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Tabak BA, Young KS, Torre JB, Way BM, Burklund LJ, Eisenberger NI, Lieberman MD, Craske MG. Preliminary Evidence That CD38 Moderates the Association of Neuroticism on Amygdala-Subgenual Cingulate Connectivity. Front Neurosci 2020; 14:11. [PMID: 32116489 PMCID: PMC7033443 DOI: 10.3389/fnins.2020.00011] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022] Open
Abstract
CD38 genetic variation has been associated with autism spectrum disorders and social anxiety disorder, which may result from CD38’s regulation of oxytocin secretion. Converging evidence has found that the rs3796863 A-allele contributes to increased social sensitivity compared to the CC genotype. The current study examined the moderating role of CD38 genetic variants (rs3796863 and rs6449182) that have been associated with enhanced (or reduced) social sensitivity on neural activation related to neuroticism, which is commonly elevated in individuals with social anxiety and depression. Adults (n = 72) with varying levels of social anxiety and depression provided biological samples for DNA extraction, completed a measure of neuroticism, and participated in a standardized emotion processing task (affect matching) while undergoing fMRI. A significant interaction effect was found for rs3796863 x neuroticism that predicted right amygdala-subgenual anterior cingulate cortex (sgACC) functional connectivity. Simple slopes analyses showed a positive association between neuroticism and right amygdala-sgACC connectivity among rs3796863 A-allele carriers. Findings suggest that the more socially sensitive rs3796863 A-allele may partially explain the relationship between a known risk factor (i.e. neuroticism) and promising biomarker (i.e. amygdala-sgACC connectivity) in the development and maintenance of social anxiety and depression.
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Affiliation(s)
- Benjamin A Tabak
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jared B Torre
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Baldwin M Way
- Department of Psychology, The Ohio State University, Columbus, OH, United States
| | - Lisa J Burklund
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Naomi I Eisenberger
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew D Lieberman
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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Sewart AR, Niles AN, Burklund LJ, Saxbe DE, Lieberman MD, Craske MG. Corrigendum to "Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder" [Behav. Ther. 50(6) (2019) 1112-1124]. Behav Ther 2020; 51:203. [PMID: 32005337 PMCID: PMC7219512 DOI: 10.1016/j.beth.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sewart AR, Niles AN, Burklund LJ, Saxbe DE, Lieberman MD, Craske MG. Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder. Behav Ther 2019; 50:1112-1124. [PMID: 31735246 PMCID: PMC6866675 DOI: 10.1016/j.beth.2019.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Received: 10/22/2018] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
Traditional cognitive-behavioral therapy (CBT) for anxiety disorders has been designed to target reductions in negative affect (NA) associated with defense-related processes. However, a subset of anxiety disorders, including social anxiety disorder (SAD), are also characterized by low positive affect (PA) resulting from separate deficits in appetitive-related processes. In contrast to CBT, "third-wave" approaches, such as acceptance and commitment therapy (ACT), align more consistently with motivational processes and, as a result, PA. However, the differential effect of CBT and ACT on PA and NA has yet to be investigated. Using secondary data from a randomized controlled trial, the present study sought to compare CBT's (n = 45) and ACT's (n = 35) effect on PA and NA in SAD. Findings were compared to a wait-list (WL) control condition (n = 31), as well as normative data from a general adult sample. Baseline PA and NA were also examined as moderators and predictors of theory-relevant treatment outcomes. NA decreased significantly in both CBT and ACT from pre to posttreatment. Although ACT outperformed WL in reducing NA, this effect was not observed for CBT. PA increased significantly in both CBT and ACT from pre to posttreatment, with neither ACT nor CBT outperforming WL in increasing PA. Neither PA nor NA were found to moderate theoretically relevant treatment outcomes. Findings suggest that ACT and CBT share common treatment mechanisms, making them more similar than distinct. Further efforts should be focused on optimizing CBT's and ACT's influence on threat and reward learning, and elucidating common processes of change.
