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Tully LM, Blendermann M, Fine JR, Zakskorn LN, Fritz M, Hamlett GE, Lamb ST, Moody AK, Ng J, Parakul N, Ritter BM, Rahim R, Yu G, Taylor SL. The SocialVidStim: a video database of positive and negative social evaluation stimuli for use in social cognitive neuroscience paradigms. Soc Cogn Affect Neurosci 2024; 19:nsae024. [PMID: 38597895 PMCID: PMC11015894 DOI: 10.1093/scan/nsae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 01/06/2023] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
This paper describes the SocialVidStim-a database of video stimuli available to the scientific community depicting positive and negative social evaluative and neutral statements. The SocialVidStim comprises 53 diverse individuals reflecting the demographic makeup of the USA, ranging from 9 to 41 years old, saying 20-60 positive and 20-60 negative social evaluative statements (e.g. 'You are a very trustworthy/annoying person'), and 20-60 neutral statements (e.g. 'The sky is blue'), totaling 5793 videos post-production. The SocialVidStim are designed for use in behavioral and functional magetic resonance imaging paradigms, across developmental stages, in diverse populations. This study describes stimuli development and reports initial validity and reliability data on a subset videos (N = 1890) depicting individuals aged 18-41 years. Raters perceive videos as expected: positive videos elicit positively valenced ratings, negative videos elicit negatively valenced ratings and neutral videos are rated as neutral. Test-retest reliability data demonstrate intraclass correlations in the good-to-excellent range for negative and positive videos and the moderate range for neutral videos. We also report small effects on valence and arousal that should be considered during stimuli selection, including match between rater and actor sex and actor believability. The SocialVidStim is a resource for researchers and we offer suggestions for using the SocialVidStim in future research.
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Affiliation(s)
- Laura M Tully
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Mary Blendermann
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Jeffrey R Fine
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Lauren N Zakskorn
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Matilda Fritz
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Gabriella E Hamlett
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Shannon T Lamb
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Anna K Moody
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Julenne Ng
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Narimes Parakul
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Bryn M Ritter
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Raisa Rahim
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Grace Yu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA
| | - Sandra L Taylor
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA 95817, USA
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Vanderkruik RC, Ferguson C, Kobylski LA, Locascio JJ, Hamlett GE, Killenberg PC, Lewis R, Jones N, Rossa ET, Dineen H, Picard R, Cohen LS. Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study. JMIR Form Res 2024; 8:e44029. [PMID: 38277191 PMCID: PMC10858420 DOI: 10.2196/44029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. OBJECTIVE The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. METHODS This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. RESULTS The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=-.35; t61=-3.05; P=.003), number of activities completed (β=-.12; t61=-2.05; P=.04), days played (β=-.12; t58=-2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=-3.05; t45=-2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. CONCLUSIONS Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression.
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Affiliation(s)
- Rachel C Vanderkruik
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Craig Ferguson
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lauren A Kobylski
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, United States
| | - Joseph J Locascio
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | | | - Parker C Killenberg
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
| | - Robert Lewis
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Noah Jones
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ella T Rossa
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah Dineen
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
| | - Rosalind Picard
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lee S Cohen
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Tyler J, Gallagher T, Wheaton MG, Hamlett GE, Rosenfield B, Rosenfield D, Simpson HB, Foa EB. Predictors of clinical worsening during a discontinuation trial of serotonin reuptake inhibitors for obsessive compulsive disorder. J Anxiety Disord 2024; 101:102805. [PMID: 38113781 DOI: 10.1016/j.janxdis.2023.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To explore predictors and moderators of clinical worsening during a double-blind trial in which patients with obsessive-compulsive disorder (OCD) were randomized to either continue or discontinue their Serotonin Reuptake Inhibitor (SRI) medication after achieving wellness from the addition of exposure and response prevention (EX/RP) therapy. METHOD The data came from a double-blind discontinuation trial that included N = 101 participants, 35 of whom were removed from the study due to clinical worsening. We first used LASSO logistic regression to identify which of the 34 potential baseline variables of interest (including demographics, diagnoses, other relevant clinical constructs, and specific genotypes), might moderate or predict this clinical worsening. Then logistic regression was used to examine which of these identified variables were significantly related to later clinical worsening. We verified the validity of our final prediction model using k-fold cross-validation. RESULTS There was one significant predictor of clinical worsening: In both groups, those with more past diagnoses had a greater likelihood of clinical worsening (p = .015). There were several moderators. Rates of clinical worsening were higher in the Discontinuation group compared to the Continuation group for participants who were taking a shorter half-life SRI (p = .044), were female (p = .022), had higher baseline levels of maladaptive metacognitions (p < .001), had fewer sleep problems at baseline (p = .001), and/or had more years of education (p < .001). CONCLUSIONS Our results identified several factors that may predict the development of clinical worsening in OCD patients discontinuing SRI medication following successful EX/RP treatment.
