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Smits JAJ, Abramowitz JS, Arch JJ, Papini S, Anderson RA, Dixon LJ, Graham BM, Hofmann SG, Hoyer J, Huppert JD, Jacquart J, Johnson D, McEvoy PM, McKay D, Newby J, Otto MW, Pittig A, Rief W, Rosenfield D, Timpano KR, Wannemüller A. Improving Exposure Therapy: Rationale and Design of an International Consortium. Psychiatr Clin North Am 2024; 47:433-444. [PMID: 38724129 PMCID: PMC11082449 DOI: 10.1016/j.psc.2024.02.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, this article describes the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team science and larger-scale collaborative research in this area. Clinical working groups have begun to identify opportunities to enhance access to helpful resources for implementing exposure therapy effectively. This article discusses directions for expanding the consortium's activities and its impact on a global scale.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, 1 University Station, Mail Code A8000, Austin, TX 78712, USA.
| | - Jonathan S Abramowitz
- Department of Psychology, The University of North Carolina at Chapel Hill, Campus Box 3270, Chapel Hill, NC 27599, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96822, USA
| | - Rebecca A Anderson
- School of Population Health and enAble Institute, Curtin University, Bentley, Western Australia, 6102 Australia
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS 38677, USA
| | - Bronwyn M Graham
- School of Psychology, UNSW Sydney, New South Wales 2052 Australia
| | - Stefan G Hofmann
- Department of Psychology, University of Marburg, Marburg 35032, Germany
| | | | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905 Israel
| | - Jolene Jacquart
- Department of Psychology, The University of Arizona, 1503 E. University Boulevard, Tucson, AZ 85721, USA
| | - David Johnson
- Department of Psychological & Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia 6000, Australia
| | - Dean McKay
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458-5198, USA
| | - Jill Newby
- School of Psychology, UNSW Sydney at the Black Dog Institute, Hospital Road, Randwick, New South Wales 2031, Australia
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA 02215, USA
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Germany
| | - Winfried Rief
- Department of Psychology, University of Marburg, 35032 Marburg, Germany
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6425 Boaz Lane, Dallas TX 75205, USA
| | - Kiara R Timpano
- Department of Psychology, The University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr University Bochum, Massenbergstr. 9-13, Bochum 44787, Germany
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Smits JAJ, Zvolensky MJ, Cheney MK, Rosenfield D, Brown RA, Manser SS, Otto MW, Freeman SZ, Sarmiento MI, Thureen SE. Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial. Contemp Clin Trials 2024; 141:107521. [PMID: 38580103 DOI: 10.1016/j.cct.2024.107521] [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: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Michael J Zvolensky
- Department of Psychology and Health Institute, The University of Houston, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX 75205, USA
| | - Richard A Brown
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA; School of Nursing, The University of Texas at Austin, Austin, TX 78712, USA
| | | | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Slaton Z Freeman
- Department of Psychology, University of Colorado Denver, Denver, CO 80204, USA
| | - Marla I Sarmiento
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
| | - Sydney E Thureen
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
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Young CC, Papini S, Minami H, Morikawa H, Otto MW, Roache JD, Smits JAJ. Isradipine augmentation of virtual reality cue exposure therapy for tobacco craving: a triple-blind randomized controlled trial. Neuropsychopharmacology 2024:10.1038/s41386-024-01872-9. [PMID: 38789642 DOI: 10.1038/s41386-024-01872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Preclinical research with rodents suggests that the L-type calcium channel blocker isradipine can enhance long-term extinction of conditioned place preference for addictive substances when it is administered in conjunction with extinction training. Although isradipine alone, which is FDA-approved for hypertension, has not shown a direct effect on craving in human drug users, its potential to augment behavioral treatments designed to reduce craving remains unknown. We conducted a triple-blind, randomized placebo-controlled pilot clinical trial of isradipine combined with a novel virtual reality cue exposure therapy (VR-CET) approach with multimodal cues that targeted craving. After 24 hours of abstinence, 78 adults with an ongoing history of daily cigarette use received isradipine (n = 40) or placebo (n = 38) and reported craving levels after each of 10 trials of VR-CET. Consistent with pre-registered hypotheses, the isradipine group had significantly lower mean craving across cue exposure trials at the medication-free 24-hour follow-up (d = -0.42, p = 0.046). There were no serious adverse events; however, side effects such as headache and dizziness occurred more frequently in the isradipine group. The findings of the current study support follow-up clinical trials that specifically test the efficacy of isradipine-augmented VR-CET for reducing smoking relapse rates after an initial quit attempt. clinicaltrials.gov: NCT03083353.
