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Antici EE, Kuhlman KR, Treanor M, Craske MG. Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder. Brain Behav Immun 2024; 118:300-309. [PMID: 38467380 DOI: 10.1016/j.bbi.2024.03.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/17/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) places a profound burden on public health and individual wellbeing. Systemic inflammation may be important to the onset and maintenance of SAD, and anti-inflammatory treatments have shown promise in relieving symptoms of SAD. In the present study, we conducted secondary analyses on data from a randomized clinical trial to determine whether C-reactive protein (CRP) concentrations and social anxiety symptoms decreased over the course of virtual reality exposure therapy, and whether changes in social anxiety symptoms as a function of treatment varied as a function of CRP. METHOD Adult participants (N = 78) with a diagnosis of SAD (59 % female) were randomized to receive exposure therapy alone, or exposure therapy supplemented with scopolamine. Social anxiety symptoms, salivary CRP, and subjective units of distress were measured across three exposure therapy sessions, at a post-treatment extinction retest, and at a 1-month follow-up. RESULTS CRP decreased over the course of treatment, b = -0.03 (SE = 0.01), p =.02 95 %CI [-0.06, -0.004], as did all social anxiety symptom domains and subjective distress. Higher CRP was associated with greater decreases from pre-treatment to 1-month follow-up in fear, b = -0.45 (SE = 0.15), p =.004 95 %CI [-0.74, -0.15], and avoidance, b = -0.62 (SE = 0.19), p =.002 95 %CI [-1.01, -0.23], and in-session subjective distress from pre-treatment to post-treatment, b = -0.42 (SE = 0.21), p =.05 95 %CI [-0.83, -0.001]. However, declines in CRP were not correlated with declines in fear, r = -0.07, p =.61, or avoidance, r = -0.10, p =.49, within-persons. CONCLUSIONS Virtual reality exposure therapy may be associated with an improvement in systemic inflammation in patients with severe SAD. Pre-treatment CRP may also be of value in predicting which patients stand to benefit the most from this treatment.
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Affiliation(s)
- Elizabeth E Antici
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, USA.
| | - Kate R Kuhlman
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael Treanor
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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2
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Barnes-Horowitz NM, Metts A, Rosenfield D, Yarrington JS, Treanor M, Echiverri-Cohen A, Ritz T, Meuret AE, Craske MG. Changes in positive and negative affect in psychotherapy for depression and anxiety. J Consult Clin Psychol 2024; 92:249-259. [PMID: 38127575 DOI: 10.1037/ccp0000865] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Positive and negative affect play critical roles in depression and anxiety treatment, but the dynamic processes of how affect changes over treatment in relation to changes in symptoms is unclear. The study goal was to examine relationships among changes in positive and negative affect with changes in depression and anxiety symptoms. METHOD This secondary analysis used a combined sample (N = 196) of two trials (Craske et al., 2019, 2023) comparing positive affect treatment (PAT) to negative affect treatment. Longitudinal cross-lag panel models explored whether changes in positive and negative affect (Positive and Negative Affect Schedule; Watson et al., 1988) predicted subsequent changes in depression and anxiety symptoms (Depression Anxiety Stress Scales; Lovibond & Lovibond, 1995), whether symptoms predicted subsequent changes in affect, and whether treatment condition moderated these relationships. RESULTS Increases in positive affect predicted subsequent decreases in depression and anxiety symptoms, regardless of treatment condition. Symptoms did not reciprocally predict changes in positive affect. For individuals in PAT, decreases in negative affect predicted subsequent decreases in symptoms. Moreover, decreases in symptoms predicted subsequent decreases in negative affect, regardless of treatment condition. CONCLUSIONS Results did not support a reciprocal relationship between positive affect and symptoms of depression and anxiety since positive affect predicted depression and anxiety symptoms but not vice versa. Results supported a reciprocal relationship between negative affect and symptoms of depression and anxiety since negative affect predicted depression and anxiety symptoms in PAT, and depression and anxiety symptoms predicted negative affect in both treatment conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Allison Metts
- Department of Psychology, University of California, Los Angeles
| | | | | | - Michael Treanor
- Department of Psychology, University of California, Los Angeles
| | | | - Thomas Ritz
- Department of Psychology, Southern Methodist University
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3
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Cichocki AC, Zinbarg RE, Craske MG, Chat IKY, Young KS, Bookheimer SY, Nusslock R. Transdiagnostic symptom of depression and anxiety associated with reduced gray matter volume in prefrontal cortex. Psychiatry Res Neuroimaging 2024; 339:111791. [PMID: 38359709 PMCID: PMC10938645 DOI: 10.1016/j.pscychresns.2024.111791] [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: 07/10/2023] [Revised: 10/25/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
Dimensional models of psychopathology may provide insight into mechanisms underlying comorbid depression and anxiety and improve specificity and sensitivity of neuroanatomical findings. The present study is the first to examine neural structure alterations using the empirically derived Tri-level Model. Depression and anxiety symptoms of 269 young adults were assessed using the Tri-level Model dimensions: General Distress (transdiagnostic depression and anxiety symptoms), Anhedonia-Apprehension (relatively specific depression symptoms), and Fears (specific anxiety symptoms). Using structural MRI, gray matter volumes were extracted for emotion generation (amygdala, nucleus accumbens) and regulation (orbitofrontal, ventrolateral, and dorsolateral prefrontal cortex) regions, often implicated in depression and anxiety. Each Tri-level symptom was regressed onto each region of interest, separately, adjusting for relevant covariates. General Distress was significantly associated with smaller gray matter volumes in bilateral orbitofrontal cortex and ventrolateral prefrontal cortex, independent of Anhedonia-Apprehension and Fears symptom dimensions. These results suggests that prefrontal alterations are associated with transdiagnostic dysphoric mood common across depression and anxiety, rather than unique symptoms of these disorders. Additionally, no regions of interest were associated with Anhedonia-Apprehension or Fears, highlighting the importance of studying transdiagnostic features of depression and anxiety. This has implications for understanding mechanisms of and interventions for depression and anxiety.
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Affiliation(s)
- Anna C Cichocki
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States.
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States; The Family Institute at Northwestern University, Evanston, IL, United States
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Iris K-Y Chat
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States
| | - Katherine S Young
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Susan Y Bookheimer
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States
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4
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van Veen SC, Zbozinek TD, van Dis EAM, Engelhard IM, Craske MG. Positive mood induction does not reduce return of fear: A virtual reality exposure study for public speaking anxiety. Behav Res Ther 2024; 174:104490. [PMID: 38354451 DOI: 10.1016/j.brat.2024.104490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
Previous laboratory work has shown that induction of positive mood prior to fear extinction decreases the negative valence of the conditional stimulus (CS) and reduces reinstatement of fear. Before translating these insights to clinical practice, it is important to test this strategy in anxious individuals. Students with a high fear of public speaking (N = 62) were randomized to either a positive mood induction, a negative mood induction, or no induction control group. All participants performed two weekly sessions of virtual reality exposure and a 1-week follow-up test including a spontaneous recovery test and reinstatement test after a social rejection (unconditional stimulus). We used self-reported fear measures and skin conductance responses. We expected that the positive group, compared to the other groups, would evaluate the CS (i.e., speaking in front of an audience) as less negative following exposure and would show less spontaneous recovery and reinstatement of fear following a social rejection. Although mood was successfully manipulated, there were no group differences in CS valence following exposure. In all conditions, VR exposure successfully reduced public speaking fear, and these effects were stable at follow-up. In contrast with expectations, the positive group showed more spontaneous recovery of CS negative valence than the negative group. To conclude, we found no evidence that positive mood induction prior to exposure optimizes exposure effects for anxious individuals.
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Affiliation(s)
| | - Tomislav D Zbozinek
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
| | - Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, CA, United States
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5
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Miller GE, Carroll AL, Armstrong CC, Craske MG, Zinbarg RE, Bookheimer SY, Ka-Yi Chat I, Vinograd M, Young KS, Nusslock R. Major stress in early childhood strengthens the association between peripheral inflammatory activity and corticostriatal responsivity to reward. Brain Behav Immun 2024; 117:215-223. [PMID: 38244947 PMCID: PMC10932835 DOI: 10.1016/j.bbi.2024.01.013] [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: 03/31/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Severe, chronic stress during childhood accentuates vulnerability to mental and physical health problems across the lifespan. To explain this phenomenon, the neuroimmune network hypothesis proposes that childhood stressors amplify signaling between peripheral inflammatory cells and developing brain circuits that support processing of rewards and threats. Here, we conducted a preliminary test of the basic premises of this hypothesis. METHODS 180 adolescents (mean age = 19.1 years; 68.9 % female) with diverse racial and ethnic identities (56.1 % White; 28.3 % Hispanic; 26.1 % Asian) participated. The Childhood Trauma Interview was administered to quantify early adversity. Five inflammatory biomarkers were assayed in antecubital blood - C-reactive protein, tumor necrosis factor-a, and interleukins-6, -8, and -10 - and were averaged to form a composite score. Participants also completed a functional MRI task to measure corticostriatal responsivity to the anticipation and acquisition of monetary rewards. RESULTS Stress exposure and corticostriatal responsivity interacted statistically to predict the inflammation composite. Among participants who experienced major stressors in the first decade of life, higher inflammatory activity covaried with lower corticostriatal responsivity during acquisition of monetary rewards. This relationship was specific to participants who experienced major stress in early childhood, implying a sensitive period for exposure, and were evident in both the orbitofrontal cortex and the ventral striatum, suggesting the broad involvement of corticostriatal regions. The findings were independent of participants' age, sex, racial and ethnic identity, family income, and depressive symptoms. CONCLUSIONS Collectively, the results are consistent with hypotheses suggesting that major stress in childhood alters brain-immune signaling.