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Affiliation(s)
- Jeremy Tyler
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Thea Gallagher
- New York University, Department of Psychiatry, New York, NY 10016, USA
| | - Michael G Wheaton
- Barnard College, Columbia University, New York, NY 10027, USA; New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Helen B Simpson
- New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Brown LA, Zhu Y, Hamlett GE, Moore TM, DiDomenico GE, Visoki E, Greenberg DM, Gur RC, Gur RE, Barzilay R. COVID-19 Worries and Insomnia: A Follow-Up Study. Int J Environ Res Public Health 2023; 20:4568. [PMID: 36901578 PMCID: PMC10001605 DOI: 10.3390/ijerph20054568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elevations in either worry or insomnia should be considered for evidence-based treatments for these symptoms to prevent secondary symptoms in the future. Future research should evaluate the extent to which dissemination of evidence-based practices for chronic worry (a core feature of generalized anxiety disorder or illness anxiety disorder) or insomnia reduces the development of co-occurring symptoms during a global disaster.
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Affiliation(s)
- Lily A. Brown
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Yiqin Zhu
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Gabriella E. Hamlett
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Tyler M. Moore
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Grace E. DiDomenico
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Elina Visoki
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - David M. Greenberg
- Department of Music, Bar Ilan University, Ramat Gan 5290002, Israel
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
| | - Ruben C. Gur
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Raquel E. Gur
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Ran Barzilay
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
- Department of Child Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Hamlett GE, Tyler J, Bredemeier K, Ballentine E, Brown LA. The impact of COVID-19 on treatment seeking and interest in internet-based therapy for anxiety-related disorders: An interrupted time-series analysis. Psychiatry Res 2023; 320:115044. [PMID: 36638695 PMCID: PMC9798668 DOI: 10.1016/j.psychres.2022.115044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
AIMS To examine whether the onset of the COVID-19 pandemic led to a change in demand for psychiatric treatment, interest in internet-based therapy, and differences in treatment requests by self-reported diagnoses (e.g., Posttraumatic Stress Disorder, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder). METHODS Using an interrupted time series design, we analyzed intake questionnaires of treatment-seeking patients (N = 1,954) at an anxiety treatment center between June 6, 2019 through September 13, 2021. RESULTS The change in general treatment-seeking from before to immediately after the global pandemic declaration was not statistically significant. However, there was a steady increase in treatment seeking, with a more pronounced increase from 2020 into 2021. Interest in internet-based therapy increased significantly after the onset of COVID-19. The number of treatment-seeking individuals who self-reported "concerns or diagnoses" of PTSD increased significantly. CONCLUSION The study supports anecdotal reports from clinics across the country about unprecedented demand for services. It highlights that many patients experienced an immediate impact of the pandemic on their self-reported concerns about trauma and PTSD symptoms, which has important clinical implications. It also highlights a shifting openness to internet-based services during the pandemic.
