this BII phobia mini-review and case report, we describe the successful treatment of a severe BII phobia case with combined fainting and psychogenic non-epileptic seizures (PNES) and demonstrate the role of specialized outpatient care. CASE REPORT The patient was a 28-year-old woman. She suffered from intense fear and recurrent fainting with regard to needles, injections, injuries, and at the sight of blood since early childhood. Medical history revealed infrequent events suggestive of PNES following panic attacks after sustained exposure to phobic stimuli. Family history was positive for circulation problems and BII fears. Psychopathological evaluation confirmed BII phobia symptoms and diagnosis was made according to the DSM-5. The Multidimensional Blood/Injury Phobia Inventory short version (MBPI-K) revealed severe manifestation of the disease. Neurological examination was ordinary. Repeated electroencephalography detected no epileptic pattern. Cranial magnetic resonance imaging showed normal morphology. Treatment was carried out by a seasoned, multidisciplinary team. Cognitive behavior therapy and exposure were performed. Modification of standard treatment protocol was necessary due to hurdles posed by recurrent fainting and a severe panic-triggered dissociative PNES during in vivo exposure. Modification was implemented by limiting in vivo exposure intensity to moderate anxiety levels. In addition to applied muscle tension and ventilation techniques, increased psychoeducation, cognitive restructuring, and distress tolerance skills (e.g., ice pack, verbal self-instructions) were used to strengthen the patient's situational control during in vivo exposure. A total of 15 sessions were performed. Therapy success was proven by 83% reduction in MBPI-K rating, SARS-CoV-19 vaccination, and a blood draw without psychological assistance, fainting, or seizure. CONCLUSION Taken together, this case demonstrates the potential of and need for specialized outpatient care and individualized treatment for severe BII phobia patients in order to provide them the perspective to have necessary medical procedures done and get vaccinated.
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Affiliation(s)
- Iven-Alex von Mücke-Heim
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Isabelle Walter
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Sandra Nischwitz
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Angelika Erhardt
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Würzburg, Germany
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19
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Comparing three extinction methods to reduce fear expression and generalization. Behav Brain Res 2021; 420:113714. [PMID: 34906608 DOI: 10.1016/j.bbr.2021.113714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 01/19/2023]
Abstract
Fear extinction is easy to achieve but difficult to maintain, as evidenced by the relapse of fear after extinction. Counterconditioning and novelty-facilitated extinction have been shown to interfere with fear expression without erasing it. Because of the similarity between the two extinction paradigms, we extended the standard extinction, which merely omitted the expected threat outcomes after exposure to original threat cues. The modified paradigm provided a stimulus (neutral picture or positive picture) to replace the omitted threat outcomes during extinction. Sixty-four healthy volunteers were randomized into three groups for a three-day procedure: fear acquisition (day 1), fear extinction (day 2), and fear recall and generalization test (day 3). Our results showed the modified extinction paradigm failed to prevent fear expression in spontaneous recovery and reinstatement tests. However, novelty-facilitated extinction showed powerful effects in preventing fear generalization. Besides, there was a negative correlation between spontaneous recovery index and emotion regulation scores. We speculated that emotion and prediction error may be important factors influencing fear extinction and affect fear recall and generalization. Overall, this study suggests that novelty-facilitated extinction had a superior effect in preventing fear generalization, providing new perspectives for enhancing the effect of exposure therapy.
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20
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Plaisted H, Waite P, Creswell C. Optimising exposure for adolescents with public speaking anxiety: Affect labelling or positive coping statements? Behav Res Ther 2021; 148:103997. [PMID: 34847497 DOI: 10.1016/j.brat.2021.103997] [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: 05/12/2021] [Revised: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 11/02/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is the first line treatment for anxiety disorders in youth however many adolescents do not benefit. Behavioural exposure is believed to be the critical ingredient of CBT and research with adults has shown that labelling affect, but not positive coping statements, enhances exposure outcomes. However, many CBT protocols for young people involve using positive coping statements alongside exposure. We compared the effects of exposure with positive coping statements, affect labelling, and neutral statements on fear responses in adolescents (age 13-14 years) with public speaking anxiety as they delivered a series of speeches in front of a pre-recorded classroom audience. Self-rated anxiety, heart rate, and observer ratings of expressed anxiety were assessed pre-test, immediate post-test and at 1-week follow-up. Neither affect labelling nor positive coping statements enhanced exposure on any measure from pre-test to 1-week follow-up. While there was an initial advantage of exposure with positive coping statements for post-speech self-reported anxiety, this effect was not maintained, and there was a significant increase in anxiety from immediate post-test to 1-week follow-up in this condition, compared to the other conditions. The short-term benefits from generating positive coping statements may explain why this is often employed in the treatment of anxiety problems in young people, but also indicate that it may not confer any advantage in the longer term. These intriguing findings highlight the urgent need for further attention to improve understanding of how to optimise exposure in young people and maximise treatment outcomes.
