1
|
Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD. Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial. Behav Res Ther 2024; 172:104458. [PMID: 38103359 DOI: 10.1016/j.brat.2023.104458] [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: 05/02/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
Collapse
Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Andrew Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Matthew A Hiller
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Luke J Norman
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aileen Prout
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Angela A Shunnarah
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hannah C Becker
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stefanie R Russman Block
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA
| |
Collapse
|
2
|
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] [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] [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.
Collapse
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)
| |
Collapse
|
3
|
De Nadai AS, Fitzgerald KD, Norman LJ, Russman Block SR, Mannella KA, Himle JA, Taylor SF. Defining brain-based OCD patient profiles using task-based fMRI and unsupervised machine learning. Neuropsychopharmacology 2023; 48:402-409. [PMID: 35681047 PMCID: PMC9751092 DOI: 10.1038/s41386-022-01353-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022]
Abstract
While much research has highlighted phenotypic heterogeneity in obsessive compulsive disorder (OCD), less work has focused on heterogeneity in neural activity. Conventional neuroimaging approaches rely on group averages that assume homogenous patient populations. If subgroups are present, these approaches can increase variability and can lead to discrepancies in the literature. They can also obscure differences between various subgroups. To address this issue, we used unsupervised machine learning to identify subgroup clusters of patients with OCD who were assessed by task-based fMRI. We predominantly focused on activation of cognitive control and performance monitoring neurocircuits, including three large-scale brain networks that have been implicated in OCD (the frontoparietal network, cingulo-opercular network, and default mode network). Participants were patients with OCD (n = 128) that included both adults (ages 24-45) and adolescents (ages 12-17), as well as unaffected controls (n = 64). Neural assessments included tests of cognitive interference and error processing. We found three patient clusters, reflecting a "normative" cluster that shared a brain activation pattern with unaffected controls (65.9% of clinical participants), as well as an "interference hyperactivity" cluster (15.2% of clinical participants) and an "error hyperactivity" cluster (18.9% of clinical participants). We also related these clusters to demographic and clinical correlates. After post-hoc correction for false discovery rates, the interference hyperactivity cluster showed significantly longer reaction times than the other patient clusters, but no other between-cluster differences in covariates were detected. These findings increase precision in patient characterization, reframe prior neurobehavioral research in OCD, and provide a starting point for neuroimaging-guided treatment selection.
Collapse
Affiliation(s)
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Luke J Norman
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Joseph A Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Rueppel M, Mannella KA, Fitzgerald KD, Schroder HS. Post-error slowing in anxiety and obsessive-compulsive disorders. Cogn Affect Behav Neurosci 2022; 22:610-624. [PMID: 34966981 DOI: 10.3758/s13415-021-00976-9] [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] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
Altered brain response to errors in anxiety and obsessive-compulsive disorders (OCD) suggests cognitive control abnormalities across both types of illness, but behavioral metrics of cognitive control function have yet to be compared in patients selected from these different diagnostic categories. Thus, we examined post-error slowing (PES), a behavioral adjustment that typically occurs after a mistake, in children and adolescents with and without a primary anxiety disorder (N = 103 anxiety and N = 28 healthy controls) and adolescents and adults with and without OCD (N = 118 OCD and N = 60 healthy controls) using a go/no-go task. Primary analyses tested for differences in PES between diagnostic groups (anxiety, OCD, healthy), controlling for age, overall reaction time, and overall accuracy. Results indicated that patients with anxiety disorders exhibited more post-error slowing than both patients with OCD and healthy volunteers. In contrast, participants with OCD did not differ from healthy volunteers in post-error slowing. In subgroup analyses restricted to adolescent participants (ages 13-17 years), more post-error slowing was observed in the anxiety disorders group compared with either the OCD or healthy groups. These data suggest that excessive post-error slowing, an index of behavioral adjustment following errors, may uniquely characterize patients with anxiety disorders relative to healthy individuals and those with OCD.