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Affiliation(s)
- Amy R. Sewart
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA,Corresponding author at: Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, California 90095.
| | - Andrea N. Niles
- San Francisco VA Medical Center, 4150 Clement St., San Francisco CA 94121
| | - Lisa J. Burklund
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Darby E. Saxbe
- University of Southern California, Department of Psychology, 3620 S. McClintock Ave., Los Angeles, CA 90089-1061
| | - Matthew D. Lieberman
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Michelle G. Craske
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
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Tan KM, Burklund LJ, Craske MG, Lieberman MD. Posttraumatic stress disorder and the social brain: Affect-related disruption of the default and mirror networks. Depress Anxiety 2019; 36:1058-1071. [PMID: 31654545 DOI: 10.1002/da.22953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 03/02/2019] [Revised: 07/01/2019] [Accepted: 07/27/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Social cognitive impairments, specifically in mentalizing and emotion recognition, are common and debilitating symptoms of posttraumatic stress disorder (PTSD). Despite this, little is known about the neurobiology of these impairments, as there are currently no published neuroimaging investigations of social inference in PTSD. METHODS Trauma-exposed veterans with and without PTSD (n = 20 each) performed the Why/How social inference task during functional magnetic resonance imaging (fMRI). Patients with PTSD had two fMRI sessions, between which they underwent affect labeling training. We probed the primary networks of the "social brain"-the default mode network (DMN) and mirror neuron system (MNS)-by examining neural activity evoked by mentalizing and action identification prompts, which were paired with emotional and nonemotional targets. RESULTS Hyperactivation to emotional stimuli differentiated PTSD patients from controls, correlated with symptom severity, and predicted training outcomes. Critically, these effects were nonsignificant or marginal for nonemotional stimuli. Results were generally consistent throughout DMN and MNS. Unexpectedly, effects were nonsignificant in core affect regions, but robust in regions that overlap with the dorsal attention, ventral attention, and frontoparietal control networks. CONCLUSIONS The array of social cognitive processes subserved by DMN and MNS appear to be inordinately selective for emotional stimuli in PTSD. However, core affective processes do not appear to be the primary instigators of such selectivity. Instead, we propose that affective attentional biases may instigate widespread affect-selectivity throughout the social brain. Affect labeling training may inhibit such biases. These accounts align with numerous reports of affect-biased attentional processes in PTSD.
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Affiliation(s)
- Kevin M Tan
- Department of Psychology, University of California, Los Angeles, USA
| | - Lisa J Burklund
- Department of Psychology, University of California, Los Angeles, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Matthew D Lieberman
- Department of Psychology, University of California, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
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Brown LA, Young KS, Goldin PR, Torre JB, Burklund LJ, Davies CD, Niles AN, Lieberman MD, Saxbe DE, Craske MG. Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation. Psychiatry Res Neuroimaging 2019; 284:13-20. [PMID: 30622047 PMCID: PMC6415528 DOI: 10.1016/j.pscychresns.2018.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/31/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 01/08/2023]
Abstract
Self-referential processing is critical to understanding social anxiety disorder (SAD). This study examined neural differences in self-referential processing in healthy controls (HC) and participants with SAD at pre- and post-treatment. Participants (n = 64) underwent fMRI scanning while viewing a video of themselves ("Self") or another person ("Other"). SAD participants were randomized to cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT), or waitlist, and were re-scanned at post-treatment. In SAD vs. HC, the fusiform face area (FFA) showed significantly more activation during Self vs. Other, and greater SAD severity was associated with significantly more activation during Self vs. Other in the right FFA and the left extrastriate body area (EBA). Greater reduction in SAD severity was associated with stronger connectivity between the amygdala and FFA during Self vs. Other at post-treatment, whereas the strength of connectivity during Self and Other was comparable at post-treatment for those with less SAD reduction. Thus, there were significant differences in activation and functional connectivity of brain regions implicated in self-referential processing in SAD. Change in connectivity between the amygdala and FFA were observed as a function of change in SAD severity, suggesting that improvements in SAD severity may correct this altered functional connectivity.