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Affiliation(s)
- Hannah Plaisted
- School of Psychology, University of Birmingham, UK; School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, UK; Department of Experimental Psychology & Department of Psychiatry, University of Oxford, UK.
| | - Cathy Creswell
- Department of Experimental Psychology & Department of Psychiatry, University of Oxford, UK
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21
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Affective and psycholinguistic norms of Greek words: Manipulating their affective or psycho-linguistic dimensions. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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McInerney J, Brown P, Bird JC, Nickless A, Brown G, Freeman D. Does raising heart rate prior to a behavioural test enhance learning in cognitive therapy for anxiety? An experimental test for the treatment of fear of heights using virtual reality. Behav Res Ther 2021; 144:103928. [PMID: 34246887 DOI: 10.1016/j.brat.2021.103928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests. METHODS Sixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief. RESULTS Heart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56). DISCUSSION An increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.
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Affiliation(s)
- Josephine McInerney
- Royal Holloway, University of London, UK; Broadmoor Hospital, West London NHS Trust, UK.
| | - Poppy Brown
- Department of Psychiatry, University of Oxford, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | | | - Gary Brown
- Royal Holloway, University of London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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23
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Loo Gee B, Batterham PJ, Gulliver A, Reynolds J, Griffiths KM. An Ecological Momentary Intervention for people with social anxiety: A descriptive case study. Inform Health Soc Care 2021; 46:370-398. [PMID: 33779480 DOI: 10.1080/17538157.2021.1896525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study describes the development and pilot evaluation of a smartphone- delivered Ecological Momentary Intervention (EMI) for people with social anxiety symptoms. Using a software engineering framework (agile modeling, model-driven development, bottom-up development), mental health experts and software developers collaborated to develop a 4-module EMI app designed to reduce social anxiety in real-time. Fifty-five participants with social anxiety were randomly allocated to the EMI or a wait-list control arm. App downloads, usage and user satisfaction data were collected and mental health outcomes assessed at baseline and post-intervention. Software development practices allowed mental health experts to distil core elements of a psychological intervention into discrete software components but there were challenges in engaging mental health experts in the process. Relative to control there was no significant reduction in social anxiety among the EMI participants in the pilot trial. However, post-test data were available for only 4 intervention and 10 control participants and only 2 (4.0%) of the EMI participants downloaded the app. The two participants who both accessed the app and completed the post-test reported being satisfied with the intervention. Future research should address managing resources and providing additional training to support ongoing engagement with key stakeholders.
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Affiliation(s)
- Brendan Loo Gee
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Julia Reynolds
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
| | - Kathleen M Griffiths
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
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24
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Magson NR, Handford CM, Norberg MM. The Empirical Status of Cue Exposure and Response Prevention Treatment for Binge Eating: A Systematic Review. Behav Ther 2021; 52:442-454. [PMID: 33622512 DOI: 10.1016/j.beth.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022]
Abstract
Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating.
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25
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Duits P, Baas JMP, Engelhard IM, Richter J, Huisman-van Dijk HM, Limberg-Thiesen A, Heitland I, Hamm AO, Cath DC. Latent class growth analyses reveal overrepresentation of dysfunctional fear conditioning trajectories in patients with anxiety-related disorders compared to controls. J Anxiety Disord 2021; 78:102361. [PMID: 33508747 DOI: 10.1016/j.janxdis.2021.102361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Recent meta-analyses indicated differences in fear acquisition and extinction between patients with anxiety-related disorders and comparison subjects. However, these effects are small and may hold for only a subsample of patients. To investigate individual trajectories in fear acquisition and extinction across patients with anxiety-related disorders (N = 104; before treatment) and comparison subjects (N = 93), data from a previous study (Duits et al., 2017) were re-analyzed using data-driven latent class growth analyses. In this explorative study, subjective fear ratings, shock expectancy ratings and startle responses were used as outcome measures. Fear and expectancy ratings, but not startle data, yielded distinct fear conditioning trajectories across participants. Patients were, compared to controls, overrepresented in two distinct dysfunctional fear conditioning trajectories: impaired safety learning and poor fear extinction to danger cues. The profiling of individual patterns allowed to determine that whereas a subset of patients showed trajectories of dysfunctional fear conditioning, a significant proportion of patients (≥50 %) did not. The strength of trajectory analyses as opposed to group analyses is that it allows the identification of individuals with dysfunctional fear conditioning. Results suggested that dysfunctional fear learning may also be associated with poor treatment outcome, but further research in larger samples is needed to address this question.
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Affiliation(s)
- Puck Duits
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - Johanna M P Baas
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | | | - Anke Limberg-Thiesen
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Ivo Heitland
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Danielle C Cath
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands; Department of Psychiatry, University Medical Center Groningen and University of Groningen, GGZ Drenthe, Department of Specialist Training, The Netherlands.