Collapse
Affiliation(s)
- Meryl Rueppel
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
5
|
Horbatch F, Hruschak J, Hall M, Mannella KA, Synger A, Ip KI, Liu Y, Sadlier R, Gillett CB, Moser JS, Muzik M, Rosenblum KL, Fitzgerald KD. Conducting EEG research in clinically anxious preschoolers: A pilot study and preliminary recommendations. Dev Psychobiol 2021; 63:e22183. [PMID: 34674238 DOI: 10.1002/dev.22183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/14/2021] [Revised: 06/28/2021] [Accepted: 07/23/2021] [Indexed: 11/08/2022]
Abstract
Electroencephalography (EEG) data collection can be challenging in preschoolers with anxiety who are often debilitated by fear of the unknown. Thus, we iteratively refined techniques for EEG collection in three cohorts of children with anxiety enrolled in our study of a novel intervention. Techniques involved directing child attention away from the EEG setup (Cohort 1, N = 18), open discussion of equipment and processes during setup (Cohort 2, N = 21), and a preparatory EEG-exposure session prior to data collection (Cohort 3, N = 6). Children (N = 45, 4-7 years) attempted a Time 1 EEG before intervention, and those who completed intervention (N = 28) were invited to a Time 2 EEG. The percentages who provided analyzable EEGs were assessed by cohort. Cohort 3 provided more Time 1 EEGs (83.3%) than Cohorts 1 or 2 (66.7% each), suggesting that the preparatory session supported first-time EEG collection. More children provided Time 2 EEG data across successive cohorts (Cohort 1: 66.7%, Cohort 2: 82%, Cohort 3: 100%), suggesting that more open communication facilitated repeat EEG collection. Ultimately, increased EEG exposure and child-friendly communication about procedures improved data acquisition in this sample of clinically anxious preschoolers. Detailed study procedures are shared to support future EEG research in young children with anxiety.
Collapse
Affiliation(s)
- Faith Horbatch
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jessica Hruschak
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Melissa Hall
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kristin A Mannella
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ashley Synger
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ka I Ip
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Raleigh Sadlier
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Carrie B Gillett
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Katherine L Rosenblum
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York, USA
| |
Collapse
|
6
|
Premo JE, Mannella KA, Duval ER, Liu Y, Morrison CL, Moser JS, Muzik M, Rosenblum KL, Fitzgerald KD. Startle to neutral, not negative stimuli: A neurophysiological correlate of behavioral inhibition in young children. Dev Psychobiol 2021; 63:1322-1329. [PMID: 33782955 DOI: 10.1002/dev.22120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/08/2020] [Revised: 01/27/2021] [Accepted: 03/06/2021] [Indexed: 11/06/2022]
Abstract
A putative biomarker of anxiety risk, the startle response is typically enhanced by negative compared to neutral emotion modulation in adults, but remains understudied in children. To determine the extent to which neutral, negative, and positively valenced emotional conditions modulate startle response in early life, a child-friendly film paradigm was used to vary emotion across these conditions during startle induction in sixty-four 4- to 7-year-old children. Association of emotion-modulated startle with parent-reported anxiety symptom severity and child behavioral inhibition, a risk factor for anxiety problems, were assessed. Analyses revealed no difference in startle magnitude during negative compared to neutral film clips. By contrast, startle during both negative and neutral conditions was greater than startle during the positive condition. Larger startle magnitude during the neutral condition associated with higher levels of child behavioral inhibition (BI). These results are consistent with possible immaturity of startle response in young children, and suggest that startle amplitude in more emotionally ambiguous, neutral conditions could serve as an early biomarker for anxiety risk.