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Affiliation(s)
- Lily A Brown
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N Philadelphia, PA 19104, USA.
| | - Katherine S Young
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Social, Genetic and Development Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK.
| | - Philippe R Goldin
- Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street Suite 4202, Sacramento, CA 95817, USA.
| | - Jared B Torre
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Lisa J Burklund
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; NeuroGen Technologies, Inc., P.O. Box 775 Burbank, CA 91505, USA.
| | - Carolyn D Davies
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Andrea N Niles
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Matthew D Lieberman
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, 3620 South McClintock Avenue, Los Angeles, CA 90089, USA.
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA.
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Young KS, LeBeau RT, Niles AN, Hsu KJ, Burklund LJ, Mesri B, Saxbe D, Lieberman MD, Craske MG. Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder. J Affect Disord 2019; 242:105-110. [PMID: 30173058 PMCID: PMC6816743 DOI: 10.1016/j.jad.2018.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 05/10/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment. Identifying factors associated with improved outcomes can facilitate individualized treatment choices. We investigated whether patterns of neural connectivity predicted treatment responses and whether treatment type, cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), moderated this effect. METHODS Participants with SAD (n = 34) underwent fMRI prior to treatment and completed implicit and explicit emotion regulation tasks. Neural connectivity measures were estimates of amygdala-prefrontal cortex connectivity. Treatment responder status was defined using the 'clinically significant change index' (Loerinc et al., 2015). RESULTS Right amygdala-right ventrolateral prefrontal cortex connectivity during implicit emotion regulation was a significant predictor of treatment response (OR = 9.01, 95% CI = 1.77, 46.0, p = .008). Stronger inverse connectivity was associated with greater likelihood of treatment response. There were no significant neural moderators of treatment response to CBT versus ACT. LIMITATIONS The primary limitation of this work was the small sample size which restricted the power to detect significant moderation effects, and results should be interpreted as preliminary. CONCLUSIONS Amygdala-vlPFC connectivity during affect labeling predicted treatment responder status following CBT or ACT for social anxiety disorder. This suggests that the functioning of neural circuitry supporting emotion regulation capacities may be a 'gateway' to receiving benefit from psychological treatments. Future work should aim to replicate this effect in a larger sample and consider methods for enhancing functional connectivity within this circuitry as a potential treatment adjunct.
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Affiliation(s)
| | | | - Andrea N. Niles
- Department of Psychiatry, University of California, San Francisco
| | | | | | - Bita Mesri
- Department of Psychology, University of California, Los Angeles
| | - Darby Saxbe
- Department of Psychology, University of Southern California
| | | | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles,Correspondence: Michelle Craske, Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, 310-825-8403,
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Young KS, Burklund LJ, Torre JB, Saxbe D, Lieberman MD, Craske MG. Treatment for social anxiety disorder alters functional connectivity in emotion regulation neural circuitry. Psychiatry Res 2017; 261:44-51. [PMID: 28129555 PMCID: PMC5330298 DOI: 10.1016/j.pscychresns.2017.01.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 09/09/2016] [Revised: 01/05/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
Abstract
Social anxiety disorder (SAD) is characterized at a neurobiological level by disrupted activity in emotion regulation neural circuitry. Previous work has demonstrated amygdala hyperreactivity and disrupted prefrontal responses to social cues in individuals with SAD (Kim et al., 2011). While exposure-based psychological treatments effectively reduce SAD symptoms, not all individuals respond to treatment. Better understanding of the neural mechanisms involved offers the potential to improve treatment efficacy. In this study, we investigated functional connectivity in emotion regulation neural circuitry in a randomized controlled treatment trial for SAD. Participants with SAD underwent fMRI scanning while performing an implicit emotion regulation task prior to treatment (n=62). Following 12 weeks of cognitive behavioral therapy, acceptance and commitment therapy, or wait-list, participants completed a second scan (n=42). Psychophysiological interaction analyses using amygdala seed regions demonstrated differences between SAD and healthy control participants (HC; n=16) in right amygdala-vmPFC connectivity. SAD participants demonstrated more negative amygdala-to-vmPFC connectivity, compared to HC participants, an effect that was correlated with SAD symptom severity. Post-treatment symptom reduction was correlated with altered amygdala-to-vm/vlPFC connectivity, independent of treatment type. Greater symptom reduction was associated with more negative amygdala-to-vm/vlPFC connectivity. These findings suggest that effective psychological treatment for SAD enhances amygdala-prefrontal functional connectivity.