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26
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Rief W. Moving from tradition-based to competence-based psychotherapy. EVIDENCE-BASED MENTAL HEALTH 2021; 24:ebmental-2020-300219. [PMID: 33468517 PMCID: PMC8311107 DOI: 10.1136/ebmental-2020-300219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
Current education and training in psychological interventions is mostly based on different 'schools' (traditions such as cognitive-behavioural or psychodynamic therapy), and strong identification with these specific traditions continuously hinders a scientifically based development of psychotherapy. This review is selective rather than systematic and comprehensive. In addition to the consideration of other influential publications, we relied on a literature search in Web of Science using the following terms (update: 24 December 2020): (psychotherapy AND meta-analy* AND competence*). After summarising current problems, a pathway for solving these problems is presented. First, we have to recategorise psychological interventions according to the mechanisms and subgoals that are addressed. The interventions can be classified according to the foci: (1) skills acquisition (eg, communication, emotion regulation, mentalisation); (2) working with relationship patterns and using the therapeutic relationship to modify them; and (3) clarification of motives and goals. Afterwards, the training of psychotherapists can switch from focusing on one theoretical framework to learning the different competences for modification according to these new categories. The selection of topics to be addressed should follow best evidence-based mechanisms and processes of mental disorders and interventions. Psychology offers knowledge about these mechanisms that can be understood as a basic science for psychological treatments in general. This requires better connection with basic science, new research efforts that focus on treatment subgoals, theory-overarching optimisation of the selection and personalisation of treatments, and new types of training for psychotherapists that are designed to optimise therapists' competences accordingly, instead of limiting training programmes to one single theoretical framework.
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Affiliation(s)
- Winfried Rief
- Clinical Psychology, University of Marburg, Marburg, Germany
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27
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Wetterneck CT, Leonard RC, Adams TG, Riemann BC, Grau P, Franklin ME. The effects of depression on the treatment of OCD in a residential sample. Bull Menninger Clin 2020; 84:12-33. [PMID: 33074022 DOI: 10.1521/bumc.2020.84.suppa.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment. OCD patients receiving residential treatment based primarily on exposure and response prevention (ERP) provided data regarding symptoms of depression and OCD at admission and discharge. Patients reported large and significant reductions in OCD symptoms over the course of treatment. Change in OCD symptoms was not significantly affected by depressive symptoms, including patients with severe depressive symptoms. Change in depressive symptoms over the course of treatment was, however, robustly related to change in OCD symptoms, especially among patients who began treatment with severe symptoms of depression. These findings suggest that cognitive-behavior therapy delivered in a residential treatment setting drastically reduces OCD symptoms regardless of depressive symptoms.
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Affiliation(s)
- Chad T Wetterneck
- Trauma Recovery Services, Rogers Behavioral Health, Oconomowoc, Wisconsin
| | | | - Thomas G Adams
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut.,Rogers Behavioral Health, as well as the Clinical Neuroscience Division of the VA National Center for PTSD, West Haven, Connecticut
| | | | - Peter Grau
- Department of Counseling and Education at Marquette University, Milwaukee, Wisconsin
| | - Martin E Franklin
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Department of Psychiatry at the University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Kube T, Hildebrandt A. “Ich denke, also sage ich vorher”: Wie “Predictive Processing-Modelle den Einsatz von Verhaltensexperimenten bei Depressionen optimieren können. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000510610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Verhaltensexperimente stellen eine wichtige Interventionsform bei depressiven Störungen dar, um dysfunktionale Annahmen zu modifizieren. Häufig ist jedoch zu beobachten, dass Patient*innen trotz einer fachgerechten Durchführung von Verhaltensexperimenten weiter an negativen Annahmen festhalten. Vor diesem Hintergrund diskutieren wir in diesem Artikel, wie der Einsatz von Verhaltensexperimenten bei Depressionen optimiert werden kann und beziehen uns dabei auf ein neues Störungsmodell, das interessante Implikationen hierzu liefern könnte. Dieses Störungsmodell aus der neurowissenschaftlichen Forschung zu “Predictive Processing” geht davon aus, dass depressive Störungen durch zwei Kernaspekte gekennzeichnet sind: (1) stark negative Erwartungen, die im Sinne von selbsterfüllenden Prophezeiungen zu negativen Erlebnissen führen und zunehmend “immun” gegen gegenteilige Erfahrungen machen; (2) das Fehlen von positiven Erwartungen, wodurch die Wahrscheinlichkeit von positiven Erlebnissen reduziert wird. Darauf aufbauend beschreiben wir zunächst, dass zur Modifikation negativer Erwartungen in einer ausführlichen Vorbesprechung erarbeitet werden sollte, welche möglichen positiven Erfahrungen aus dem Verhaltensexperiment die Patient*innen als glaubwürdig betrachten und zur Veränderung ihrer negativen Erwartungen nutzen würden. Auf diese sollte bei der Durchführung besonders geachtet werden, damit positive Erwartungsverletzungen auch als solche wahrgenommen werden. Zum anderen stellen wir dar, dass es nicht ausreichend ist, nur negative Erwartungen zu reduzieren, sondern auch explizit positive Erwartungen durch weitere Verhaltensexperimente gefördert werden sollten.