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Affiliation(s)
- Cara C Young
- School of Nursing, The University of Texas at Austin, Austin, TX, USA.
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Haruka Minami
- Department of Psychology, Fordham University, New York, NY, USA
| | - Hitoshi Morikawa
- Department of Neuroscience and Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - John D Roache
- Division of Alcohol & Drug Addiction, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
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Rubin M, Foulser AA, Siegel E, Smits JAJ, Powers MB, Angkaw A, Telch MJ. Low reliability when determining criterion a for posttraumatic stress disorder from self-report descriptions of traumatic events: The need for transparent methods. Psychol Trauma 2024; 16:435-442. [PMID: 37141027 DOI: 10.1037/tra0001477] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Exposure to a traumatic event is a primary criterion (Criterion A) for meeting Posttraumatic Stress Disorder (PTSD). Using self-report to establish diagnostic criteria in research has become more common, especially with internet-based research. However, some individuals may construe events as traumatic when they do not meet Criterion A. There has yet to be a test of interrater reliability (IRR) from self-report of traumatic events. METHOD Three graduate students in clinical psychology and three licensed psychologists rated Criterion A using the life events checklist (LEC), as well as the three modified LEC versions (specification of up to three index traumas; extension of part 2 of the LEC) aimed to increase IRR. One hundred participants completed each of the four versions of the LEC (N = 400). Bootstrapped permutation tests were used to estimate differences in IRR and to generate 95% confidence intervals (CIs). RESULTS Overall, findings indicated fair-moderate IRR (Fleiss's kappa) κ = 0.428, 95% CI [0.379, 0.477]. The other versions of the LEC (including additional clarifying questions in part 2 of the LEC and/or opportunities to describe up to three traumas) did not meaningfully increase IRR. CONCLUSIONS Findings indicate that relying on self-report from the LEC alone and/or single-rater assessment of open-text trauma descriptions is not recommended for determining whether a traumatic event meets Criterion A. We conclude that it is critical when collecting self-reported PTSD symptoms to provide a clear description of how Criterion A was assessed, initial agreement between raters, and how disagreements were resolved. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Mikael Rubin
- Psychology Department, University of Texas at Austin
| | | | - Emma Siegel
- Psychology Department, University of Texas at Austin
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Hutschemaekers MHM, de Kleine RA, Kampman M, Smits JAJ, Roelofs K. Social avoidance and testosterone enhanced exposure efficacy in women with social anxiety disorder: A pilot investigation. Psychoneuroendocrinology 2023; 158:106372. [PMID: 37672935 DOI: 10.1016/j.psyneuen.2023.106372] [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: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
Social avoidance has been associated with more persistent social anxiety disorder (SAD) symptoms and low testosterone levels in individuals with SAD. We tested whether pre-treatment avoidance tendencies moderate the efficacy of testosterone-augmented exposure therapy. Fifty-five females with SAD received two exposure sessions during which fear levels were assessed. Session 1 was augmented with testosterone (0.50 mg) or placebo. Avoidance tendencies and symptom severity were assessed pre- and post-exposure. Participants showed stronger avoidance for social versus non-social stimuli and this tendency remained stable over time. Stronger pretreatment avoidance tendencies were associated with larger fear reduction in the testosterone but not the placebo condition. This effect did not transfer to the second non-enhanced session or symptom severity. The findings support the hypothesis that individuals suffering from SAD with relatively stronger pretreatment avoidance tendencies benefit more from testosterone-augmentation, pointing to a potential behavioral marker for testosterone enhancement of exposure therapy.