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Affiliation(s)
- Katherine S Young
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Lisa J Burklund
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Jared B Torre
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Darby Saxbe
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Matthew D Lieberman
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA
| | - Michelle G Craske
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
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Burklund LJ, Torre JB, Lieberman MD, Taylor SE, Craske MG. Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder. Psychiatry Res 2017; 261:52-64. [PMID: 28129556 PMCID: PMC5435374 DOI: 10.1016/j.pscychresns.2016.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 08/20/2015] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 02/08/2023]
Abstract
Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.
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Affiliation(s)
- Lisa J Burklund
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States.
| | - Jared B Torre
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Matthew D Lieberman
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Shelley E Taylor
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
| | - Michelle G Craske
- University of California Los Angeles, Department of Psychology, Los Angeles, CA 90095-1563, United States
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9
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Niles AN, Burklund LJ, Arch JJ, Lieberman MD, Saxbe D, Craske MG. Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behav Ther 2014; 45:664-77. [PMID: 25022777 PMCID: PMC4842179 DOI: 10.1016/j.beth.2014.04.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/08/2014] [Accepted: 04/23/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. METHOD Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder. RESULTS Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms. CONCLUSIONS Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.
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Craske MG, Niles AN, Burklund LJ, Wolitzky-Taylor KB, Vilardaga JCP, Arch JJ, Saxbe DE, Lieberman MD. Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. J Consult Clin Psychol 2014; 82:1034-48. [PMID: 24999670 DOI: 10.1037/a0037212] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. METHOD The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings. RESULTS Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. CONCLUSIONS Implications for clinical practice and future research are discussed.
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Affiliation(s)
| | | | | | | | | | - Joanna J Arch
- Department of Psychology, University of Colorado at Boulder
| | - Darby E Saxbe
- Department of Psychology, University of Southern California
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Burklund LJ, Craske MG, Taylor SE, Lieberman MD. Altered emotion regulation capacity in social phobia as a function of comorbidity. Soc Cogn Affect Neurosci 2014; 10:199-208. [PMID: 24813437 DOI: 10.1093/scan/nsu058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Social phobia (SP) has been associated with amygdala hyperreactivity to fear-relevant stimuli. However, little is known about the neural basis of SP individuals' capacity to downregulate their responses to such stimuli and how such regulation varies as a function of comorbid depression and anxiety. We completed an functional magnetic resonance imaging (fMRI) study wherein SP participants without comorbidity (n = 30), with comorbid depression (n = 18) and with comorbid anxiety (n = 19) and healthy controls (n = 15) were scanned while completing an affect labeling emotion regulation task. Individuals with SP as a whole exhibited a reversal of the pattern observed in healthy controls in that they showed upregulation of amygdala activity during affect labeling. However, subsequent analyses revealed a more complex picture based on comorbidity type. Although none of the SP subgroups showed the normative pattern of amygdala downregulation, it was those with comorbid depression specifically who showed significant upregulation. Effects could not be attributed to differences in task performance, amygdala reactivity or right ventral lateral prefrontal cortex (RVLPFC) engagement, but may stem from dysfunctional communication between amygdala and RVLPFC. Furthermore, the particularly altered emotion regulation seen in those with comorbid depression could not be fully explained by symptom severity or state anxiety. Results reveal altered emotion regulation in SP, especially when comorbid with depression.