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Affiliation(s)
- Gregory E Miller
- Institute for Policy Research, Northwestern University, United States; Department of Psychology, Northwestern University, United States.
| | - Ann L Carroll
- Institute for Policy Research, Northwestern University, United States
| | - Casey C Armstrong
- Institute for Policy Research, Northwestern University, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, United States
| | - Richard E Zinbarg
- Institute for Policy Research, Northwestern University, United States; The Family Institute at Northwestern University, United States
| | - Susan Y Bookheimer
- Department of Psychology, University of California, Los Angeles, United States
| | - Iris Ka-Yi Chat
- Department of Psychology & Neuroscience, Temple University, United States
| | - Meghan Vinograd
- Department of Psychology, University of California, Los Angeles, United States
| | - Katherine S Young
- Department of Psychology, University of California, Los Angeles, United States
| | - Robin Nusslock
- Institute for Policy Research, Northwestern University, United States; Department of Psychology, Northwestern University, United States
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6
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Balliu B, Douglas C, Seok D, Shenhav L, Wu Y, Chatzopoulou D, Kaiser W, Chen V, Kim J, Deverasetty S, Arnaudova I, Gibbons R, Congdon E, Craske MG, Freimer N, Halperin E, Sankararaman S, Flint J. Personalized mood prediction from patterns of behavior collected with smartphones. NPJ Digit Med 2024; 7:49. [PMID: 38418551 PMCID: PMC10902386 DOI: 10.1038/s41746-024-01035-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/09/2024] [Indexed: 03/01/2024] Open
Abstract
Over the last ten years, there has been considerable progress in using digital behavioral phenotypes, captured passively and continuously from smartphones and wearable devices, to infer depressive mood. However, most digital phenotype studies suffer from poor replicability, often fail to detect clinically relevant events, and use measures of depression that are not validated or suitable for collecting large and longitudinal data. Here, we report high-quality longitudinal validated assessments of depressive mood from computerized adaptive testing paired with continuous digital assessments of behavior from smartphone sensors for up to 40 weeks on 183 individuals experiencing mild to severe symptoms of depression. We apply a combination of cubic spline interpolation and idiographic models to generate individualized predictions of future mood from the digital behavioral phenotypes, achieving high prediction accuracy of depression severity up to three weeks in advance (R2 ≥ 80%) and a 65.7% reduction in the prediction error over a baseline model which predicts future mood based on past depression severity alone. Finally, our study verified the feasibility of obtaining high-quality longitudinal assessments of mood from a clinical population and predicting symptom severity weeks in advance using passively collected digital behavioral data. Our results indicate the possibility of expanding the repertoire of patient-specific behavioral measures to enable future psychiatric research.
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Affiliation(s)
- Brunilda Balliu
- Departments of Computational Medicine, University of California Los Angeles, Los Angeles, USA.
- Departments of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, USA.
- Department of Biostatistics, University of California Los Angeles, Los Angeles, USA.
| | - Chris Douglas
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
| | - Darsol Seok
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Liat Shenhav
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Yue Wu
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Doxa Chatzopoulou
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - William Kaiser
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, USA
| | - Victor Chen
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, USA
| | - Jennifer Kim
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Sandeep Deverasetty
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Inna Arnaudova
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Robert Gibbons
- Departments of Medicine, Public Health Sciences and Comparative Human Development, University of Chicago, Chicago, USA
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, USA
| | - Nelson Freimer
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA
| | - Eran Halperin
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
| | - Sriram Sankararaman
- Departments of Computational Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Computer Science, University of California Los Angeles, Los Angeles, USA
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA
| | - Jonathan Flint
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, USA.
- Department of Human Genetics, University of California Los Angeles, Los Angeles, USA.
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7
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Murray SB, Strober M, Le Grange D, Schauer R, Craske MG, Zbozinek TD. A multi-modal assessment of fear conditioning in adolescent anorexia nervosa. Int J Eat Disord 2024. [PMID: 38415877 DOI: 10.1002/eat.24180] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a pernicious psychiatric disorder which is principally characterized by a fear of weight gain. Notwithstanding the centrality of fear in the psychopathology of AN, controlled assessments of negative valence systems are lacking. Herein we assess fear conditioning in adolescent females with AN. METHOD Adolescent girls (Mage = 14.6 years, ±1.57) with DSM-5 diagnoses of AN (N = 25) and age-matched control girls (Mage = 14.8 years, ±1.46) with no DSM-5 diagnoses (N = 25) completed structured clinical interviews and participated in a classical three-phase Pavlovian fear conditioning paradigm. Participants with comorbid anxiety disorders were excluded. Skin conductance response (SCR) was measured, alongside self-reported fear, valence, and fear expectancy ratings. RESULTS Both groups demonstrated significant differential acquisition across all four measures. Regarding group comparisons, no differences emerged for self-reported fear, valence, and fear expectancy ratings during acquisition, although for SCR, those with AN demonstrated reduced physiological arousal relative to controls. Both groups demonstrated significant differential extinction for unconditioned stimuli (US) expectancy, self-report fear, and self-report valence. No statistically significant group differences were evident during extinction to the conditioned stimuli (CS)+, on any outcome measure. However, controls reported more positive valence to the CS- than those with AN. CONCLUSIONS Contrary to our hypotheses, our preliminary assessment did not find support for elevated fear responding among adolescent girls with AN with regards to fear acquisition or extinction. These data suggest that AN in adolescent girls may not be associated with a heightened propensity to acquire fear, but conversely, may suggest that exposure treatments for AN may be helpful, since extinction learning is intact in AN. PUBLIC SIGNIFICANCE AN is characterized by fear-related symptoms, including food and weight-related fear, and behavioral avoidance, yet controlled studies assessing fear learning are limited. Our preliminary assessment of adolescent AN indicates no abnormalities in fear learning among adolescents with AN. These findings may inform existing mechanistic models of AN psychopathology, and the development of exposure-based treatments for AN.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michael Strober
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
| | - Rebecca Schauer
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michelle G Craske
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Tomislav D Zbozinek
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
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8
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Collier Villaume S, Stephens JE, Craske MG, Zinbarg RE, Adam EK. Sleep and Daily Affect and Risk for Major Depression: Day-to-day and Prospective Associations in Late Adolescence and Early Adulthood. J Adolesc Health 2024; 74:388-391. [PMID: 37815765 PMCID: PMC10841082 DOI: 10.1016/j.jadohealth.2023.08.042] [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: 08/24/2022] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Poor sleep is associated with short-term dysregulation of mood and is a risk factor for major depressive disorder (MDD). This study examines whether objectively measured sleep in late adolescence prospectively predicts major depressive episode (MDE) onset in early adulthood as well as whether daily affect mediates this association. METHODS The present study draws on subjective and objective sleep data, ecological momentary assessment, and diagnostic data from the longitudinal Youth Emotion Project to examine whether: a) short sleep predicts dysregulated ecological momentary assessment-measured mood the next day; b) sleep predicts depressive episodes over the subsequent 5 years; and c) dysregulated daily moods mediate the associations between short sleep and later MDD. Fixed effects, logistic regression, and formal mediation analyses were employed. RESULTS Our results showed that nights with less sleep are followed by days with more negative affect; short sleep predicted MDEs over the subsequent 5 years (adjusting for prior MDD); and negative affect mediates the relationship between short sleep and later MDEs. DISCUSSION Overall, our findings show sleep to be an important risk factor and hence a promising point of intervention for improving mood and reducing the risk of future MDEs in adolescents and early adults.
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Affiliation(s)
- Sarah Collier Villaume
- School of Education and Social Policy, Northwestern University, Evanston, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois.
| | | | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Emma K Adam
- School of Education and Social Policy, Northwestern University, Evanston, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois
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9
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Yarrington JS, Craske MG. Effects of positive and negative affect inductions on interpretive and response bias. Behav Res Ther 2024; 173:104460. [PMID: 38104511 DOI: 10.1016/j.brat.2023.104460] [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] [Received: 07/19/2023] [Revised: 11/22/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
Affective states and interpretations of ambiguous stimuli are inherently related constructs, although effects of induced affective states on interpretive and response biases have not been comprehensively explored. The present study examined the relationship between induced affective states and interpretive and response bias in a sample of 189 undergraduates. Participants completed an online study in which they were randomized into one of two mood induction conditions and subsequently completed an interpretive bias task. Results demonstrated significant condition differences in affect after the mood induction; the positive induction condition demonstrated significantly more positive mood and the negative condition demonstrated more negative mood. A significant difference between conditions emerged with respect to positive interpretive bias for non-social scenarios, with the positive mood induction condition demonstrating more positive interpretive bias to non-social situations than the negative induction condition (p = .04). The negative induction condition demonstrated significantly greater negative response bias for social scenarios (p = .03) and, unexpectedly, a significantly higher positive response bias for non-social scenarios (p = .05). Findings offer some support for the notion that inducing positive affect may promote more positive interpretations of ambiguous scenarios.
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Affiliation(s)
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, USA
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10
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Hornstein E, Leschak CJ, Parrish MH, Byrne-Haltom KE, Fanselow MS, Craske MG, Eisenberger NI. Social support and fear-inhibition: an examination of underlying neural mechanisms. Soc Cogn Affect Neurosci 2024; 19:nsae002. [PMID: 38217103 PMCID: PMC10868130 DOI: 10.1093/scan/nsae002] [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: 12/21/2022] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
Recent work has demonstrated that reminders of those we are closest to have a unique combination of effects on fear learning and represent a new category of fear inhibitors, termed prepared fear suppressors. Notably, social-support-figure images have been shown to resist becoming associated with fear, suppress conditional-fear-responding and lead to long-term fear reduction. Due to the novelty of this category, understanding the underlying neural mechanisms that support these unique abilities of social-support-reminders has yet to be investigated. Here, we examined the neural correlates that enable social-support-reminders to resist becoming associated with fear during a retardation-of-acquisition test. We found that social-support-figure-images (vs stranger-images) were less readily associated with fear, replicating prior work, and that this effect was associated with decreased amygdala activity and increased ventromedial prefrontal cortex (VMPFC) activity for social-support-figure-images (vs stranger-images), suggesting that social-support-engagement of the VMPFC and consequent inhibition of the amygdala may contribute to unique their inhibitory effects. Connectivity analyses supported this interpretation, showing greater connectivity between the VMPFC and left amygdala for social-support-figure-images (vs stranger-images).
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Affiliation(s)
- E.A Hornstein
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - C J Leschak
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - M H Parrish
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - K E Byrne-Haltom
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - M S Fanselow
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
| | - M G Craske
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
| | - N I Eisenberger
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
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11
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Cummings KK, Jung J, Zbozinek TD, Wilhelm FH, Dapretto M, Craske MG, Bookheimer SY, Green SA. Shared and distinct biological mechanisms for anxiety and sensory over-responsivity in youth with autism versus anxiety disorders. J Neurosci Res 2024; 102:e25250. [PMID: 37840458 PMCID: PMC10843792 DOI: 10.1002/jnr.25250] [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: 11/21/2022] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Abstract
Sensory over-responsivity (SOR) is a prevalent cross-diagnostic condition that is often associated with anxiety. The biological mechanisms underlying the co-occurrence of SOR and anxiety symptoms are not well understood, despite having important implications for targeted intervention. We therefore investigated the unique associations of SOR and anxiety symptoms with physiological and neural responses to sensory stimulation for youth with anxiety disorders (ANX), autism spectrum disorder (ASD), or typical development (TD). Age/IQ-matched youth aged 8-18 years (22 ANX; 30 ASD; 22 TD) experienced mildly aversive tactile and auditory stimuli during functional magnetic resonance imaging and then during skin conductance response (SCR) and heart rate (HR) measurements. Caregivers reported on participants' SOR and anxiety symptoms. ASD/ANX youth had elevated SOR and anxiety symptoms compared to TD. ASD/ANX youth showed similar, heightened brain responses to sensory stimulation compared to TD youth, but brain responses were more highly related to SOR symptoms in ASD youth and to anxiety symptoms in ANX youth. Across ASD/ANX youth, anxiety symptoms uniquely related to greater SCR whereas SOR uniquely related to greater HR responses to sensory stimulation. Behavioral and neurobiological over-responsivity to sensory stimulation was shared across diagnostic groups. However, findings support SOR and anxiety as distinct symptoms with unique biological mechanisms, and with different relationships to neural over-reactivity dependent on diagnostic group. Results indicate a need for targeted treatment approaches.