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Affiliation(s)
- Moniek H M Hutschemaekers
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
| | | | - Mirjam Kampman
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, the Netherlands
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Taylor CT, Rosenfield D, Dowd SM, Dutcher CD, Hofmann SG, Otto MW, Pollack MH, Smits JAJ. What good are positive emotions for treatment? A replication test of whether trait positive emotionality predicts response to exposure therapy for social anxiety disorder. Behav Res Ther 2023; 171:104436. [PMID: 37979218 PMCID: PMC10862259 DOI: 10.1016/j.brat.2023.104436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Positive valence emotions serve functions that may facilitate response to exposure therapy - they encourage approach behavior, diminish perceived threat reactivity, and enhance assimilation of new information in memory. Few studies have examined whether positive emotions predict exposure therapy success and extant findings are mixed. METHODS We conducted a secondary analysis of an exposure therapy trial for social anxiety disorder to test the hypothesis that patients endorsing higher trait positive emotions at baseline would display the greatest treatment response. N = 152 participants enrolled in a randomized controlled trial of d-cycloserine augmentation completed five sessions of group exposure therapy. Pre-treatment positive emotionality was assessed using the NEO Five-Factor Inventory. Social anxiety symptoms were assessed throughout treatment by blinded evaluators using the Liebowitz Social Anxiety Scale. RESULTS Accounting for baseline symptom severity, multilevel growth curve models revealed that patients with higher pre-treatment positive emotionality displayed faster social anxiety symptom reductions and lower scores at 3-month follow-up. This predictive effect remained significant after controlling for baseline depression and extraversion (without the positive emotionality facet). CONCLUSIONS These findings add to emerging evidence suggesting that explicitly targeting and enhancing positive emotions during exposure to perceived threat may improve treatment outcomes for anxiety and fear-based disorders. TRIAL REGISTRATION ClinicalTrials.gov: NCT02066792https://clinicaltrials.gov/ct2/show/NCT02066792.
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Affiliation(s)
- Charles T Taylor
- Department of Psychiatry, University of California, 9500 Gilman Drive (Mail code 0855) La Jolla, San Diego, CA, 92093-0855, United States.
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, United States
| | - Sheila M Dowd
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, United States
| | - Christina D Dutcher
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, United States
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps-University Marburg, Germany
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, United States
| | | | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, United States
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Wirtz MR, Stanton AM, Manohar R, Labbe AK, Zvolensky MJ, Smits JAJ, Hoeppner B, O’Cleirigh C. The Relationship Between Cigarette Dependence and Cessation Methods: Implications for Smoking Cessation Among People With HIV. J Stud Alcohol Drugs 2023; 84:772-780. [PMID: 37219036 PMCID: PMC10600974 DOI: 10.15288/jsad.22-00318] [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] [Received: 09/07/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE These analyses investigate how dependence may be related to cessation method choice and how this relationship may vary by subpopulation among people with HIV (PWH) who smoke cigarettes. METHOD PWH who smoke (N = 71) were recruited from clinics in Boston, MA. The Fagerström Test for Nicotine Dependence (FTND) and Smoking History Questionnaire (SHQ) were completed to assess for cigarette dependence, past-week cigarettes per day (CPD), and past cessation method use. Logistic regression examined the association between dependence and previous cessation methods for the whole sample, and moderation analyses assessed this relationship by age and race. RESULTS Higher FTND was associated with less use of behavioral modification methods (odds ratio [OR] = 0.658, 95% CI [0.435, 0.994], p = .047). Higher past-week CPD was associated with use of the American Cancer Society/American Lung Association (ACS/ALA) programs (OR = 1.159, 95% CI [1.011, 1.328], p = .035) and telephone counselling (OR = 1.142, 95% CI [1.006, 1.295], p = .040]). Older participants with more past-week CPD were more likely to have used the ACS/ALA programs (B = 0.0169, 95% CI [0.0008, 0.0331], p = .0401), and White participants with more past-week CPD were less likely to have tried to quit "cold turkey" (B = 0.1676, 95% CI [0.0027, 0.3326], p = .0464). CONCLUSIONS These preliminary results suggest that there is likely not a "one-size-fits-all" approach to cessation for PWH who smoke, especially within subpopulations (i.e., age and race). Implications include ensuring access to multiple cessation methods, identifying methods that could be culturally appropriate outside of the clinical intervention setting, and providing education and support on cessation methods offered.