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Affiliation(s)
- Gabriella E. Hamlett
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA,Harvard University, Department of Psychology, Cambridge, MA, USA
| | - Jeremy Tyler
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Keith Bredemeier
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Emily Ballentine
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Lily A. Brown
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA,Corresponding author
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Hamlett GE, Foa EB, Brown LA. Exposure Therapy and Its Mechanisms. Curr Top Behav Neurosci 2023; 64:273-288. [PMID: 37532963 DOI: 10.1007/7854_2023_428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Exposure therapy is the gold-standard treatment approach for pathological anxiety. This therapeutic approach builds on principles of extinction training from traditional fear conditioning and extinction protocols. In this chapter, we discuss principles of exposure therapy in the clinic and the laboratory experimental results that guide our decisions in the therapy. We discuss emotional processing theory and inhibitory learning principles, with a focus on expectation violation. We conclude with future research directions needed to improve exposure therapy outcomes among patients with anxiety-related disorders.
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Affiliation(s)
- Gabriella E Hamlett
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, USA
| | - Edna B Foa
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, USA
| | - Lily A Brown
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, USA.
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Foa EB, Simpson HB, Gallagher T, Wheaton MG, Gershkovich M, Schmidt AB, Huppert JD, Imms P, Campeas RB, Cahill S, DiChiara C, Tsao SD, Puliafico A, Chazin D, Asnaani A, Moore K, Tyler J, Steinman SA, Sanches-LaCay A, Capaldi S, Snorrason Í, Turk-Karan E, Vermes D, Kalanthroff E, Pinto A, Hamlett GE, Middleton R, Hahn CG, Xu B, Van Meter PE, Katechis M, Rosenfield D. Maintenance of Wellness in Patients With Obsessive-Compulsive Disorder Who Discontinue Medication After Exposure/Response Prevention Augmentation: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:193-200. [PMID: 35080598 PMCID: PMC8792795 DOI: 10.1001/jamapsychiatry.2021.3997] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/04/2021] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Serotonin reuptake inhibitors (SRIs) are the only medications approved for obsessive-compulsive disorder (OCD), yet most patients taking SRIs exhibit significant symptoms. Adding exposure/response prevention (EX/RP) therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs. OBJECTIVE To assess whether patients with OCD who are taking SRIs and have attained wellness after EX/RP augmentation can discontinue their SRI with noninferior outcomes compared with those who continue their SRI therapy. DESIGN, SETTING, AND PARTICIPANTS A 24-week, double-blind, randomized clinical trial was performed from May 3, 2013, to June 25, 2018. The trial took place at US academic medical centers. Participants included 137 adults with a principal diagnosis of OCD (≥1 year) who were taking an SRI (≥12 weeks), had at least moderate symptoms (defined as Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score ≥18 points), and received as many as 25 sessions of EX/RP therapy. Those who attained wellness (Y-BOCS score ≤14 points; 103 patients [75.2%]) were study eligible. Data were analyzed from June 29, 2019, to October 2, 2021. INTERVENTION Participants were randomly assigned either to receive taper to placebo (taper group) or to continue their SRI (continuation group) and monitored for 24 weeks. MAIN OUTCOME AND MEASURES The Y-BOCS score (range, 0-40 points) was the primary outcome; the Hamilton Depression Rating Scale (HDRS; range, 0-52 points) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF; range, 0%-100%) scores were secondary outcomes. Outcomes were assessed at 8 time points by independent evaluators who were blinded to randomization. The taper regimen was hypothesized to be noninferior to continuation at 24 weeks using a 1-sided α value of .05. RESULTS A total of 101 patients (mean [SD] age, 31.0 [11.2] years; 55 women [54.5%]) participated in the trial: 51 patients (50.5%) in the taper group and 50 patients (49.5%) in the continuation group. At 24 weeks, patients in the taper group had noninferior results compared with patients in the continuation group (mean [SD] Y-BOCS score: taper group, 11.47 [6.56] points; continuation group: 11.51 [5.97] points; difference, -0.04 points; 1-sided 95% CI, -∞ to 2.09 points [below the noninferiority margin of 3.0 points]; mean [SD] HDRS score: taper group, 5.69 [3.84] points; continuation group, 4.61 [3.46] points; difference, 1.08 points; 1-sided 95% CI, -∞ to 2.28 points [below the noninferiority margin of 2.5 points]; mean [SD] Q-LES-Q-SF score: taper group, 68.01% [15.28%]; continuation group, 70.01% [15.59%]; difference, 2.00%; 1-sided 95% CI, -∞ to 6.83 [below the noninferiority margin of 7.75]). However, the taper group had higher rates of clinical worsening (23 of 51 [45%] vs 12 of 50 [24%]; P = .04). CONCLUSIONS AND RELEVANCE Results of this randomized clinical trial show that patients with OCD who achieve wellness after EX/RP therapy could, on average, discontinue their SRI with noninferior outcomes compared with those who continued their SRI. Those who tapered the SRI had higher clinical worsening rates. Future research should evaluate if SRI half-life alters these rates. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01686087.