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Affiliation(s)
- Kaitlin K. Cummings
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jiwon Jung
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Tomislav D. Zbozinek
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Frank H. Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Susan Y. Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Shulamite A. Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
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12
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Metts AV, Roy-Byrne P, Stein MB, Sherbourne CD, Bystritsky A, Craske MG. Reciprocal and Indirect Effects Among Intervention, Perceived Social Support, and Anxiety Sensitivity Within a Randomized Controlled Trial for Anxiety Disorders. Behav Ther 2024; 55:80-92. [PMID: 38216239 DOI: 10.1016/j.beth.2023.05.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Social support may facilitate adaptive reappraisal of stressors, including somatic symptoms. Anxiety sensitivity refers to negative beliefs about somatic symptoms of anxiety, which may influence one's perception of social support. Evidence-based treatment may impact these associations. The current longitudinal study evaluated reciprocal relationships between perceived social support and anxiety sensitivity, and explored indirect intervention effects, in a randomized controlled trial for anxiety disorders that compared cognitive behavioral therapy with or without medications (CALM) to usual care. Data collected over 18 months from 940 primary care patients were examined in random intercept cross-lagged panel models. There were significant reciprocal associations between perceived social support increases and anxiety sensitivity decreases over time. There were significant indirect effects from intervention to perceived social support increases through anxiety sensitivity decreases and from intervention to anxiety sensitivity decreases through perceived social support increases. These data suggest that, relative to usual care, CALM predicted changes in one construct, which predicted subsequent changes in the other. Secondary analyses revealed an influence of anxiety and depressive symptoms on reciprocal associations and indirect effects. Findings suggest that future treatments could specifically address perceived social support to enhance reappraisal of somatic symptoms, and vice versa.
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13
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Pozuelo JR, Moffett BD, Davis M, Stein A, Cohen H, Craske MG, Maritze M, Makhubela P, Nabulumba C, Sikoti D, Kahn K, Sodi T, van Heerden A, O'Mahen HA. User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study. JMIR Form Res 2023; 7:e51423. [PMID: 38032691 PMCID: PMC10722378 DOI: 10.2196/51423] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. OBJECTIVE This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. METHODS An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. RESULTS A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules ("episodes") played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. CONCLUSIONS The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms.
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Affiliation(s)
- Julia R Pozuelo
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bianca D Moffett
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu Natal, South Africa
| | - Halley Cohen
- Lincoln College, University of Oxford, Oxford, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Meriam Maritze
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Princess Makhubela
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tholene Sodi
- SAMRC-DSI/NRF-UL SARChI Research Chair in Mental Health and Society, University of Limpopo, Limpopo, South Africa
| | - Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather A O'Mahen
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, United Kingdom
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14
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Wang S, Cushing CA, Lau H, Craske MG, Taschereau-Dumouchel V. Multi-voxel neuro-reinforcement changes resting-state functional connectivity: A pilot study. medRxiv 2023:2023.11.10.23298400. [PMID: 37986826 PMCID: PMC10659461 DOI: 10.1101/2023.11.10.23298400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Multi-voxel neuro-reinforcement has been shown to selectively reduce amygdala reactivity in response to feared stimuli, but the precise mechanisms supporting these effects are still unknown. The current pilot study seeks to identify potential intermediaries of change using functional brain connectivity at rest. Methods Individuals (N = 11) diagnosed with at least two animal subtype specific phobias took part in a double-blind multi-voxel neuro-reinforcement clinical trial targeting one of two phobic animals, with the untargeted animal as placebo control. Changes in whole-brain resting state functional connectivity from pre-treatment to post-treatment were measured using group ICA. These changes were tested to see if they predicted the previously observed decreases in amygdala reactivity in response to images of target phobic animals. Results A common functional connectivity network overlapping with the visual network was identified in resting state data pre-treatment and post-treatment. Significant increases in functional connectivity in this network from pre-treatment to post-treatment were found in higher level visual and cognitive processing regions of the brain. Increases in functional connectivity in these regions also significantly predicted decreases in task-based amygdala reactivity to targeted phobic animals following multi-voxel neuro-reinforcement. Specifically, greater increases of functional connectivity pre-treatment to post-treatment were associated with greater decreases of amygdala reactivity to target phobic stimuli pre-treatment to post-treatment. Conclusions These findings provide preliminary evidence that multi-voxel neuro-reinforcement can induce persisting functional connectivity changes in the brain. Moreover, these changes in functional connectivity were not limited to the direct area of neuro-reinforcement, suggesting neuro-reinforcement may change how the targeted region interacts with other brain regions. Identification of these brain regions represent a first step towards explaining the underlying mechanisms of change in previous multi-voxel neuro-reinforcement studies. Future research should seek to replicate these effects in a larger sample size to further assess their role in the effects observed from multi-voxel neuro-reinforcement.
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15
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Lanser I, Freimer NB, Craske MG. Reducing policing in mental health crises: A vision for university campuses. J Am Coll Health 2023; 71:2295-2298. [PMID: 34495820 DOI: 10.1080/07448481.2021.1967363] [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] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/01/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
University campuses could become leaders in developing alternatives to policing for managing public health and safety, yet, nearly all campuses rely on campus or local police to respond to mental health emergencies. Herein, we present the available evidence for campus mobile crisis intervention teams (MCITs) as an alternative to policing, consider what colleges and universities can learn from existing community MCIT models, and propose initial steps for the development and implementation of a campus MCIT.
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Affiliation(s)
- Isabelle Lanser
- Department of Psychology, University of California, Los Angeles
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16
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Haynos AF, Anderson LM, Askew AJ, Liu C, Venables K, Craske MG, Peterson CB. A randomized, controlled pilot study of positive affect treatment adapted for anorexia nervosa. Int J Eat Disord 2023:10.1002/eat.24071. [PMID: 37811810 PMCID: PMC11001784 DOI: 10.1002/eat.24071] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/09/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Novel treatments for adults with anorexia nervosa (AN) are sorely needed. Although psychological interventions have been developed for AN, none have been identified as superior to one another or nonspecific treatments. Common comorbidities (e.g., mood and anxiety disorders) are rarely targeted in AN treatments, possibly impairing long-term clinical improvement. AN is associated with reward processing dysfunctions paralleling those identified in affective disorders; however, few treatments directly target these processes. METHOD We adapted Positive Affect Treatment, a neuroscience-informed behavioral treatment developed for affective disorders, to the treatment of AN (PAT-AN). Adults with AN (N = 20) were randomized to 20 weeks of PAT-AN or waitlist to investigate the feasibility, acceptability, preliminary efficacy, and target engagement (on reward mechanisms) of PAT-AN. RESULTS PAT-AN demonstrated strong retention (100%) and acceptability ratings (M = 5.67-5.95 on a 7-point scale). BMI (p = .006) and eating disorder symptoms (p < .001) improved over PAT-AN sessions. The PAT-AN group showed medium to large pre-to-post-treatment improvements in BMI, eating disorder symptoms and impairment, depressive and anxiety symptoms, and some reward indices (ds = .56-.87); changes were largely sustained at 3-month follow-up. Waitlist showed negligible changes (ds < .20) on nearly all measures. DISCUSSION PAT-AN holds promise as an innovative treatment with capability to simultaneously improve eating disorder symptoms, affective symptoms, and underlying reward mechanisms. Findings should be interpreted cautiously due to small sample size and permitted concurrent enrollment in other treatments. Future, larger-scale research is warranted to establish the efficacy of PAT-AN. PUBLIC SIGNIFICANCE This study provided a preliminary evaluation of Positive Affect Treatment for anorexia nervosa (PAT-AN), a novel, neuroscience-informed treatment aimed at increasing rewarding life experiences outside of one's eating disorder. Initial results suggest that PAT-AN is considered acceptable and may alleviate eating disorder, depressive, and anxiety symptoms. Therefore, this study presents promising data on a treatment that may hold potential for improving the lives of individuals with this disorder.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Autumn J. Askew
- San Diego State University/University of California, San Diego, San Diego, CA
| | - Chassidie Liu
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Kira Venables
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Michelle G. Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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17
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Yarrington JS, Metts AV, Zinbarg RE, Nusslock R, Wolitzky-Taylor K, Hammen CL, Kelley NJ, Bookheimer S, Craske MG. The Role of Positive and Negative Aspects of Life Events in Depressive and Anxiety Symptoms. Clin Psychol Sci 2023; 11:910-920. [PMID: 37766940 PMCID: PMC10530959 DOI: 10.1177/21677026221141654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Negative or stressful life events are robust risk factors for depression and anxiety. Less attention has been paid to positive aspects of events and whether positivity buffers the impact of negative aspects of events. The present study examined positivity and negativity of interpersonal and non-interpersonal episodic life events in predicting anxiety and depressive symptoms in a sample of 373 young adults. Regressions tested main and interactive effects of positivity and negativity ratings of events in predicting symptom factors (Fears, Anhedonia-Apprehension (AA), General Distress (GD)) relevant to anxiety and depression. A significant interaction demonstrated that positivity protected against high levels of negativity of non-interpersonal events in predicting GD. A main effect of interpersonal negativity predicting higher AA was observed. Results for Fears were non-significant. Findings suggest that positivity of life events may buffer against negativity in predicting symptoms shared between anxiety and depression.