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Affiliation(s)
- Megan R. Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Graduate Center, City University of New York, New York, New York
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
| | - Rohin Manohar
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison K. Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- HEALTH Institute, University of Houston, Houston, Texas
| | | | - Bettina Hoeppner
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Lubin RE, Fitzgerald HE, Rosenfield D, Carpenter JK, Papini S, Dutcher CD, Dowd SM, Hofmann SG, Pollack MH, Smits JAJ, Otto MW. Using pre-treatment de novo threat conditioning outcomes to predict treatment response to DCS augmentation of exposure-based CBT. J Psychiatr Res 2023; 164:357-363. [PMID: 37399757 PMCID: PMC10557473 DOI: 10.1016/j.jpsychires.2023.06.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Over a decade and a half of research has resulted in inconsistent evidence for the efficacy of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, for augmenting exposure-based cognitive behavioral therapy (CBT) for anxiety- and fear-based disorders. These variable findings have motivated the search for moderators of DCS augmentation efficacy. METHODS In this secondary analysis of a previous randomized clinical trial, we evaluated the value of de novo threat conditioning outcomes-degree of threat acquisition, extinction, and extinction retention-for predicting treatment response to exposure-based CBT for social anxiety disorder, applied with and without DCS augmentation in a sample of 59 outpatients. RESULTS We found that average differential skin conductance response (SCR) during extinction and extinction retention significantly moderated the prediction of clinical response to DCS: participants with poorer extinction and extinction retention showed relatively improved treatment response with DCS. No such effects were found for expectancy ratings, consistent with accounts of DCS selectively aiding lower-order but not higher-order extinction learning. CONCLUSIONS These findings provide support for extinction and extinction retention outcomes from threat conditioning as potential pre-treatment biomarkers for DCS augmentation benefits. Independent of DCS augmentation, the current study did not support threat conditioning outcomes as useful for predicting response to exposure-based CBT.
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Affiliation(s)
- Rebecca E Lubin
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA.
| | - Hayley E Fitzgerald
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6116 North Central Expressway, Dallas, TX, 75206, USA
| | - Joseph K Carpenter
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, 150 S Huntington Ave, Boston, MA, 02130, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Santiago Papini
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Christina D Dutcher
- Institute of Mental Health Research and Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Sheila M Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd Suite 400, Chicago, IL, 60612, USA
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Schulstrasse 12, 35037, Marburg/Lahn, Germany
| | - Mark H Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd Suite 400, Chicago, IL, 60612, USA; Sage Therapeutics, 215 First St, Cambridge, MA, 02142, USA
| | - Jasper A J Smits
- Institute of Mental Health Research and Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA
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Raskin M, Malone C, Hilz EN, Smits JAJ, Telch MJ, Otto MW, Shumake J, Lee HJ, Monfils MH. CO 2 reactivity is associated with individual differences in appetitive extinction memory. Physiol Behav 2023; 266:114183. [PMID: 37031791 PMCID: PMC10840099 DOI: 10.1016/j.physbeh.2023.114183] [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: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
Pavlovian conditioning can underly the maladaptive behaviors seen in psychiatric disorders such as anxiety and addiction. In both the lab and the clinic, these responses can be attenuated through extinction learning, but often return with the passage of time, stress, or a change in context. Extinction to fear and reward cues are both subject to these return of behavior phenomena and have overlap in neurocircuitry, yet it is unknown whether they share any common predictors. The orexin system has been implicated in both fear and appetitive extinction and can be activated through a CO2 challenge. We previously found that behavioral CO2 reactivity predicts fear extinction and orexin activation. Here, we sought to extend our previous findings to determine whether CO2 reactivity might also predict extinction memory for appetitive light-food conditioning. We find that the same subcomponent of behavioral CO2 reactivity that predicted fear extinction also predicts appetitive extinction, but in the opposite direction. We show evidence that this subcomponent remains stable across two CO2 challenges, suggesting it may be a stable trait of both behavioral CO2 reactivity and appetitive extinction phenotype. Our findings further the possibility for CO2 reactivity to be used as a transdiagnostic screening tool to determine whether an individual would be a good candidate for exposure therapy.