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Affiliation(s)
- Lisa J Burklund
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095-1563, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095-1563, USA
| | - Shelley E Taylor
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095-1563, USA
| | - Matthew D Lieberman
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095-1563, USA
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12
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Burklund LJ, Creswell JD, Irwin MR, Lieberman MD. The common and distinct neural bases of affect labeling and reappraisal in healthy adults. Front Psychol 2014; 5:221. [PMID: 24715880 PMCID: PMC3970015 DOI: 10.3389/fpsyg.2014.00221] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 10/30/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
Emotion regulation is commonly characterized as involving conscious and intentional attempts to change felt emotions, such as, for example, through reappraisal whereby one intentionally decreases the intensity of one's emotional response to a particular stimulus or situation by reinterpreting it in a less threatening way. However, there is growing evidence and appreciation that some types of emotion regulation are unintentional or incidental, meaning that affective modulation is a consequence but not an explicit goal. For example, affect labeling involves simply verbally labeling the emotional content of an external stimulus or one's own affective responses without an intentional goal of altering emotional responses, yet has been associated with reduced affective responses at the neural and experiential levels. Although both intentional and incidental emotional regulation strategies have been associated with diminished limbic responses and self-reported distress, little previous research has directly compared their underlying neural mechanisms. In this study, we examined the extent to which incidental and intentional emotion regulation, namely, affect labeling and reappraisal, produced common and divergent neural and self-report responses to aversive images relative to an observe-only control condition in a sample of healthy older adults (N = 39). Affect labeling and reappraisal produced common activations in several prefrontal regulatory regions, with affect labeling producing stronger responses in direct comparisons. Affect labeling and reappraisal were also associated with similar decreases in amygdala activity. Finally, affect labeling and reappraisal were associated with correlated reductions in self-reported distress. Together these results point to common neurocognitive mechanisms involved in affect labeling and reappraisal, supporting the idea that intentional and incidental emotion regulation may utilize overlapping neural processes.
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Affiliation(s)
- Lisa J Burklund
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - J David Creswell
- Department of Psychology and Center for the Neural Basis of Cognition, Carnegie Mellon University Pittsburgh, PA, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew D Lieberman
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA ; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Niles AN, Mesri B, Burklund LJ, Lieberman MD, Craske MG. Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia. Behav Res Ther 2013; 51:669-79. [PMID: 23933107 PMCID: PMC3825738 DOI: 10.1016/j.brat.2013.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 02/13/2013] [Revised: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.
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Affiliation(s)
- Andrea N Niles
- University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
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14
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Creswell JD, Irwin MR, Burklund LJ, Lieberman MD, Arevalo JMG, Ma J, Breen EC, Cole SW. Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav Immun 2012; 26:1095-101. [PMID: 22820409 PMCID: PMC3635809 DOI: 10.1016/j.bbi.2012.07.006] [Citation(s) in RCA: 316] [Impact Index Per Article: 26.3] [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] [Received: 03/27/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/30/2022] Open
Abstract
Lonely older adults have increased expression of pro-inflammatory genes as well as increased risk for morbidity and mortality. Previous behavioral treatments have attempted to reduce loneliness and its concomitant health risks, but have had limited success. The present study tested whether the 8-week Mindfulness-Based Stress Reduction (MBSR) program (compared to a Wait-List control group) reduces loneliness and downregulates loneliness-related pro-inflammatory gene expression in older adults (N = 40). Consistent with study predictions, mixed effect linear models indicated that the MBSR program reduced loneliness, compared to small increases in loneliness in the control group (treatment condition × time interaction: F(1,35) = 7.86, p = .008). Moreover, at baseline, there was an association between reported loneliness and upregulated pro-inflammatory NF-κB-related gene expression in circulating leukocytes, and MBSR downregulated this NF-κB-associated gene expression profile at post-treatment. Finally, there was a trend for MBSR to reduce C Reactive Protein (treatment condition × time interaction: (F(1,33) = 3.39, p = .075). This work provides an initial indication that MBSR may be a novel treatment approach for reducing loneliness and related pro-inflammatory gene expression in older adults.