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Mulej Bratec S, Bertram T, Starke G, Brandl F, Xie X, Sorg C. Your presence soothes me: a neural process model of aversive emotion regulation via social buffering. Soc Cogn Affect Neurosci 2020; 15:561-570. [PMID: 32415970 PMCID: PMC7328019 DOI: 10.1093/scan/nsaa068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023] Open
Abstract
The reduction of aversive emotions by a conspecific's presence-called social buffering-is a universal phenomenon in the mammalian world and a powerful form of human social emotion regulation. Animal and human studies on neural pathways underlying social buffering typically examined physiological reactions or regional brain activations. However, direct links between emotional and social stimuli, distinct neural processes and behavioural outcomes are still missing. Using data of 27 female participants, the current study delineated a large-scale process model of social buffering's neural underpinnings, connecting changes in neural activity to emotional behaviour by means of voxel-wise multilevel mediation analysis. Our results confirmed that three processes underlie human social buffering: (i) social support-related reduction of activity in the orbitofrontal cortex, ventromedial and dorsolateral prefrontal cortices, anterior and mid-cingulate; (ii) downregulation of aversive emotion-induced brain activity in the superficial cortex-like amygdala and mediodorsal thalamus; and (iii) downregulation of reported aversive feelings. Results of the current study provide evidence for a distinct neural process model of aversive emotion regulation in humans by social buffering.
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Affiliation(s)
- Satja Mulej Bratec
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Teresa Bertram
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Georg Starke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Felix Brandl
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Xiyao Xie
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- TUM-NIC Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany
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Gutzweiler R, Schwarz D, In-Albon T. Transdiagnostische Behandlung emotionaler Störungen bei Jugendlichen mit dem Unified Protocol: Eine Fallstudie. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000508454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Angst- und depressive Störungen sind die häufigsten psychischen Störungen im Jugendalter und weisen untereinander eine hohe Komorbiditätsrate auf. Während kognitive Verhaltenstherapie (KVT) in der Behandlung von Angststörungen bei Jugendlichen wirksam ist, weist die Behandlung von depressiven Störungen nur moderate Wirksamkeit auf. Es liegen jedoch kaum Studien vor, die die Wirksamkeit der KVT in der Behandlung komorbid vorliegender Angst- und depressiver Störungen bei Jugendlichen untersuchen. Der transdiagnostische Ansatz des Unified Protocols (UP) für emotionale Störungen konnte seine Wirksamkeit im englischsprachigen Raum bereits im Jugend- und Erwachsenenalter nachweisen. Eine deutsche Übersetzung und Überprüfung des UP für Jugendliche steht bislang noch aus. <b><i>Falldarstellung:</i></b> In dieser Kasuistik wird eine 17-jährige Patientin vorgestellt, die die Kriterien einer sozialen Angststörung nach ICD-10 und DSM-5 erfüllt und zudem eine depressive Symptomatik aufweist. Nach einer umfassenden Diagnostik mithilfe eines strukturierten klinischen Interviews und Selbstberichtverfahrens wurden 17 Sitzungen KVT basierend auf dem UP für Adoleszente (UP-A) durchgeführt. Ziel der vorliegenden Fallbeschreibung ist die Vorstellung des Therapierationals und der Umsetzung des Manuals. Nach der Therapie erfüllte die Jugendliche die Kriterien der sozialen Angststörung nicht mehr, es zeigte sich zudem eine Abnahme der depressiven Symptomatik. <b><i>Schlussfolgerungen:</i></b> Die Fallvorstellung verweist auf die Umsetzbarkeit der deutschen Übersetzung des UP-A für die transdiagnostische Behandlung von Angst- und depressiven Störungen bei Jugendlichen. Eine randomisiert kontrollierte Studie zur Wirksamkeitsprüfung steht noch aus.
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Anxiety Sensitivity Accelerates the Temporal Changes in Obsessions and Compulsions During Cognitive Behavioral Therapy. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Asbrand J, Heinrichs N, Schmidtendorf S, Nitschke K, Tuschen-Caffier B. Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder. Child Psychiatry Hum Dev 2020; 51:427-441. [PMID: 31960175 PMCID: PMC7235054 DOI: 10.1007/s10578-019-00954-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns.Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.
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Affiliation(s)
- Julia Asbrand
- Department of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Nina Heinrichs
- Department of Psychology, University of Bremen, Bremen, Germany
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | | | - Kai Nitschke
- Department of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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Rosenbaum D, Leehr EJ, Rubel J, Maier MJ, Pagliaro V, Deutsch K, Hudak J, Metzger FG, Fallgatter AJ, Ehlis AC. Cortical oxygenation during exposure therapy - in situ fNIRS measurements in arachnophobia. NEUROIMAGE-CLINICAL 2020; 26:102219. [PMID: 32135488 PMCID: PMC7052440 DOI: 10.1016/j.nicl.2020.102219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
This is the first study that assessed cortical hemodynamic reactions during exposure therapy in situ. During exposure patients showed increased activity in the cognitive control network (CCN) compared to a control condition. CCN activity deceased during the session. Further, CCN activity was associated with fear ratings at the beginning of the session and this relationship decreased from session to session.