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Affiliation(s)
- Julia S. Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Allison V. Metts
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208
- The Family Institute at Northwestern University, Evanston, IL 60208
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL 60208
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90024
| | - Constance L. Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
| | | | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90024
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095
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18
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Cushing CA, Peng Y, Anderson Z, Young KS, Bookheimer SY, Zinbarg RE, Nusslock R, Craske MG. Broadening the scope: Multiple functional connectivity networks underlying threat and safety signaling. bioRxiv 2023:2023.08.16.553609. [PMID: 37645883 PMCID: PMC10462158 DOI: 10.1101/2023.08.16.553609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Introduction Threat learning and extinction processes are thought to be foundational to anxiety and fear-related disorders. However, the study of these processes in the human brain has largely focused on a priori regions of interest, owing partly to the ease of translating between these regions in human and non-human animals. Moving beyond analyzing focal regions of interest to whole-brain dynamics during threat learning is essential for understanding the neuropathology of fear-related disorders in humans. Methods 223 participants completed a 2-day Pavlovian threat conditioning paradigm while undergoing fMRI. Participants completed threat acquisition and extinction. Extinction recall was assessed 48 hours later. Using a data-driven group independent component analysis (ICA), we examined large-scale functional connectivity networks during each phase of threat conditioning. Connectivity networks were tested to see how they responded to conditional stimuli during early and late phases of threat acquisition and extinction and during early trials of extinction recall. Results A network overlapping with the default mode network involving hippocampus, vmPFC, and posterior cingulate was implicated in threat acquisition and extinction. Another network overlapping with the salience network involving dACC, mPFC, and inferior frontal gyrus was implicated in threat acquisition and extinction recall. Other networks overlapping with parts of the salience, somatomotor, visual, and fronto-parietal networks were involved in the acquisition or extinction of learned threat responses. Conclusions These findings help confirm previous investigations of specific brain regions in a model-free fashion and introduce new findings of spatially independent networks during threat and safety learning. Rather than being a single process in a core network of regions, threat learning involves multiple brain networks operating in parallel coordinating different functions at different timescales. Understanding the nature and interplay of these dynamics will be critical for comprehensive understanding of the multiple processes that may be at play in the neuropathology of anxiety and fear-related disorders.
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19
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Metts AV, Craske MG. Influence of social support on cognitive reappraisal in young adults elevated on neuroticism. Behav Res Ther 2023; 167:104355. [PMID: 37379609 DOI: 10.1016/j.brat.2023.104355] [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] [Received: 11/07/2022] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Social support offers protection from depression and anxiety, possibly through its beneficial effects upon cognitive reappraisal. The present study evaluates potential mechanisms of social support, utilizing a reappraisal task in 121 undergraduates elevated on neuroticism. Participants were instructed to reinterpret stressful images with (Social Condition) and without (Solo Condition) the reminder of a social support figure. Aversiveness, negative affect, and positive affect ratings, as well as written reappraisal responses, were collected trial-by-trial. Results indicated that participants reported lower aversiveness and negative affect and higher positive affect when reinterpreting images in the Social Condition compared to the Solo Condition. Analyses of adherence ratings of written reappraisals revealed that participants generated reinterpretations more in the Social Condition than in the Solo Condition. Exploratory mediation analyses indicated that Condition was indirectly associated with reappraisal efficacy as measured by aversiveness and affect ratings through reappraisal adherence. Results suggest that cognitive reappraisal with the influence of social support may be more effective than cognitive reappraisal without such social influence, and thus may be a suitable target for interventions for depression and anxiety.
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Affiliation(s)
- Allison V Metts
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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20
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Cohen ZD, Barnes-Horowitz NM, Forbes CN, Craske MG. Measuring the active elements of cognitive-behavioral therapies. Behav Res Ther 2023; 167:104364. [PMID: 37429044 DOI: 10.1016/j.brat.2023.104364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.
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Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | | | - Courtney N Forbes
- Department of Psychology, University of California, Los Angeles, United States
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
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21
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Waters AM, Ryan KM, Luck CC, Craske MG, Lipp OV. Approximating exposure therapy in the lab: Replacing the CS+ with a similar versus a different stimulus and including additional stimuli resembling the CS+ during extinction. Behav Res Ther 2023; 167:104357. [PMID: 37364363 DOI: 10.1016/j.brat.2023.104357] [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] [Received: 06/29/2022] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Recent studies have shown that extinction training including the conditional stimulus (CS+) and stimuli that are similar to the CS + enhances extinction retention and generalisation to novel stimuli. However, in a clinical setting, the CS+ is rarely available for use during exposure therapy. The aim of the present study was to determine if replacing the CS+ with a similar versus different stimulus, and including other similar stimuli during extinction, could reduce fear at test on par with extinction using the original CS+ with and without other similar stimuli. In an experiment conducted in a single session, participants completed a habituation phase followed by an acquisition phase using two dog images presented with (CS+) and without (CS-) an acoustic unconditional stimulus (US). Participants were randomly allocated to four extinction conditions: similar CS + dog with novel dog images (Similar replacement extinction condition); different CS + dog with novel dog images (Different replacement extinction condition); original CS + dog with novel dog images (Multiple extinction control condition); and original CS + without novel dog images (Standard extinction control condition). All participants completed a test phase with the original CSs followed by a generalisation test with another two novel dog images. All groups acquired, and then extinguished differential skin conductance responses (SCRs) with no differences observed between groups. Whereas the Similar replacement extinction group and the Multiple and Standard extinction control groups did not exhibit significant differential SCRs when re-exposed to the original CS + relative to the CS- at test, differential responding to the CSs was significant at test in the Different replacement extinction group. There were no significant differences between groups in SCRs to the two novel dog images during the generalisation phase and in between-phase subjective ratings. Findings suggest that replacement stimuli used during extinction should be as similar as possible to the CS + to reduce physiological arousal to the original CS+.
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Affiliation(s)
| | | | | | - Michelle G Craske
- Department of Psychology & Department of Psychiatry & Biobehavioral Sciences, UCLA, United States
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Australia
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22
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Berg H, Akeman E, McDermott TJ, Cosgrove KT, Kirlic N, Clausen A, Cannon M, Yeh HW, White E, Thompson WK, Choquette EM, Sturycz-Taylor CA, Cochran G, Ramirez S, Martell CR, Wolitzky-Taylor KB, Craske MG, Abelson JL, Paulus MP, Aupperle RL. A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder. J Mood Anxiety Disord 2023; 1:100004. [PMID: 38384390 PMCID: PMC10881118 DOI: 10.1016/j.xjmad.2023.100004] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD. Method In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure. Results Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment. Conclusions BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.
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Affiliation(s)
- Hannah Berg
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Elisabeth Akeman
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Ashley Clausen
- St. Vincent Hospital, Billings, 1233 N 30th St, Billings, MT 59101, USA
| | - Mallory Cannon
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Evan White
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Wesley K. Thompson
- Family Medicine and Public Health, UC San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Emily M. Choquette
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | | | - Gabe Cochran
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Sam Ramirez
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Christopher R. Martell
- Department of Psychological and Brain Sciences, University of Massachusetts–Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kate B. Wolitzky-Taylor
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - Michelle G. Craske
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
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23
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Escovar EL, Bocanegra ES, Craske MG, Bystritsky A, Roy-Byrne P, Sherbourne CD, Stein MB, Chavira DA. Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders. J Nerv Ment Dis 2023; 211:427-439. [PMID: 37252881 PMCID: PMC10234492 DOI: 10.1097/nmd.0000000000001533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/01/2023]
Abstract
ABSTRACT Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.
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Affiliation(s)
| | | | | | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, University of Washington at Harborview Medical Center, Seattle, Washington
| | | | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Pubic Health, University of California, San Diego, La Jolla, California
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24
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McGlade AL, Treanor M, Kim R, Craske MG. Does fear reduction predict treatment response to exposure for social anxiety disorder? J Behav Ther Exp Psychiatry 2023; 79:101833. [PMID: 36563534 DOI: 10.1016/j.jbtep.2022.101833] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 06/21/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Fear activation and reduction have traditionally been considered important mechanisms of exposure therapy. Evidence to date is mixed and impeded by inadequate methodology. This study examined the extent to which fear activation and reduction within and across exposures predicted treatment outcomes for social anxiety disorder within a paradigm suitable for their measurement. METHODS Sixty-eight adults with social anxiety disorder and fear of public speaking completed seven exposure sessions, each consisting of seven speeches conducted in virtual reality. Exposures were identical in duration, task requirements, and virtual public speaking situation. Fear was measured with skin conductance and subjective distress ratings. At baseline and post-treatment, participants completed a public speaking behavioral approach test with a panel of confederate judges; subjective fear was measured. A standardized questionnaire of anxiety symptoms was administered at baseline, post-treatment, and one-month follow-up. RESULTS No indices of within- or between-session fear reduction, measured by subjective distress and skin conductance response, predicted treatment outcome. One measure of fear activation was associated with outcomes such that less activation predicted greater symptom reduction; remaining indices did not predict outcomes. LIMITATIONS Data were collected in the context of a randomized controlled trial of scopolamine; drug group was included in analytic models to account for drug influence. VR exposures elicited mild levels of distress that may underestimate levels of distress in clinical settings. CONCLUSIONS Findings failed to support fear activation or reduction within or across exposure sessions as significant predictors of treatment outcome for social anxiety. Treatment implications are discussed.
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Affiliation(s)
- Anastasia L McGlade
- University of California Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA.
| | - Michael Treanor
- University of California Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA.
| | - Richard Kim
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX, 75275, USA.
| | - Michelle G Craske
- University of California Los Angeles, Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA.
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25
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Gill JL, Schneiders JA, Stangl M, Aghajan ZM, Vallejo M, Hiller S, Topalovic U, Inman CS, Villaroman D, Bari A, Adhikari A, Rao VR, Fanselow MS, Craske MG, Krahl SE, Chen JWY, Vick M, Hasulak NR, Kao JC, Koek RJ, Suthana N, Langevin JP. A pilot study of closed-loop neuromodulation for treatment-resistant post-traumatic stress disorder. Nat Commun 2023; 14:2997. [PMID: 37225710 PMCID: PMC10209131 DOI: 10.1038/s41467-023-38712-1] [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: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023] Open
Abstract
The neurophysiological mechanisms in the human amygdala that underlie post-traumatic stress disorder (PTSD) remain poorly understood. In a first-of-its-kind pilot study, we recorded intracranial electroencephalographic data longitudinally (over one year) in two male individuals with amygdala electrodes implanted for the management of treatment-resistant PTSD (TR-PTSD) under clinical trial NCT04152993. To determine electrophysiological signatures related to emotionally aversive and clinically relevant states (trial primary endpoint), we characterized neural activity during unpleasant portions of three separate paradigms (negative emotional image viewing, listening to recordings of participant-specific trauma-related memories, and at-home-periods of symptom exacerbation). We found selective increases in amygdala theta (5-9 Hz) bandpower across all three negative experiences. Subsequent use of elevations in low-frequency amygdala bandpower as a trigger for closed-loop neuromodulation led to significant reductions in TR-PTSD symptoms (trial secondary endpoint) following one year of treatment as well as reductions in aversive-related amygdala theta activity. Altogether, our findings provide early evidence that elevated amygdala theta activity across a range of negative-related behavioral states may be a promising target for future closed-loop neuromodulation therapies in PTSD.