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Affiliation(s)
- J. David Creswell
- Department of Psychology and Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, 15213, Corresponding Author: J. David Creswell, Department of Psychology, Carnegie Mellon University. 5000 Forbes Ave, Pittsburgh, PA. (; 412-268-9182)
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, 300 Medical Plaza, Los Angeles, CA, 90095,Departments of Psychology, Psychiatry, & Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095
| | - Lisa J. Burklund
- Departments of Psychology, Psychiatry, & Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095
| | - Matthew D. Lieberman
- Departments of Psychology, Psychiatry, & Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095
| | - Jesusa M. G. Arevalo
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, 300 Medical Plaza, Los Angeles, CA, 90095
| | - Jeffrey Ma
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, 300 Medical Plaza, Los Angeles, CA, 90095
| | - Elizabeth Crabb Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, 300 Medical Plaza, Los Angeles, CA, 90095
| | - Steven W. Cole
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, 300 Medical Plaza, Los Angeles, CA, 90095
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Burklund LJ, Eisenberger NI, Lieberman MD. The face of rejection: rejection sensitivity moderates dorsal anterior cingulate activity to disapproving facial expressions. Soc Neurosci 2008; 2:238-53. [PMID: 18461157 DOI: 10.1080/17470910701391711] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous research has examined neural responses to threatening facial expressions such as those displaying anger, fear, and disgust. Here, we examined neural responses to a different type of threatening facial expression that primarily signifies a threat to social connection, namely a "disapproving" facial expression. We hypothesized that neural responses to disapproving facial expressions would be moderated by individual differences in rejection sensitivity. Using functional magnetic resonance imaging (fMRI), we scanned participants while they viewed brief video clips of facial expressions depicting disapproval, anger, and disgust. As expected, all three expressions yielded bilateral amygdala activation relative to a resting baseline. Additionally, individuals who scored higher on a measure of rejection sensitivity exhibited greater dorsal anterior cingulate cortex activity in response to disapproving facial expressions, but not in response to anger or disgust facial expressions. Results suggest that, at the neural level, individuals high in rejection sensitivity may be more sensitive to facial expressions signaling potential rejection, but not to threatening facial expressions in general. Results also suggest that disapproving facial expressions convey a distinct type of threat and should be considered in future studies of socially threatening facial expressions.
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Affiliation(s)
- Lisa J Burklund
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA.
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Taylor SE, Burklund LJ, Eisenberger NI, Lehman BJ, Hilmert CJ, Lieberman MD. Neural bases of moderation of cortisol stress responses by psychosocial resources. J Pers Soc Psychol 2008; 95:197-211. [PMID: 18605860 DOI: 10.1037/0022-3514.95.1.197] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychosocial resources have been tied to lower psychological and biological responses to stress. The present research replicated this relationship and extended it by examining how differences in dispositional reactivity of certain neural structures may underlie this relationship. Two hypotheses were examined: (a) psychosocial resources are tied to decreased sensitivity to threat and/or (b) psychosocial resources are associated with enhanced prefrontal inhibition of threat responses during threat regulation. Results indicated that participants with greater psychosocial resources exhibited significantly less cortisol reactivity following a stress task, as predicted. Analyses using functional magnetic resonance imaging revealed that psychosocial resources were associated with greater right ventrolateral prefrontal cortex and less amygdala activity during a threat regulation task but were not associated with less amygdala activity during a threat sensitivity task. Mediational analyses suggest that the relation of psychosocial resources to low cortisol reactivity was mediated by lower amygdala activity during threat regulation. Results suggest that psychosocial resources are associated with lower cortisol responses to stress by means of enhanced inhibition of threat responses during threat regulation, rather than by decreased sensitivity to threat.
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Affiliation(s)
- Shelley E Taylor
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
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