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Affiliation(s)
- Edna B. Foa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
- Associate Editor, JAMA Psychiatry
| | - Thea Gallagher
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael G. Wheaton
- New York State Psychiatric Institute, New York
- Barnard College, Columbia University, New York, New York
| | - Marina Gershkovich
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Andrew B. Schmidt
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | | | - Patricia Imms
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raphael B. Campeas
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | | | - Christina DiChiara
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Anxiety and Behavior Therapy, Bryn Mawr, Pennsylvania
| | - Steven D. Tsao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Anxiety and Behavior Therapy, Bryn Mawr, Pennsylvania
| | - Anthony Puliafico
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Daniel Chazin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anu Asnaani
- Department of Psychology, University of Utah, Salt Lake City
| | - Kelly Moore
- Rutgers University/Biomedical Health Sciences, New Brunswick, New Jersey
| | - Jeremy Tyler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Sandy Capaldi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Elizabeth Turk-Karan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Donna Vermes
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | - Eyal Kalanthroff
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Columbia University, New York, New York
- University of Wisconsin, Milwaukee
| | - Anthony Pinto
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, New York
| | - Gabriella E. Hamlett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Chang-Gyu Hahn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bin Xu
- Department of Psychiatry, Columbia University, New York, New York
| | - Page E. Van Meter
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas
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8
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Brown LA, Hamlett GE, Zhu Y, Wiley JF, Moore TM, DiDomenico GE, Visoki E, Greenberg DM, Gur RC, Gur RE, Barzilay R. Worry about COVID-19 as a predictor of future insomnia. J Sleep Res 2022; 31:e13564. [PMID: 35165971 PMCID: PMC9115197 DOI: 10.1111/jsr.13564] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Abstract
The coronavirus disease 2019 (COVID‐19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID‐19 are more strongly associated with insomnia. Using a three‐part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID‐19 exposures, COVID‐19 worries, and insomnia. We hypothesised that COVID‐19‐related worries and exposure to risk of COVID‐19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time‐points indicating their exposures to COVID‐19 risk factors, COVID‐19‐related worries, and insomnia. COVID‐19 worry variables were consistently associated with greater insomnia severity, whereas COVID‐19 exposure variables were not. COVID‐19 worries decreased significantly over time, and there were significant interactions between change in COVID‐19 worries and change in insomnia severity over time. Individuals who experienced increases in COVID‐19 worries also experienced increases in insomnia severity. Changes in worry during the COVID‐19 pandemic were associated with changes in insomnia; worries about COVID‐19 were a more consistent predictor of insomnia than COVID‐19 exposures. Evidence‐based treatments targeting virus‐related worries may improve insomnia during this and future calamities.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gabriella E Hamlett
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yiqin Zhu
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Grace E DiDomenico
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Elina Visoki
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ran Barzilay
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania, USA.,Children's Hospital of Philadelphia Department of Child Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania, USA
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