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Affiliation(s)
- Jay L Gill
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Medical Scientist Training Program, University of California, Los Angeles, CA, USA
| | - Julia A Schneiders
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthias Stangl
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Zahra M Aghajan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Mauricio Vallejo
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Uros Topalovic
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Cory S Inman
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Diane Villaroman
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Avishek Adhikari
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Vikram R Rao
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Michael S Fanselow
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Scott E Krahl
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - James W Y Chen
- Neurology Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, CA, USA
| | | | - Nicholas R Hasulak
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Phoenix Research Consulting LLC, Gilbert, AZ, USA
| | - Jonathan C Kao
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Psychiatry and Mental Health Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
- Department of Bioengineering, University of California, Los Angeles, CA, USA.
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Neurosurgery Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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26
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Losiewicz OM, Metts AV, Zinbarg RE, Hammen C, Craske MG. Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents. J Affect Disord 2023; 329:350-358. [PMID: 36863468 DOI: 10.1016/j.jad.2023.02.125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms. METHODS This study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period. RESULTS In partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress. LIMITATIONS Study limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective. CONCLUSIONS More targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.
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Affiliation(s)
- Olivia M Losiewicz
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Allison V Metts
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Richard E Zinbarg
- Northwestern University, Department of Psychology, 2029 Sheridan Road, Swift Hall 102, Evanston, IL 60208, USA; The Family Institute, Northwestern University, Evanston, IL, USA
| | - Constance Hammen
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA
| | - Michelle G Craske
- University of California, Department of Psychology, 1285 Franz Hall, Los Angeles, CA 90025, USA.
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27
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Metts AV, Echiverri-Cohen AM, Yarrington JS, Zinbarg RE, Mineka S, Craske MG. Longitudinal associations among dimensional symptoms of depression and anxiety and first onset suicidal ideation in adolescents. Suicide Life Threat Behav 2023. [PMID: 36942926 DOI: 10.1111/sltb.12956] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Depression and anxiety are implicated in suicide risk, but the contributionof specific symptom dimensions within these disorders is not well understood. The present study examined longitudinal associations of transdiagnostic symptoms (General Distress[GD]) and unique symptom dimensions (Anhedonia-Apprehension [AA], Fears, and Narrow Depression [ND]) of depression and anxiety and suicidal ideation (SI). METHODS Data from 551 adolescents oversampled on high neuroticism were examined in a series of discrete-time survival analyses to predict first SI onset over an 8-year period. RESULTS Results indicate that GD, AA, and ND were independent predictors of increased likelihood of SI onset and remained significant when controlling for effects of fears. Furthermore, AA and GD remained significant when controlling for one another. ND effects reduced by 24% when adjusting for AA and 74% when adjusting for GD. Fears did not significantly predict SI onset. CONCLUSION Results suggest that broad levels of distress across depression and anxiety, deficits in positive affect, and elevated negative affect specific to depression increase the likelihood of suicidal thoughts. As such, attention to broader distress and a lack of pleasure, interest, and motivation-potentially more so than negative affect characterizing depression-are particularly important for addressing suicide risk in adolescents.
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Affiliation(s)
- Allison V Metts
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | | | - Julia S Yarrington
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- The Family Institute, Northwestern University, Evanston, Illinois, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
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28
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Craske MG, Meuret AE, Echiverri-Cohen A, Rosenfield D, Ritz T. Positive affect treatment targets reward sensitivity: A randomized controlled trial. J Consult Clin Psychol 2023; 91:350-366. [PMID: 36892884 DOI: 10.1037/ccp0000805] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Determine whether a novel psychosocial treatment for positive affect improves clinical status and reward sensitivity more than a form of cognitive behavioral therapy that targets negative affect and whether improvements in reward sensitivity correlate with improvements in clinical status. METHOD In this assessor-blinded, parallel-group, multisite, two-arm randomized controlled clinical superiority trial, 85 treatment-seeking adults with severely low positive affect, moderate-to-severe depression or anxiety, and functional impairment received 15 weekly individual therapy sessions of positive affect treatment (PAT) or negative affect treatment (NAT). Clinical status measures were self-reported positive affect, interviewer-rated anhedonia, and self-reported depression and anxiety. Target measures were eleven physiological, behavioral, cognitive, and self-report measures of reward anticipation-motivation, response to reward attainment, and reward learning. All analyses were intent-to-treat. RESULTS Compared to NAT, individuals receiving PAT achieved superior improvements in the multivariate clinical status measures at posttreatment, b = .37, 95% CI [.15, .59], t(109) = 3.34, p = .001, q = .004, d = .64. Compared to NAT, individuals receiving PAT also achieved higher multivariate reward anticipation-motivation, b = .21, 95% CI [.05, .37], t(268) = 2.61, p = .010, q = .020, d = .32, and higher multivariate response to reward attainment, b = .24, 95% CI [.02, .45], t(266) = 2.17, p = .031, q = .041, d = .25, at posttreatment. Measures of reward learning did not differ between the two groups. Improvements in reward anticipation-motivation and in response to reward attainment correlated with improvements in the clinical status measures. CONCLUSIONS Targeting positive affect results in superior improvements in clinical status and reward sensitivity than targeting negative affect. This is the first demonstration of differential target engagement across two psychological interventions for anxious or depressed individuals with low positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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29
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Kuhlman KR, Cole SW, Irwin MR, Craske MG, Fuligni AJ, Bower JE. The role of early life adversity and inflammation in stress-induced change in reward and risk processes among adolescents. Brain Behav Immun 2023; 109:78-88. [PMID: 36621653 PMCID: PMC10112053 DOI: 10.1016/j.bbi.2023.01.004] [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: 09/15/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Early life adversity (ELA) has long been associated with increased risk for stress-related psychopathology, particularly depression. The neuroimmune network hypothesis posits that ELA increases sensitivity to psychosocial stress, moderating the association between increases in peripheral markers of inflammation and decreases in reward outcomes linked to anhedonia and risk-taking behaviors. The present study examined this hypothesis in a sample of adolescents by using acute psychosocial stress to probe the role of inflammatory signaling in behavioral measures of reward and risk processing. METHOD 80 adolescents [13.86 years (SD = 1.54); 45 % female], oversampled for ELA, underwent the Trier Social Stress Test for Children while providing blood samples immediately before and 60-minutes after stress onset. Blood samples were assayed for plasma IL-6. One hour before stress onset, and then 60 min after, participants completed computer-administered behavioral tasks measuring reward (Pirate Task) and risk (Balloon Analog Risk Task). RESULTS ELA moderated the association between increases in IL-6 and decreases in risk tolerance in pursuit of rewards (p = 0.003) and reward response bias (p = 0.04). Stress-induced increases in IL-6 were associated with decreases in pumps for rewards among adolescents exposed to high, relative to little or no, ELA. Further, greater IL-6 increases were associated with increases in bias toward high relative to low value rewards among adolescents with low adversity exposure but not among those exposed to higher adversity. CONCLUSIONS The present study provides the first evidence in a pediatric sample that ELA may alter the role of stress-induced inflammation in reward and risk processing, and may extend our understanding of why stress leads to depression in this high-risk population.
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Affiliation(s)
- Kate R Kuhlman
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA; Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - Steve W Cole
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael R Irwin
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Michelle G Craske
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew J Fuligni
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Julienne E Bower
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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30
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Klumpp H, Bauer BW, Glazer J, Macdonald-Gagnon G, Feurer C, Duffecy J, Medrano GR, Craske MG, Phan KL, Shankman SA. Neural responsiveness to reward and suicidal ideation in social anxiety and major depression before and after psychotherapy. Biol Psychol 2023; 178:108520. [PMID: 36801433 PMCID: PMC10106432 DOI: 10.1016/j.biopsycho.2023.108520] [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: 10/19/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
Suicidality is prevalent in Social Anxiety Disorder (SAD) and Major Depressive Disorder (MDD). Limited data indicate the reward positivity (RewP), a neurophysiological index of reward responsivity, and subjective capacity for pleasure may serve as brain and behavioral assays for suicide risk though this has yet to be examined in SAD or MDD in the context of psychotherapy. Therefore, the current study tested whether suicidal ideation (SI) relates to RewP and subjective capacity for anticipatory and consummatory pleasure at baseline and whether Cognitive Behavioral Therapy (CBT) impacts these measures. Participants with SAD (n = 55) or MDD (n = 54) completed a monetary reward task (gains vs. losses) during electroencephalogram (EEG) before being randomized to CBT or supportive therapy (ST), a comparator common factors arm. EEG and SI data were collected at baseline, mid-treatment, and post-treatment; capacity for pleasure was collected at baseline and post-treatment. Baseline results showed participants with SAD or MDD were comparable in SI, RewP, and capacity for pleasure. When controlling for symptom severity, SI negatively corresponded with RewP following gains and SI positively corresponded with RewP following losses at baseline. Yet, SI did not relate to subjective capacity for pleasure. Evidence of a distinct SI-RewP association suggests RewP may serve as a transdiagnositic brain-based marker of SI. Treatment outcome revealed that among participants with SI at baseline, SI significantly decreased regardless of treatment arm; also, consummatory, but not anticipatory, pleasure increased across participants regardless of treatment arm. RewP was stable following treatment, which has been reported in other clinical trial studies.
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Affiliation(s)
- Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Brian W Bauer
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - James Glazer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | | | - Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Gustavo R Medrano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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Metts AV, LeBeau RT, Craske MG, Himle JA. Perceived interpersonal competence as a predictor of clinical outcomes in a randomized controlled trial for social anxiety and employment. Cogn Behav Ther 2023; 52:146-162. [PMID: 36409226 PMCID: PMC9839579 DOI: 10.1080/16506073.2022.2137578] [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: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
This study explored relationships among perceived interpersonal competence and demographic and work history variables in a randomized control trial for social anxiety disorder (SAD) that compared work-related group cognitive behavioral therapy plus vocational services (WCBT+VSAU) to vocational services only (VSAU-alone). Intervention effects of perceived interpersonal competence on treatment outcomes over 12 weeks were also examined. Data from 250 job seekers with SAD (59.2% Female; 40.8% Black/African American; 82.4% Non-Hispanic/non-Latino/a) were analyzed. We predicted negative relationships between perceived interpersonal competence and symptoms/impairment and that individuals with lower perceived interpersonal competence would benefit more quickly in WCBT+VSAU relative to VSAU-alone. Results indicated that perceived interpersonal competence did not vary by gender, race, ethnicity, homeless status, or employment history. There were no intervention effects of perceived interpersonal competence regarding social anxiety or overall functional impairment, but results supported negative relationships between perceived interpersonal competence and lower social anxiety and overall functional impairment in both conditions. Separately, perceived interpersonal competence moderated effects in the depression model such that there were faster declines in depression at lower perceived interpersonal competence levels in WCBT+VSAU, but not in VSAU-alone. Results indicate the value of attending to perceived interpersonal competence in interventions, which may result in mood benefits.