Exposure therapy is a well-studied and highly efficacious treatment for phobic disorders. Although the neurobiological model of fear is well underpinned by various studies, the mechanisms of exposure therapy are still under discussion. Partly, this is due to the fact that most neurophysiological methods like fMRI are not able to be used in the natural therapeutic settings. The current study used in situ measurements of cortical blood oxygenation (O2Hb) during exposure therapy by means of functional near-infrared spectroscopy. 37 subjects (N = 30 completers) underwent exposure therapy during 5 adapted sessions in which subjects were exposed to Tegenaria Domestica (domestic house spider – experimental condition) and Dendrobaena Veneta/ Eisenaia hortensis (red earthworm – control condition). Compared to the control condition, patients showed higher O2Hb levels in the anticipation and exposure phase of spider exposure in areas of the cognitive control network (CCN). Further, significant decreases in O2Hb were observed during the session accompanied by reductions in fear related symptoms. However, while symptoms decreased in a linear quadratic manner, with higher reductions in the beginning of the session, CCN activity decreased linearly. Further, higher anxiety at the beginning of session one was associated with increased O2Hb in the CCN. This association decreased within the following sessions. The current study sheds light on the neuronal mechanisms of exposure therapy. The results are discussed in light of a phase model of exposure therapy that posits a role of cognitive control in the beginning and routine learning at the end of the therapy session.
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Affiliation(s)
- David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany.
| | | | - Julian Rubel
- Psychotherapy Research Lab, Psychology and Sport Sciences, Justus-Liebig-University Giessen, Giessen, Germany
| | - Moritz J Maier
- Fraunhofer IAO
- Center for Responsible Research and Innovation, Berlin, Germany
| | - Valeria Pagliaro
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Kira Deutsch
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Justin Hudak
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT 84112, United States
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
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Landkroon E, Mertens G, Engelhard IM. Devaluation of threat memory using a dual-task intervention does not reduce context renewal of fear. Behav Res Ther 2020; 124:103480. [DOI: 10.1016/j.brat.2019.103480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
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Bas‐Hoogendam JM, van Steenbergen H, Blackford JU, Tissier RLM, van der Wee NJA, Westenberg PM. Impaired neural habituation to neutral faces in families genetically enriched for social anxiety disorder. Depress Anxiety 2019; 36:1143-1153. [PMID: 31600020 PMCID: PMC6916167 DOI: 10.1002/da.22962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is an incapacitating disorder running in families. Previous work associated social fearfulness with a failure to habituate, but the habituation response to neutral faces has, as of yet, not been investigated in patients with SAD and their family members concurrently. Here, we examined whether impaired habituation to neutral faces is a putative neurobiological endophenotype of SAD by using data from the multiplex and multigenerational Leiden Family Lab study on SAD. METHODS Participants (n = 110; age, 9.2 - 61.5 years) performed a habituation paradigm involving neutral faces, as these are strong social stimuli with an ambiguous meaning. We used functional magnetic resonance imaging data to investigate whether brain activation related to habituation was associated with the level of social anxiety within the families. Furthermore, the heritability of the neural habituation response was estimated. RESULTS Our data revealed a relationship between impaired habituation to neutral faces and social anxiety in the right hippocampus and right amygdala. In addition, our data indicated that this habituation response displayed moderate - to-moderately high heritability in the right hippocampus. CONCLUSION The present results provide support for altered habituation as a candidate SAD endophenotype; impaired neural habitation cosegregrated with the disorder within families and was heritable. These findings shed light on the genetic susceptibility to SAD.
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Affiliation(s)
- Janna M. Bas‐Hoogendam
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands,Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Henk van Steenbergen
- Leiden Institute for Brain and CognitionLeidenThe Netherlands,Cognitive Psychology Unit, Institute of PsychologyUniversity of LeidenLeidenThe Netherlands
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennessee,Department of Veterans Affairs Medical CenterResearch Service, Research and DevelopmentNashvilleTennessee
| | - Renaud L. M. Tissier
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of PsychologyLeiden UniversityLeidenThe Netherlands,Leiden Institute for Brain and CognitionLeidenThe Netherlands
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Himle JA, LeBeau RT, Weaver A, Brydon DM, Bybee D, Kilbourne AM, Rose RD, Tucker KM, Kim R, Perez M, Smith FN, Sinco BR, Levine S, Hamameh N, Golenberg Z, McKiver M, Wierzbicki PT, Hasratian AM, Craske MG. Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety. Contemp Clin Trials Commun 2019; 16:100464. [PMID: 31701038 PMCID: PMC6831710 DOI: 10.1016/j.conctc.2019.100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA.,Department of Psychiatry, Medical School, University of Michigan, USA
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | - Deborah Bybee
- Department of Psychology, Michigan State University, USA
| | - Amy M Kilbourne
- Department of Psychiatry, Medical School, University of Michigan, USA.,Department of Learning Health Sciences, Medical School, University of Michgan, USA
| | - Raphael D Rose
- Department of Psychology, University of California Los Angeles, USA
| | | | - Richard Kim
- Department of Psychology, University of California Los Angeles, USA
| | - Marcelina Perez
- Department of Psychology, University of California Los Angeles, USA
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Panayiotou G, Panteli M, Vlemincx E. Adaptive and maladaptive emotion processing and regulation, and the case of alexithymia. Cogn Emot 2019; 35:488-499. [PMID: 31556808 DOI: 10.1080/02699931.2019.1671322] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In this conceptual review, we discuss models of emotion and its regulation and identify a spectrum of processes that characterise adaptive adjustment to the affective environment. We describe a dynamic-phasic model of emotion processing and regulation, focusing on five stages: anticipation, response, recovery, habituation and rest as part of a cascade of responses to emotional challenges, as these become progressively expected, proximal, chronic or repeated. We argue for the need to investigate beyond simple reactivity to emotional stimuli, in order to understand mental and physical health conditions where emotional dysregulation plays a role. We propose that a hallmark of an effective and adaptive emotion regulation system is its flexibility, in the service of life goals and values. Consistent with McEwen's model (1998, Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33-44), inflexible emotion regulation can lead to increased allostatic load, from frequent stress, inadequate reactivity, failed shutdown and habituation, which may result in physical and mental illness. Alexithymia exemplifies inflexible emotion regulation, with dysfunctions potentially across all stages of emotion processing, both psychologically and physiologically. These maladaptive processes and their consequence on allostatic load potentially explain the association between alexithymia and physical and mental illness.