Collapse
Affiliation(s)
- Julie E Premo
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Elizabeth R Duval
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Claire L Morrison
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Norman LJ, Mannella KA, Yang H, Angstadt M, Abelson JL, Himle JA, Fitzgerald KD, Taylor SF. Treatment-Specific Associations Between Brain Activation and Symptom Reduction in OCD Following CBT: A Randomized fMRI Trial. Am J Psychiatry 2021; 178:39-47. [PMID: 32854533 PMCID: PMC8528223 DOI: 10.1176/appi.ajp.2020.19080886] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to examine whether brain activity is associated with treatment response to cognitive-behavioral therapy (CBT) in adolescents and adults with obsessive-compulsive disorder (OCD), and whether any associations are treatment specific relative to an active control psychotherapy (stress management therapy; SMT). METHODS Eighty-seven patients with OCD (age range 12-45 years; 57 female, 39 medicated) were randomly assigned to receive 12 weeks of CBT or SMT. Prior to treatment, functional MRI scans were conducted in patients performing an incentive flanker task, which probes brain activation to both cognitive control and reward processing. Voxelwise linear mixed-effects models examined whether baseline brain activation was differentially associated with change in scores on the Yale-Brown Obsessive Compulsive Scale (standard or Children's version) over the course of CBT or SMT treatment. RESULTS Within the CBT group, a better treatment response was significantly associated with greater pretreatment activation within the right temporal lobe and rostral anterior cingulate cortex during cognitive control and within the ventromedial prefrontal, orbitofrontal, lateral prefrontal, and amygdala regions during reward processing. In contrast, reduced pretreatment activation within a largely overlapping set of regions was significantly associated with a better treatment response to SMT. CONCLUSIONS The study findings demonstrate that associations between brain activation and treatment response were treatment specific to CBT relative to a control psychotherapy and that these associations were stable from adolescence to mature adulthood. Such treatment-specific associations are important for the development of biomarkers to personalize treatment in OCD.
Collapse
Affiliation(s)
- Luke J. Norman
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA.,Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, 20892, USA
| | - Kristin A. Mannella
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Huan Yang
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA.,The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mike Angstadt
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - James L. Abelson
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Joseph A. Himle
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Kate D. Fitzgerald
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Stephan F. Taylor
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| |
Collapse
|
8
|
Krentzman AR, Mannella KA, Hassett AL, Barnett NP, Cranford JA, Brower KJ, Higgins MM, Meyer PS. Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder. J Posit Psychol 2015; 10:477-488. [PMID: 27076837 PMCID: PMC4827271 DOI: 10.1080/17439760.2015.1015158] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/30/2015] [Indexed: 01/17/2023]
Abstract
This mixed-methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the 'Three Good Things' exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder (AUD). Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily emails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g., feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable, and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery.
Collapse
Affiliation(s)
- Amy R. Krentzman
- University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Kristin A. Mannella
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Afton L. Hassett
- University of Michigan, Department of Anesthesiology, Chronic Pain and Fatigue Research Center, 24 Frank Lloyd Wright Drive, Ann Arbor Charter Township, MI, USA, 48105
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies and Department of Behavioral and Social Sciences, Brown University, 121 South Main Street, Providence, RI, USA, 02903
| | - James A. Cranford
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Kirk J. Brower
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Margaret M. Higgins
- University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
| | - Piper S. Meyer
- Minnesota Center for Mental Health, University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
| |
Collapse
|
9
|
Konstantinova SA, Mannella KA, Skulachev VP, Zorov DB. [Detection of porin in inter-mitochondrial contacts]. Biokhimiia 1994; 59:1109-21. [PMID: 7529565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The binding of monoclonal antibodies (mAb) to the N-terminal part of VDAC with freshly isolated, unfixed rat heart mitochondria has been studied. It was established that mAb do not react with the main portion of the mitochondria. At the same time, successful binding to some of those was observed. Gold particles were organized, as a rule in three types of clusters: (i) thread-like clusters; (ii) small, irregularly shaped clusters, and (iii) big clusters covering the greater part of the mitochondrial surface. In the region of tight junctions between mitochondria, specific binding of mAb to mitochondrial VDAC, such as thread-like and small clusters, was found. In some cases, antibody clusters were localized in the region which separates two mitochondrial compartments differing in configuration of the cristae. When the outer mitochondrial membrane was partially stripped off, this membrane was extensively labelled by antibodies. It is concluded that the N-terminus of porin is localized on the inner surface of the outer mitochondrial membrane, so that some damage of the outer membrane appears to be required to allow the N-terminal porin antibody to contact the antigenic determinant. Such a damage is apparently more probable in the place of contacts of two mitochondria or two mitoplasts covered by the common outer membrane. In any case, the data obtained strongly suggest that porin is present in the junction region.
Collapse
|