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Affiliation(s)
- Allison V. Metts
- Department of Psychology, University of California, Los Angeles, USA
| | - Richard T. LeBeau
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Joseph A. Himle
- School of Social Work University of Michigan, USA
- Department of Psychiatry, University of Michigan, USA
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Anderson Z, Damme KSF, Carroll AL, Ka-Yi Chat I, Young KS, Craske MG, Bookheimer S, Zinbarg R, Nusslock R. Association between reward-related functional connectivity and tri-level mood and anxiety symptoms. Neuroimage Clin 2023; 37:103335. [PMID: 36736199 PMCID: PMC9926301 DOI: 10.1016/j.nicl.2023.103335] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
Depression and anxiety are associated with abnormalities in brain regions that process rewards including the medial orbitofrontal cortex (mOFC), the ventral striatum (VS), and the amygdala. However, there are inconsistencies in these findings. This may be due to past reliance on categorical diagnoses that, while valuable, provide less precision than may be required to understand subtle neural changes associated with symptoms of depression and anxiety. In contrast, the tri-level model defines symptom dimensions that are common (General Distress) or relatively specific (Anhedonia-Apprehension, Fears) to depression and anxiety related disorders, which provide increased precision. In the current study, eligibility was assessed by quasi-orthogonal screening questionnaires measuring reward and threat sensitivity (Behavioral Activation Scale; Eysenck Personality Questionnaire-Neuroticism). These participants were assessed on tri-level symptom severity and completed the Monetary Incentive Delay task during fMRI scanning. VS-mOFC and VS-amygdala connectivity were estimated during reward anticipation and reward outcome. Heightened General Distress was associated with lower VS-mOFC connectivity during reward anticipation (b = -0.064, p = 0.021) and reward outcome (b = -0.102, p = 0.014). Heightened Anhedonia-Apprehension was associated with greater VS-amygdala connectivity during reward anticipation (b = 0.065, p = 0.004). The present work has important implications for understanding the coupling between the mOFC and vS and the amygdala and the vS during reward processing in the pathophysiology of mood and anxiety symptoms and for developing targeted behavioral, pharmacological, and neuromodulatory interventions to help manage these symptoms.
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Affiliation(s)
- Zachary Anderson
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovation in Developmental Sciences, Chicago, IL, USA
| | - Ann L Carroll
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Iris Ka-Yi Chat
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Katherine S Young
- Social, Genetic and Development Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London SE5 8AF, UK
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Susan Bookheimer
- Department of Psychology, University of California Los Angeles, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA; Ahmanson-Lovelace Brain Mapping Center, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA; The Family Institute at Northwestern University, Evanston, IL, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Peng Y, Knotts JD, Young KS, Bookheimer SY, Nusslock R, Zinbarg RE, Kelley NJ, Echiverri-Cohen AM, Craske MG. Threat Neurocircuitry Predicts the Development of Anxiety and Depression Symptoms in a Longitudinal Study. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:102-110. [PMID: 35031524 DOI: 10.1016/j.bpsc.2021.12.013] [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] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Owing to high heterogeneity and comorbidity, the shared and unique neural mechanisms underlying the development of anxiety and major depressive disorders remain unclear. Using a dimensional model describing shared versus unique symptoms associated with anxiety and depression, this study investigated how longitudinal changes in symptom dimensions relate to threat neurocircuitry. METHODS Participants were 18- to 19-year-olds (N = 279, 186 females) who completed self-report measures of anxiety and depression at baseline and at 10, 20, and 30 months. Linear slopes of symptom dimensions of general distress, fear, and anhedonia-apprehension were estimated through a trilevel factorial model. In addition, functional magnetic resonance imaging scans were obtained while participants performed Pavlovian fear conditioning tasks at baseline and 30 months, including three phases of fear acquisition, extinction, and extinction recall. Neural responses in regions of interest related to threat neural circuitry (e.g., amygdala, ventromedial prefrontal cortex, and subgenual anterior cingulate cortex) were extracted. RESULTS Linear mixed models used to estimate relationships between changes of symptom dimensions and neural responses revealed two major findings: 1) greater neural responses to threatening stimuli during fear acquisition at baseline were associated with a greater increase in fear symptoms during the 30-month prospective period; and 2) elevated neural responses to the extinguished stimulus during extinction recall at 30 months were negatively associated with changes in general distress, suggesting that greater increases in general distress are associated with larger deficits in extinction memory. CONCLUSIONS These findings improve our understanding of pathophysiological pathways underlying the development of anxiety and depression, while separating symptom dimensions that are shared versus unique between the two disorders.
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Affiliation(s)
- Yujia Peng
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China; Institute for Artificial Intelligence, Peking University, Beijing, China; Beijing Institute for General Artificial Intelligence, Beijing, China; Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey D Knotts
- Department of Psychology, University of California, Los Angeles, Los Angeles, California; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Katherine S Young
- Department of Psychology, University of California, Los Angeles, Los Angeles, California; Social, Genetic and Development Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; NIHR Maudsley Biomedical Research Centre, King's College London, London, United Kingdom
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois; Family Institute at Northwestern University, Evanston, Illinois
| | - Nicholas J Kelley
- Department of Psychology, Northwestern University, Evanston, Illinois; Department of Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.
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Craske MG, Sandman CF, Stein MB. How can neurobiology of fear extinction inform treatment? Neurosci Biobehav Rev 2022; 143:104923. [DOI: 10.1016/j.neubiorev.2022.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
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Craske MG. The future of CBT and evidence-based psychotherapies is promising. World Psychiatry 2022; 21:417-419. [PMID: 36073704 PMCID: PMC9453923 DOI: 10.1002/wps.21002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2022] Open
Affiliation(s)
- Michelle G. Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCAUSA
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McDermott TJ, Berg H, Touthang J, Akeman E, Cannon MJ, Santiago J, Cosgrove KT, Clausen AN, Kirlic N, Smith R, Craske MG, Abelson JL, Paulus MP, Aupperle RL. Striatal reactivity during emotion and reward relates to approach-avoidance conflict behaviour and is altered in adults with anxiety or depression. J Psychiatry Neurosci 2022; 47:E311-E322. [PMID: 36223130 PMCID: PMC9448414 DOI: 10.1503/jpn.220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We have previously reported activation in reward, salience and executive control regions during functional MRI (fMRI) using an approach-avoidance conflict (AAC) decision-making task with healthy adults. Further investigations into how anxiety and depressive disorders relate to differences in neural responses during AAC can inform their understanding and treatment. We tested the hypothesis that people with anxiety or depression have altered neural activation during AAC. METHODS We compared 118 treatment-seeking adults with anxiety or depression and 58 healthy adults using linear mixed-effects models to examine group-level differences in neural activation (fMRI) during AAC decision-making. Correlational analyses examined relationships between behavioural and neural measures. RESULTS Adults with anxiety or depression had greater striatal engagement when reacting to affective stimuli (p = 0.008, d = 0.31) regardless of valence, and weaker striatal engagement during reward feedback (p = 0.046, d = -0.27) regardless of the presence of monetary reward. They also had blunted amygdala activity during decision-making (p = 0.023, d = -0.32) regardless of the presence of conflict. Across groups, approach behaviour during conflict decision-making was inversely correlated with striatal activation during affective stimuli (p < 0.001, r = -0.28) and positively related to striatal activation during reward feedback (p < 0.001, r = 0.27). LIMITATIONS Our transdiagnostic approach did not allow for comparisons between specific anxiety disorders, and our cross-sectional approach did not allow for causal inference. CONCLUSION Anxiety and depression were associated with altered neural responses to AAC. Findings were consistent with the role of the striatum in action selection and reward responsivity, and they point toward striatal reactivity as a future treatment target. Blunting of amygdala activity in anxiety or depression may indicate a compensatory response to inhibit affective salience and maintain approach.
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Affiliation(s)
- Timothy J McDermott
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Hannah Berg
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - James Touthang
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Elisabeth Akeman
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Mallory J Cannon
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Jessica Santiago
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Kelly T Cosgrove
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Ashley N Clausen
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Namik Kirlic
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Ryan Smith
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Michelle G Craske
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - James L Abelson
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Martin P Paulus
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
| | - Robin L Aupperle
- From the Laureate Institute for Brain Research, Tulsa, OK (McDermott, Berg, Touthang, Akeman, Cannon, Santiago, Cosgrove, Clausen, Kirlic, Smith, Paulus, Aupperle); the Department of Psychology, University of Tulsa, Tulsa, OK (McDermott, Cosgrove); the Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, MN (Berg); the Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (Craske); the Department of Psychiatry, University of Michigan, Ann Arbor, MI (Abelson); the Department of Community Medicine, University of Tulsa, Tulsa, OK (Paulus, Aupperle)
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Yarrington JS, Vinograd M, Williams AL, Wolitzky-Taylor KB, Zinbarg RE, Mineka S, Waters AM, Craske MG. Fear-potentiated startle predicts longitudinal change in transdiagnostic symptom dimensions of anxiety and depression. J Affect Disord 2022; 311:399-406. [PMID: 35597470 DOI: 10.1016/j.jad.2022.05.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/04/2021] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Elevated defensive responding, through startle reflex (SR) and skin conductance response (SCR), may contribute to onset and maintenance of depression and anxiety. Most work examining SR and SCR has predicted psychiatric diagnoses. There is a paucity of research examining links between SR or SCR and dimensional measures of psychopathology. METHODS We used latent growth curve modeling to predict longitudinal change in three symptom factors (i.e., General Distress, Fears, Anhedonia-Apprehension) from SR and SCR measured during a fear-potentiated startle paradigm among adolescents oversampled for neuroticism (N = 129). RESULTS Elevated SCR in danger phases before and after an unpleasant muscle contraction predicted increasing Fears over time. Elevated SR in safe phases post-contraction also predicted increasing Fears over time. Attenuated SR in safe phases post-contraction predicted elevated General Distress longitudinally. Attenuated SCR pre-contraction in danger phases predicted elevated Anhedonia-Apprehension over time. LIMITATIONS Our non-clinical sample may limit generalizability of results. Additionally, we did not assess change in SR and SCR over time. CONCLUSIONS The present study demonstrates that SR and SCR during a fear-potentiated startle paradigm predict longitudinal change in dimensional anxiety and depression symptom factors and relatedly, that SR and SCR may represent risk factors for the exacerbation of symptomatology.