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Affiliation(s)
- Georgia Panayiotou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Maria Panteli
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Elke Vlemincx
- School of Biological and Chemical Sciences, Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
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Mitsopoulou T, Kasvikis Y, Koumantanou L, Giaglis G, Skapinakis P, Mavreas V. Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia. Psychother Res 2019; 30:776-787. [PMID: 31510890 DOI: 10.1080/10503307.2019.1663956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.
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Affiliation(s)
- Titika Mitsopoulou
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece.,Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Yiannis Kasvikis
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Lia Koumantanou
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Georgios Giaglis
- School of Psychology, Aristotle University, Thessaloniki, Greece
| | - Petros Skapinakis
- Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Wechsler TF, Kümpers F, Mühlberger A. Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Front Psychol 2019; 10:1758. [PMID: 31551840 PMCID: PMC6746888 DOI: 10.3389/fpsyg.2019.01758] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is in vivo exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and in vivo exposure in studies applying an equivalent amount of exposure in both treatments is necessary. Methods: We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and in vivo. We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' g effect sizes for the treatment effects of VR exposure, in vivo exposure, and the comparison of VR to in vivo exposure in all studies and separately for studies on each diagnosis. Results: Nine studies (n = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and in vivo exposure both showed large, significant effect sizes. The comparison of VR to in vivo exposure revealed a small, but non-significant effect size favoring in vivo (g = -0.20). Specifically, effect sizes for Specific Phobia (g = -0.15) and Agoraphobia (g = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring in vivo (g = -0.50). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring in vivo exposure. Conclusions: We found no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
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Affiliation(s)
- Theresa F. Wechsler
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
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Hoferichter E, Schmidt R, Höfler M, Hoyer J, Rottstädt F, Weidner K, Noack R. Symptombezogene Subgruppen von Patienten mit agoraphobischer Angst. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2019. [DOI: 10.1026/1616-3443/a000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisher ist wenig über symptombezogene Teilgruppen von Patient_innen mit agoraphobischer Angst über die Betrachtung als mit oder ohne Panikstörung hinausgehend bekannt. So sind existierende Behandlungsprogramme meist nicht modularisiert und berücksichtigen die möglicherweise vorhandenen spezifischen Bedarfe kaum. Daher untersuchten wir die Frage, welche Subgruppen anhand von symptombezogenen Variablen identifiziert werden können. Methode: N = 290 Patient_innen mit SKID-Diagnose Agoraphobie mit oder ohne Panikstörung, in einer auf die Behandlung von Angststörungen spezialisierten universitären Tagesklinik, wurden anhand von Skalenwerten des Fragebogens zu angstbezogenen Kognitionen (ACQ) sowie der Panik- und Agoraphobie-Skala (PAS) mittels einer Clusteranalyse nach dem Ward-Verfahren mit anschließender k-means-Optimierung nach inhaltlicher Interpretierbarkeit gruppiert. Die Validität wurde am externen Kriterium „Therapieerfolg“ geprüft. Ergebnisse: Neben zwei Subgruppen mit sehr hoher ( n = 67) und sehr niedriger ( n = 56) Symptomausprägung auf sämtlichen Skalen, wurden zwei qualitativ-symptomatisch differentielle Subtypen identifiziert: der Typus „Körperliche Befürchtungen“ ( n = 81) und der Typus „Verhaltenskontrollverlust“ ( n = 86). Letztere zeigten keine Unterschiede im Therapieerfolg. Schlussfolgerungen: Die Identifikation spezifischer Patient_innengruppen impliziert spezifische Therapiebedarfe und -erwartungen über das Vorliegen einer Paniksymptomatik hinaus. Es zeigte sich, dass der individuellen agoraphobischen Befürchtung bei den unterschiedlichen Patient_innengruppen besondere Bedeutung zukommt, weswegen diese bei der Therapieplanung besondere Beachtung erfahren sollte.
