The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis

Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review

Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.

Insights into the nutritional prevention of macular degeneration based on a comparative topic modeling approach

Topic modeling and text mining are subsets of natural language processing (NLP) with relevance for conducting meta-analysis (MA) and systematic review (SR). For evidence synthesis, the above NLP methods are conventionally used for topic-specific literature searches or extracting values from reports to automate essential phases of SR and MA. Instead, this work proposes a comparative topic modeling approach to analyze reports of contradictory results on the same general research question. Specifically, the objective is to identify topics exhibiting distinct associations with significant results for an outcome of interest by ranking them according to their proportional occurrence in (and consistency of distribution across) reports of significant effects. Macular degeneration (MD) is a disease that affects millions of people annually, causing vision loss. Augmenting evidence synthesis to provide insight into MD prevention is therefore of central interest in this article. The proposed method was tested on broad-scope studies addressing whether supplemental nutritional compounds significantly benefit macular degeneration. Six compounds were identified as having a particular association with reports of significant results for benefiting MD. Four of these were further supported in terms of effectiveness upon conducting a follow-up literature search for validation (omega-3 fatty acids, copper, zeaxanthin, and nitrates). The two not supported by the follow-up literature search (niacin and molybdenum) also had scores in the lowest range under the proposed scoring system. Results therefore suggest that the proposed method's score for a given topic may be a viable proxy for its degree of association with the outcome of interest, and can be helpful in the systematic search for potentially causal relationships. Further, the compounds identified by the proposed method were not simultaneously captured as salient topics by state-of-the-art topic models that leverage document and word embeddings (Top2Vec) and transformer models (BERTopic). These results underpin the proposed method's potential to add specificity in understanding effects from broad-scope reports, elucidate topics of interest for future research, and guide evidence synthesis in a scalable way. All of this is accomplished while yielding valuable and actionable insights into the prevention of MD.

Sensitivity and specificity in affective and social learning in adolescence

Adolescence is a period of heightened affective and social sensitivity. In this review we address how this increased sensitivity influences associative learning. Based on recent evidence from human and rodent studies, as well as advances in computational biology, we suggest that, compared to other age groups, adolescents show features of heightened Pavlovian learning but tend to perform worse than adults at instrumental learning. Because Pavlovian learning does not involve decision-making, whereas instrumental learning does, we propose that these developmental differences might be due to heightened sensitivity to rewards and threats in adolescence, coupled with a lower specificity of responding. We discuss the implications of these findings for adolescent mental health and education.

Comparison between Standard Expository Cognitive Behavioral Therapy (CBT-E) and Immersive Virtual Reality CBT (CBT-VR) for Rehabilitation of Patients Affected by Occupational Stress Disorders: Study Protocol

Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms that can lead to occupational stress diseases, namely Adjustment Disorder and Post-Traumatic Stress Disorder. The literature has evidenced that "exposure therapy" of cognitive-behavioral training (CBT-E) seems to be the most effective technique to manage stress symptoms, including work stress diseases, and several studies have considered Virtual Reality (VR) as an adjuvant tool to exposure-based psychotherapy (CBT-VR) for the treatment of multiple psychiatric disorders. The aim of this study is to evaluate the effectiveness of CBT with exposure to stressful work scenarios in imaginative (CBT-E) and in immersive virtual reality (CBT-VR) scenarios in a group of workers affected by work-related stress disorders and compare the clinical and physiological outcomes between the two exposure techniques. A long-term goal would be to develop an evidence-based rehabilitation program as a treatment for the reintegration into work of patients affected by these psychiatric disorders.

Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder

Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic approaches, including medication, are effective in alleviating symptoms of anxiety disorders and posttraumatic stress disorder (PTSD), at least in some individuals, but have unwanted side-effects and do not resolve underlying pathophysiology. After a period of stagnation, there is renewed enthusiasm from public, academic and commercial parties in designing and developing drug treatments for these disorders. Here, we aim to provide a snapshot of the current state of this field that is written for neuropharmacologists, but also practicing clinicians and the interested lay-reader. After introducing currently available drug treatments, we summarize recent/ongoing clinical assessment of novel medicines for anxiety and PTSD, grouped according to primary neurochemical targets and their potential to produce acute and/or enduring therapeutic effects. The evaluation of putative treatments targeting monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic and neuropeptide systems, amongst others, are discussed. We emphasize the importance of designing and clinically assessing new medications based on a firm understanding of the underlying neurobiology stemming from the rapid advances being made in neuroscience. This includes harnessing neuroplasticity to bring about lasting beneficial changes in the brain rather than - as many current medications do - produce a transient attenuation of symptoms, as exemplified by combining psychotropic/cognitive enhancing drugs with psychotherapeutic approaches. We conclude by noting some of the other emerging trends in this promising new phase of drug development.

Psychotherapeutic interventions for childhood posttraumatic stress disorder: an update

PURPOSE OF THE REVIEW

We review treatment outcome studies and systematic reviews for childhood and adolescent posttraumatic stress disorder (PTSD) between January 2020 and August 2022, including studies involving younger children and different treatment delivery methods and models. We address predictors, moderators, treatment engagement, and attrition.

RECENT FINDINGS

Recent randomised controlled trials corroborate earlier trials documenting trauma-focused cognitive behaviour therapy (TF-CBT) as a highly efficacious treatment for PTSD. Evidence for treatment effects in complex PTSD in youth is still sparse. Research on moderators and predictors of treatment continues to be hampered by multiple factors, including a lack of sufficiently large homogeneous trauma samples.

SUMMARY

TF-CBT is a very effective treatment for children and adolescents with PTSD. Further work is needed to (i) demonstrate that task-shifting models utilising lay community health counsellors and peer counsellors can effectively and cost-effectively close the mental health treatment gap that exists world-wide in children and adolescents diagnosed with PTSD, but particularly within low- and middle income countries, and (ii) better understand moderators and predictors of treatment which remains a priority.