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Affiliation(s)
- Julia S Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meghan Vinograd
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Michelle G Craske
- 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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Klumpp H, Jimmy J, Burkhouse KL, Bhaumik R, Francis J, Craske MG, Phan KL, Ajilore O. Brain response to emotional faces in anxiety and depression: neural predictors of cognitive behavioral therapy outcome and predictor-based subgroups following therapy. Psychol Med 2022; 52:2095-2105. [PMID: 33168110 DOI: 10.1017/s0033291720003979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neuroimaging studies have shown variance in brain response to emotional faces predicts cognitive behavioral therapy (CBT) outcome. An important next step is to determine if individual differences in neural predictors of CBT response represent distinct patient groups. METHODS In total, 90 patients with internalizing disorders completed a face-matching task during functional magnetic resonance imaging before and after 12 weeks of CBT and 45 healthy controls completed the task before and after 12 weeks. Patients exhibiting a pre-to-post CBT >50% reduction in symptom severity on two measures were considered treatment responders. Regions of interest (ROIs) for angry, fearful, and happy faces were submitted to receiver operating characteristic (ROC) curve analysis. Significant ROIs were then submitted to decision tree analysis to classify responder/non-responder subgroups. Psychophysiological interactions (PPI) were used to explore functional connectivity in the region(s) that delineated subgroups. RESULTS A total of 51 patients were treatment responders and ROC curve results were significant for all face types though specific regions varied. Decision tree results revealed superior occipital response to angry faces identified patient subgroups such that the subgroup with 'high' occipital activity had more responders than the 'low' occipital subgroup. Following CBT, the high, relative to low, occipital subgroup was less symptomatic. Controls exhibited stable superior occipital activation over time. Whole-brain PPI showed reduced baseline superior occipital-postcentral gyrus functional connectivity in responders compared to non-responders. CONCLUSIONS Preliminary findings indicate patients characterized by relatively more pre-treatment superior occipital gyrus engagement to angry faces and reduced superior occipital-postcentral gyrus connectivity, relative to non-responders, may represent a phenotype likely to benefit from CBT.
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Affiliation(s)
- Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jagan Jimmy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Runa Bhaumik
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Francis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Feurer C, Jimmy J, Bhaumik R, Duffecy J, Medrano GR, Ajilore O, Shankman SA, Langenecker SA, Craske MG, Phan KL, Klumpp H. Anterior cingulate cortex activation during attentional control as a transdiagnostic marker of psychotherapy response: a randomized clinical trial. Neuropsychopharmacology 2022; 47:1350-1357. [PMID: 34718341 PMCID: PMC8556845 DOI: 10.1038/s41386-021-01211-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Abstract
Anterior cingulate cortex (ACC) response during attentional control in the context of task-irrelevant emotional faces is a promising biomarker of cognitive behavioral therapy (CBT) outcome in patients with social anxiety disorder (SAD). However, it is unclear whether this biomarker extends to major depressive disorder (MDD) and is specific to CBT outcome. In the current study, 72 unmedicated patients with SAD (n = 39) or MDD (n = 33) completed a validated emotional interference paradigm during functional magnetic resonance imaging before treatment. Participants viewed letter strings superimposed on task-irrelevant threat and neutral faces under low perceptual load (high interference) and high perceptual load (low interference). Biomarkers comprised anatomy-based rostral ACC (rACC) and dorsal ACC (dACC) response to task-irrelevant threat (>neutral) faces under low and high perceptual load. Patients were randomly assigned to 12 weeks of CBT or supportive therapy (ST) (ClinicalTrials.gov identifier: NCT03175068). Clinician-administered measures of social anxiety and depression severity were obtained at baseline and every 2 weeks throughout treatment (7 assessments total) by an assessor blinded to the treatment arm. A composite symptom severity score was submitted to latent growth curve models. Results showed more baseline rACC activity to task-irrelevant threat>neutral faces under low, but not high, perceptual load predicted steeper trajectories of symptom improvement throughout CBT or ST. Post-hoc analyses indicated this effect was driven by subgenual ACC (sgACC) activation. Findings indicate ACC activity during attentional control may be a transdiagnostic neural predictor of general psychotherapy outcome.
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Affiliation(s)
- Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jagan Jimmy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Runa Bhaumik
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Jennifer Duffecy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Gustavo R. Medrano
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Olusola Ajilore
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Stewart A. Shankman
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL USA
| | - Scott A. Langenecker
- grid.223827.e0000 0001 2193 0096Department of Psychiatry, University of Utah, Salt Lake City, UT USA
| | - Michelle G. Craske
- grid.19006.3e0000 0000 9632 6718Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA USA
| | - K. Luan Phan
- grid.261331.40000 0001 2285 7943Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH USA
| | - Heide Klumpp
- grid.185648.60000 0001 2175 0319Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Department of Psychology, University of Illinois at Chicago, Chicago, IL USA
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Young KS, Ward C, Vinograd M, Chen K, Bookheimer SY, Nusslock R, Zinbarg RE, Craske MG. Individual differences in threat and reward neural circuitry activation: Testing dimensional models of early adversity, anxiety and depression. Eur J Neurosci 2022; 55:2739-2753. [PMID: 34989038 PMCID: PMC9149108 DOI: 10.1111/ejn.15592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/30/2020] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 01/31/2023]
Abstract
Altered functioning of the brain's threat and reward circuitry has been linked to early life adversity and to symptoms of anxiety and depression. To date, however, these relationships have been studied largely in isolation and in categorical-based approaches. It is unclear to what extent early life adversity and psychopathology have unique effects on brain functioning during threat and reward processing. We examined functional brain activity during a face processing task in threat (amygdala and ventromedial prefrontal cortex) and reward (ventral striatum and orbitofrontal cortex) regions of interest among a sample (N = 103) of young adults (aged 18-19 years) in relation to dimensional measures of early life adversity and symptoms of anxiety and depression. Results demonstrated a significant association between higher scores on the deprivation adversity dimension and greater activation of reward neural circuitry during viewing of happy faces, with the largest effect sizes observed in the orbitofrontal cortex. We found no significant associations between the threat adversity dimension, or symptom dimensions of anxiety and depression, and neural activation in threat or reward circuitries. These results lend partial support to theories of adversity-related alterations in neural activation and highlight the importance of testing dimensional models of adversity and psychopathology in large sample sizes to further our understanding of the biological processes implicated.
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Affiliation(s)
- Katherine S. Young
- Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and NeuroscienceKing's College LondonLondonUK,NIHR Maudsley Biomedical Research CentreKing's College LondonLondonUK
| | - Camilla Ward
- Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and NeuroscienceKing's College LondonLondonUK
| | - Meghan Vinograd
- Center of Excellence for Stress and Mental HealthVeterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA,Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Kelly Chen
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Susan Y. Bookheimer
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles (UCLA)Los AngelesCaliforniaUnited States
| | - Robin Nusslock
- Department of PsychologyNorthwestern UniversityEvanstonIllinoisUSA
| | - Richard E. Zinbarg
- Department of PsychologyNorthwestern UniversityEvanstonIllinoisUSA,The Family InstituteNorthwestern UniversityEvanstonIllinoisUSA
| | - Michelle G. Craske
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles (UCLA)Los AngelesCaliforniaUnited States,Department of PsychologyUniversity of California, Los Angeles (UCLA)Los AngelesCaliforniaUSA
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41
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Yarrington JS, Enders CK, Zinbarg RE, Mineka S, Craske MG. Examining the dimensionality of anxiety and depression: A latent profile approach to modeling transdiagnostic features. J Psychopathol Behav Assess 2022; 44:214-226. [PMID: 35573659 PMCID: PMC9094145 DOI: 10.1007/s10862-021-09913-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/30/2022]
Abstract
Depression and anxiety are highly prevalent psychological disorders; our understanding of these conditions remains limited. Efforts to explain anxiety and depression have been constrained in part by binary classification systems. Dimensional approaches to understanding psychopathology may be more effective. The present study used latent profile analysis (LPA) to assess whether unique subgroups exist within a tri-level model of anxiety and depression. Participants (N=627) completed self-report questionnaires from which tri-level model factors were derived. LPA was conducted on those factors. A 4-profile model offered optimal fit to the data at baseline. This model was replicated at a second time point. Models derived included profiles labelled 'Mixed Fears,' 'Anxious Arousal,' 'Low Mood/Anhedonia,' and 'Sub-Clinical.' Profiles were validated at Time 1 using diagnostic status and clinical severity ratings associated with mood and anxiety presentations. Profiles demonstrated flexibility in accommodating breadth in clinical presentations and common comorbidities. Latent variable models may offer more ecologically valid approaches to understanding psychopathology.
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Affiliation(s)
- Julia S. Yarrington
- Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA 90095
| | - Craig K. Enders
- Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA 90095
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208
| | - Susan Mineka
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA 90095
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Kuhlman KR, Cole SW, Craske MG, Fuligni AJ, Irwin MR, Bower JE. Enhanced immune activation following acute social stress among adolescents with early life adversity. Biological Psychiatry Global Open Science 2022; 3:213-221. [PMID: 37124349 PMCID: PMC10140462 DOI: 10.1016/j.bpsgos.2022.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022] Open
Abstract
Background Early-life adversity (ELA) has been linked to higher depression risk across the life span and chronic inflammatory conditions that contribute to earlier mortality. In this study, we characterized innate immune responses to acute social stress in a community sample of adolescents (mean age = 13.9 ± 1.6 years; 46.4% female) as a potential pathway linking ELA and depression pathogenesis. Methods Parents reported their child's exposure to 9 ELAs, and adolescents participated in the Trier Social Stress Test for Children, with blood collected immediately before and then at 60 and 90 minutes thereafter. Overall, 65 adolescents had complete data for analysis of stress-induced changes in gene expression and 84 adolescents had complete data for circulating inflammatory markers. Results Relative to adolescents exposed to no ELA (11.9%) or low ELA (ELA = 1-3; 67.9%), those exposed to high ELA (ELA = 4+; 20.2%) showed larger stress-associated increases in expression of both proinflammatory and innate antiviral gene transcripts in circulating blood. Consistent with a potential mediating role of sympathetic nervous system activity, promoter-based bioinformatics analyses implicated CREB transcription factor activity in structuring observed gene expression differences. These effects were accompanied by a smaller initial but protracted increase in circulating interleukin 6 in adolescents with high ELA. Conclusions Results are consistent with the hypothesis that ELA may enhance cellular and gene regulatory reactivity to stress, which may, in turn, increase vulnerability to depression and other inflammation-related disease processes.