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Affiliation(s)
- Esther Hoferichter
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Ruth Schmidt
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Michael Höfler
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Fabian Rottstädt
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - René Noack
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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van Dis EAM, Hagenaars MA, Bockting CLH, Engelhard IM. Reducing negative stimulus valence does not attenuate the return of fear: Two counterconditioning experiments. Behav Res Ther 2019; 120:103416. [PMID: 31254717 DOI: 10.1016/j.brat.2019.103416] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
Exposure-based treatment for anxiety disorders is effective for many patients, but relapse is not uncommon. One predictor of the return of fear is the negative valence of fear-relevant stimuli. The aim of the current experiments was to examine whether counterconditioning with positive film clips reduces this negative stimulus valence as well as the return of fear, compared to standard extinction training and to an extinction training with non-contingent exposure to the positive film clips. Participants were 87 students in Experiment 1 (three-day paradigm), and 90 students in Experiment 2 (one-day paradigm). They first underwent a differential acquisition phase, in which one of three pictures was paired with an electric shock. They were then randomly allocated to one of the three intervention groups. Afterwards, they underwent a test phase in which pictures were presented without shock (to measure spontaneous recovery of fear), which was followed by unsignaled shocks to induce reinstatement of extinguished fear. Outcome variables were self-reported stimulus valence, shock expectancy, skin conductance, and fear-potentiated startle. In both experiments, counterconditioning decreased negative stimulus valence, relative to the other interventions, but it did not reduce spontaneous fear recovery or fear reinstatement. Overall, our findings do not support the notion that counterconditioning reduces return of fear.
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Affiliation(s)
- Eva A M van Dis
- Utrecht University, Department of Clinical Psychology, the Netherlands.
| | | | | | - Iris M Engelhard
- Utrecht University, Department of Clinical Psychology, the Netherlands
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Veen C, Jacobs G, Philippens I, Vermetten E. Subanesthetic Dose Ketamine in Posttraumatic Stress Disorder: A Role for Reconsolidation During Trauma-Focused Psychotherapy? Curr Top Behav Neurosci 2019; 38:137-162. [PMID: 29637527 DOI: 10.1007/7854_2017_34] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite efforts to develop more effective therapies, PTSD remains a difficult disorder to treat. Insight into the dynamic nature of memory formation and its required molecular machinery can provide an opportunity to target pathological memories for emotionally arousing events. As memories become labile upon retrieval, novel information can update the strength and course of these consolidated memories. Targeting the process of reconsolidation may offer a relevant approach to attenuate fearful and traumatic memories. Specific molecular mechanisms that are required for reconsolidation of arousing information include an intact functioning of the glutamatergic signaling pathways and, more specifically, the integrity of NMDA receptors. Ketamine, a noncompetitive NMDA-receptor antagonist, is receiving increasing interest for a variety of psychiatric indications. This compound can also be an interesting candidate for targeting emotional memories. We explore whether single intravenous infusion of a subanesthetic dose of ketamine can be considered as a viable augmentation strategy for trauma-focused psychotherapy in patients with PTSD. As a consequence, a systematic approach is needed to assess the pharmacodynamic effects of ketamine in relation to both psychotherapy and its pharmacokinetics prior to its application in patient populations. By using a "question-based drug development plan," we can explore such aspects for novel drugs, and we formulated five additional topics that need to be addressed concerning the psychotherapeutic approach and phase orientation of pharmacological assisted psychotherapy.
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Affiliation(s)
- Cato Veen
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Gabriel Jacobs
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Arq Psychotrauma Research Group, Diemen, The Netherlands
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Abstract
The cognitive model of depression was highly stimulating for a better understanding and development of treatment for depression. However, the concept of “cognition” is rather broad and unspecific, and we suggest to focus on the cognitive subset of expectation.
We conducted a narrative review on the role of expectations, and present an expectation-focused model of explaining why depression tends to persist despite the occurrence of positive events.
Several results from basic neuroscience to effects in clinical interventions indicate that expectations play a special role not only for the understanding of the development of mental disorders and the effects of treatment approaches, but especially for an improved understanding of the persistence of mental disorders. If expectations are a major mechanism of depression, the treatment of depression must maximize the violation of dysfunctional expectations. We also introduce the concept of immunization that describes any cognitive or behavioral strategies to reduce the effect of expectation violation experiences, and hereby contributing to expectation maintenance despite expectation contradicting events. We postulate that the development of immunization strategies could help to better understand the transition from episodic to chronic depression.
While in early periods of depression development, a focus on expectation change might be sufficient in treatment, the treatment of patients with chronic depression requires addressing these cognitive and behavioral immunization strategies more intensively. Further implications for treatment and research are outlined that are derived from this balance between expectation violation and cognitive immunization in depression.
A focus on “expectations” helps to better understand the maintenance of depression
We offer a model that explains why depression persists even in the presence of positive experiences.
Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success.
We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization.
A focus on “expectations” helps to better understand the maintenance of depression
We offer a model that explains why depression persists even in the presence of positive experiences.
Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success.
We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization.
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Kube T, Glombiewski J, Rief W. Erwartungsfokussierte psychotherapeutische Interventionen bei Personen mit depressiver Symptomatik. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000496944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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de Jong R, Lommen MJ, de Jong PJ, Nauta MH. Using Multiple Contexts and Retrieval Cues in Exposure-Based Therapy to Prevent Relapse in Anxiety Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Laposa JM, Hawley LL, Grimm KJ, Katz DE, Rector NA. What Drives OCD Symptom Change During CBT Treatment? Temporal Relationships Among Obsessions and Compulsions. Behav Ther 2019; 50:87-100. [PMID: 30661569 DOI: 10.1016/j.beth.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 01/04/2023]
Abstract
Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.
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Affiliation(s)
- Judith M Laposa
- Centre for Addiction and Mental Health, Toronto; University of Toronto.
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
| | | | - Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
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Sevenster D, Visser RM, D'Hooge R. A translational perspective on neural circuits of fear extinction: Current promises and challenges. Neurobiol Learn Mem 2018; 155:113-126. [PMID: 29981423 PMCID: PMC6805216 DOI: 10.1016/j.nlm.2018.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023]
Abstract
Fear extinction is the well-known process of fear reduction through repeated re-exposure to a feared stimulus without the aversive outcome. The last two decades have witnessed a surge of interest in extinction learning. First, extinction learning is observed across species, and especially research on rodents has made great strides in characterising the physical substrate underlying extinction learning. Second, extinction learning is considered of great clinical significance since it constitutes a crucial component of exposure treatment. While effective in reducing fear responding in the short term, extinction learning can lose its grip, resulting in a return of fear (i.e., laboratory model for relapse of anxiety symptoms in patients). Optimization of extinction learning is, therefore, the subject of intense investigation. It is thought that the success of extinction learning is, at least partly, determined by the mismatch between what is expected and what actually happens (prediction error). However, while much of our knowledge about the neural circuitry of extinction learning and factors that contribute to successful extinction learning comes from animal models, translating these findings to humans has been challenging for a number of reasons. Here, we present an overview of what is known about the animal circuitry underlying extinction of fear, and the role of prediction error. In addition, we conducted a systematic literature search to evaluate the degree to which state-of-the-art neuroimaging methods have contributed to translating these findings to humans. Results show substantial overlap between networks in animals and humans at a macroscale, but current imaging techniques preclude comparisons at a smaller scale, especially in sub-cortical areas that are functionally heterogeneous. Moreover, human neuroimaging shows the involvement of numerous areas that are not typically studied in animals. Results obtained in research aimed to map the extinction circuit are largely dependent on the methods employed, not only across species, but also across human neuroimaging studies. Directions for future research are discussed.
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Affiliation(s)
- Dieuwke Sevenster
- Laboratory of Biological Psychology, Department of Psychology, KU Leuven, Tiensestraat 102, B-3000 Leuven, Belgium; Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | - Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Rudi D'Hooge
- Laboratory of Biological Psychology, Department of Psychology, KU Leuven, Tiensestraat 102, B-3000 Leuven, Belgium
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Wannemueller A, Fasbender A, Kampmann Z, Weiser K, Schaumburg S, Velten J, Margraf J. Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals. Front Psychol 2018; 9:1534. [PMID: 30186206 PMCID: PMC6110887 DOI: 10.3389/fpsyg.2018.01534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Large-group one-session treatments (LG-OSTs) might represent a promising treatment tool as increasing evidence suggests their effectiveness in individuals with different situational fears. In the present study, we explored feasibility and effectiveness of an exposure-based LG-OST protocol applying applied tension and diaphragmatic breathing as coping strategies in a sample of 40 individuals, highly fearful of blood-injury-injection (BII). Method: We assessed participants’ BII-fear using questionnaires and a behavioral approach test (BAT) before and after treatment, consisting of a blood-drawing procedure. Stability of treatment effects was assessed via online-survey at 7-month follow-up. Results: The LG-OST procedure evidenced feasible and effective. Pre-post treatment comparisons showed medium to large treatment effects (d = 0.40–0.93) regarding the questionnaire measures. After being treated, 70% of the individuals successfully underwent a blood drawing. Moreover, participants continued to improve in the post follow-up interval leading to large treatment effects (d = 1.19–1.62). Conclusion: In treating BII-fear, LG-OSTs might not only serve within a framework of a stepped care approach but also could represent a useful single-treatment option. Additionally, due to their high efficiency and standardization of treatment delivery, LG-OST protocols might foster research at the interface of basic and clinical research.
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Affiliation(s)
- André Wannemueller
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Alessa Fasbender
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Zarah Kampmann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Kristin Weiser
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Svenja Schaumburg
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Julia Velten
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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Thompson A, McEvoy PM, Lipp OV. Enhancing extinction learning: Occasional presentations of the unconditioned stimulus during extinction eliminate spontaneous recovery, but not necessarily reacquisition of fear. Behav Res Ther 2018; 108:29-39. [DOI: 10.1016/j.brat.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/21/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023]
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