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Boland EM, Kelley NJ, Chat IKY, Zinbarg R, Craske MG, Bookheimer S, Nusslock R. Poor sleep quality is significantly associated with effort but not temporal discounting of monetary rewards. Motiv Sci 2022; 8:70-76. [PMID: 37476692 PMCID: PMC10358359 DOI: 10.1037/mot0000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Elaine M Boland
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
- Mental Illness Research Education and Clinical Center (MIRECC), Cpl. Michael J. Crescenz VA Medical Center, Philadelphia PA
| | - Nicholas J Kelley
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Iris Ka-Yi Chat
- Department of Psychology, Temple University, Philadelphia PA
- Department of Psychology, Northwestern University, Evanston, IL
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL
- The Family Institute at Northwestern University, Evanston, IL
| | - Michelle G Craske
- Departments of Psychology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Susan Bookheimer
- Departments of Psychology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL
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Rosenberg BM, Kodish T, Cohen ZD, Gong-Guy E, Craske MG. A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation. JMIR Ment Health 2022; 9:e32430. [PMID: 35080504 PMCID: PMC8829693 DOI: 10.2196/32430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 08/02/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023] Open
Abstract
Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Gong-Guy
- Semel Institute for Neuroscience and Human Behavior, 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.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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45
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Metts A, Arnaudova I, Staples-Bradley L, Sun M, Zinbarg R, Nusslock R, Wassum KM, Craske MG. Disruption in Pavlovian-Instrumental Transfer as a Function of Depression and Anxiety. J Psychopathol Behav Assess 2022. [DOI: 10.1007/s10862-021-09941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Leuchter MK, Rosenberg BM, Schapira G, Wong NR, Leuchter AF, McGlade AL, Krantz DE, Ginder ND, Lee JC, Wilke SA, Tadayonnejad R, Levitt J, Marder KG, Craske MG, Iacoboni M. Treatment of Spider Phobia Using Repeated Exposures and Adjunctive Repetitive Transcranial Magnetic Stimulation: A Proof-of-Concept Study. Front Psychiatry 2022; 13:823158. [PMID: 35370840 PMCID: PMC8965447 DOI: 10.3389/fpsyt.2022.823158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Specific phobias represent the largest category of anxiety disorders. Previous work demonstrated that stimulating the ventromedial prefrontal cortex (vmPFC) with repetitive Transcranial Magnetic Stimulation (rTMS) may improve response to exposure therapy for acrophobia. OBJECTIVE To examine feasibility of accelerating extinction learning in subjects with spider phobia using intermittent Theta Burst Stimulation (iTBS) rTMS of vmPFC. METHODS In total, 17 subjects with spider phobia determined by spider phobia questionnaires [Spider Phobia Questionnaire (SPQ) and Fear of Spiders questionnaire (FSQ)] underwent ratings of fear of spiders as well as behavioral and skin conductance data during a behavioral avoidance test (BAT). Subjects then received a sequential protocol of in vivo spider exposure followed by iTBS for three sessions administered to either active or control treatment sites (vmPFC [n = 8] or vertex [n = 9], respectively), followed 1 week later by repetition of questionnaires and BAT. RESULTS All subjects improved significantly regardless of group across both questionnaires (FSQ η2 = 0.43, p = 0.004; SPQ η2 = 0.39, p = 0.008) and skin conductance levels during BAT (Wald χ2 = 30.9, p < 0.001). Subjects in the vmPFC group tolerated lower treatment intensity than in the control group, and there was a significant correlation between treatment intensity, BAT subjective distress improvement, and physiologic measures (all ρ > 0.5). CONCLUSION This proof-of-concept study provides preliminary evidence that a sequential exposure and iTBS over vmPFC is feasible and may have rTMS intensity-dependent effects on treatment outcomes, providing evidence for future areas of study in the use of rTMS for phobias.
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Affiliation(s)
- Michael K Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Giuditta Schapira
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nicole R Wong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Anastasia L McGlade
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David E Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nathaniel D Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jonathan C Lee
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Scott A Wilke
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Reza Tadayonnejad
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
| | - Jennifer Levitt
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Katharine G Marder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Rosenberg BM, Taschereau-Dumouchel V, Lau H, Young KS, Nusslock R, Zinbarg RE, Craske MG. A Multivoxel Pattern Analysis of Anhedonia During Fear Extinction: Implications for Safety Learning. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 8:417-425. [PMID: 34954395 DOI: 10.1016/j.bpsc.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pavlovian learning processes are central to the etiology and treatment of anxiety disorders. Anhedonia and related perturbations in reward processes have been implicated in Pavlovian learning. Associations between anhedonia symptoms and neural indices of Pavlovian learning can inform transdiagnostic associations among depressive and anxiety disorders. METHODS Participants ages 18 to 19 years (67% female) completed a fear extinction (n = 254) and recall (n = 249) paradigm during functional magnetic resonance imaging. Symptom dimensions of general distress (common to anxiety and depression), fears (more specific to anxiety), and anhedonia-apprehension (more specific to depression) were evaluated. We trained whole-brain multivoxel pattern decoders for anhedonia-apprehension during extinction and extinction recall and tested the decoders' ability to predict anhedonia-apprehension in an external validation sample. Specificity analyses examined effects covarying for general distress and fears. Decoding was repeated within canonical brain networks to highlight candidate neurocircuitry underlying whole-brain effects. RESULTS Whole-brain decoder training succeeded during both tasks. Prediction of anhedonia-apprehension in the external validation sample was successful for extinction (R2 = 0.047; r = 0.276, p = .002) but not extinction recall (R2 < 0.001, r = -0.063, p = .492). The extinction decoder remained significantly associated with anhedonia-apprehension covarying for fears and general distress (t121 = 3.209, p = .002). Exploratory results highlighted activity in the cognitive control, default mode, limbic, salience, and visual networks related to these effects. CONCLUSIONS Results suggest that patterns of brain activity during extinction, particularly in the cognitive control, default mode, limbic, salience, and visual networks, can be predictive of anhedonia symptoms. Future research should examine associations between anhedonia and extinction, including studies of exposure therapy or positive affect treatments among anhedonic individuals.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, California.
| | - Vincent Taschereau-Dumouchel
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Hakwan Lau
- RIKEN Center for Brain Science, Saitama, Japan
| | - Katherine S Young
- Social, Genetic and Development Psychiatry Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Maudsley Biomedical Research Centre, King's College London, London, United Kingdom
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois; Family Institute at Northwestern University, Northwestern University, Evanston, Illinois
| | - Michelle G Craske
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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48
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Abstract
Anhedonia, a loss of interest or pleasure in activities, is a transdiagnostic symptom that characterizes many individuals suffering from depression and anxiety. Most psychological interventions are designed to decrease negative affect rather than increase positive affect, and are largely ineffective for reducing anhedonia. More recently, affective neuroscience has been leveraged to inform treatments for anhedonia by targeting aspects of the Positive Valence Systems, including impairments in reward anticipation, reward responsiveness, and reward learning. In this chapter, we review the efficacy of treatments and, when possible, highlight links to reward constructs. Augmented behavioral approaches and targeted cognitive interventions designed to target reward anticipation, responsiveness, and learning show preliminary efficacy in reducing anhedonia, while there is a relative lack of treatments that target positive emotion regulation and reward devaluation. In addition to developing treatments that address these targets, the field will benefit from establishing standardized measurement of anhedonia across units of analysis, mapping mechanisms of change onto aspects of reward processing, and examining anhedonia outcomes in the long-term.
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49
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White EJ, Nacke M, Akeman E, Cannon MJ, Mayeli A, Touthang J, Zoubi OA, McDermott TJ, Kirlic N, Santiago J, Kuplicki R, Bodurka J, Paulus MP, Craske MG, Wolitzky-Taylor K, Abelson J, Martell C, Clausen A, Stewart JL, Aupperle RL. P300 amplitude during a monetary incentive delay task predicts future therapy completion in individuals with major depressive disorder. J Affect Disord 2021; 295:873-882. [PMID: 34706458 PMCID: PMC8554135 DOI: 10.1016/j.jad.2021.08.106] [Citation(s) in RCA: 9] [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: 05/10/2021] [Revised: 07/24/2021] [Accepted: 08/28/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Treatment effectiveness for major depressive disorder (MDD) is often affected by client non-adherence, dropout, and non-response. Identification of client characteristics predicting successful treatment completion and/or response (i.e., symptom reduction) may be an important tool to increase intervention effectiveness. It is unclear whether neural attenuations in reward processing associated with MDD predict behavioral treatment outcome. METHODS This study aimed to determine whether blunted neural responses to reward at baseline differentiate MDD (n = 60; 41 with comorbid anxiety) and healthy control (HC; n = 40) groups; and predict MDD completion of and response to 7-10 sessions of behavior therapy. Participants completed a monetary incentive delay (MID) task. The N200, P300, contingent negative variation (CNV) event related potentials (ERPs) and behavioral responses (reaction time [RT], correct hits) were quantified and extracted for cross-sectional group analyses. ERPs and behavioral responses demonstrating group differences were then used to predict therapy completion and response within MDD. RESULTS MDD exhibited faster RT and smaller P300 amplitudes than HC across conditions. Within the MDD group, treatment completers (n = 37) exhibited larger P300 amplitudes than non-completers (n = 21). LIMITATIONS This study comprises secondary analyses of EEG data; thus task parameters are not optimized to examine feedback ERPs from the paradigm. We did not examine heterogenous presentations of MDD; however, severity and comorbidity did not influence findings. CONCLUSIONS Previous studies suggest that P300 is an index of motivational salience and stimulus resource allocation. In sum, individuals who deploy greater neural resources to task demands are more likely to persevere in behavioral therapy.
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Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | - Mariah Nacke
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | | | - Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Touthang
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychiatry, Harvard Medical School/McLean Hospital, Boston MA, United States
| | - Timothy J McDermott
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Psychology, University of Tulsa, Tulsa, OK, United States
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | | | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States; Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, OK, United States
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral science, University of California Los Angeles, Los Angeles, CA, United States
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral science, University of California Los Angeles, Los Angeles, CA, United States
| | - James Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Martell
- Department of Psychological and Brain Sciences, University of Massachusetts- Amherst, Amherst, MA United States
| | - Ashley Clausen
- Kansas City VA Medical Center, Kansas City, MO, United States; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, Kansas United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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Pittig A, Heinig I, Goerigk S, Thiel F, Hummel K, Scholl L, Deckert J, Pauli P, Domschke K, Lueken U, Fydrich T, Fehm L, Plag J, Ströhle A, Kircher T, Straube B, Rief W, Koelkebeck K, Arolt V, Dannlowski U, Margraf J, Totzeck C, Schneider S, Neudeck P, Craske MG, Hollandt M, Richter J, Hamm A, Wittchen HU. Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial. Depress Anxiety 2021; 38:1169-1181. [PMID: 34293223 DOI: 10.1002/da.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. METHODS This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. RESULTS Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. CONCLUSIONS Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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Affiliation(s)
- Andre Pittig
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany.,Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Stephan Goerigk
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Freya Thiel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katrin Hummel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lucie Scholl
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology & Center for Mind, Brain and Behavior - CMBB, Philipps-University of Marburg, Marburg, Germany
| | - Katja Koelkebeck
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Christina Totzeck
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Neudeck
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Protect-AD Study Site Cologne, Cologne, Germany
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Maike Hollandt
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Jan Richter
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Alfons Hamm
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
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