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Affiliation(s)
- Marissa Raskin
- The University of Texas at Austin, Institute for Neuroscience, United States
| | - Cassidy Malone
- The University of Texas at Austin, Department of Psychology, United States
| | - Emily N Hilz
- The University of Texas at Austin, Department of Psychology, United States
| | - Jasper A J Smits
- The University of Texas at Austin, Department of Psychology, United States; The University of Texas at Austin, Institute for Mental Health Research, United States
| | - Michael J Telch
- The University of Texas at Austin, Department of Psychology, United States; The University of Texas at Austin, Institute for Mental Health Research, United States
| | | | - Jason Shumake
- The University of Texas at Austin, Department of Psychology, United States; The University of Texas at Austin, Institute for Mental Health Research, United States
| | - Hongjoo J Lee
- The University of Texas at Austin, Institute for Neuroscience, United States; The University of Texas at Austin, Department of Psychology, United States
| | - Marie-H Monfils
- The University of Texas at Austin, Institute for Neuroscience, United States; The University of Texas at Austin, Department of Psychology, United States; The University of Texas at Austin, Institute for Mental Health Research, United States.
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Natal S, Young CC, Kaur K, Gebhardt ES, Perrone A, Morikawa H, Tirado C, Smits JAJ. Applications of isradipine in human addiction studies: A systematic literature review. Exp Clin Psychopharmacol 2023; 31:507-522. [PMID: 36595455 PMCID: PMC10152997 DOI: 10.1037/pha0000633] [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] [Indexed: 01/04/2023]
Abstract
Given the personal and public health burden of addictive disorders, innovative approaches to treatment are sorely needed. This systematic review examined the use of the pharmacological agent isradipine in the context of potential applications for addiction treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided a comprehensive search of PubMed, Cochrane Library, and PsycINFO between the years 1985 to July 2022. Studies were included if isradipine was administered to adults with a current Diagnostic and Statistical Manual of Mental Disorders-5th edition diagnosis of a substance use disorder and/or to healthy volunteers alone and in conjunction with a substance (i.e, cocaine, methamphetamine, alcohol). A total of 16 studies with 252 participants were included in this review. Substantial variability was identified with study designs, isradipine dosages/dosing, and addictive substance of interest. Outcomes clustered in four categories: (a) cerebral blood flow (CBF), (b) hemodynamic effects, (c) subjective effects, and (d) cognitive effects. Isradipine was found to improve CBF in individuals with cocaine-induced hypoperfusion and in several studies was found to reduce parameters of blood pressure elevation after stimulant use. There were no significant findings on isradipine's effect on subjective reporting (i.e., craving, mood, drug affect) or cognition/attention. Given the limited number of studies identified in this review, there is insufficient data to draw clear conclusions. The direct effects of isradipine as a pharmacologic agent for addictive disorder treatment appear minimal, however, future work may benefit from examining the impact of isradipine as an augmentative agent within existing cue exposure paradigms for preventing cue-induced drug relapse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Samantha Natal
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Cara C. Young
- School of Nursing, The University of Texas at Austin, Austin Texas
| | - Karamveer Kaur
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Eli S. Gebhardt
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Alexander Perrone
- Department of Psychology, The University of Texas at Austin, Austin Texas
| | - Hitoshi Morikawa
- Department of Neuroscience, The University of Texas at Austin, Austin Texas
| | - Carlos Tirado
- School of Pharmacy, The University of Texas at Austin, Austin Texas
| | - Jasper A. J. Smits
- Department of Psychology, The University of Texas at Austin, Austin Texas
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11
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Clausen B, Rinck M, Nizio P, Matoska CT, Zappi C, Smits JAJ, Gallagher MW, Zvolensky MJ, Garey L. Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users. Contemp Clin Trials 2023; 128:107145. [PMID: 36905980 DOI: 10.1016/j.cct.2023.107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Electronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults. Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely. Retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol and CC use treatments. However, approach bias retraining for both CC and (ECIG) users has not been explored. Therefore, the objective of the study is to evaluate the initial efficacy of approach bias retraining among dual CC and ECIG users. METHODS Eligible dual CC/ECIG using adults (N = 90) will complete a phone-screener, baseline assessment, 4 treatment sessions over 2 weeks, ecological momentary assessments (EMAs) post-intervention, and follow-ups at 4- and 6-week post-intervention. Participants will be assigned to one of three conditions at baseline: (1) CC + ECIG retraining; (2) CC only retraining; and (3) sham retraining. Participants will engage in a self-guided quit attempt to abstain from all nicotine products starting at treatment session 4. CONCLUSIONS The study may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The findings should guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG, and provide initial effect size data for a brief intervention, thus providing necessary data for a large-scale follow-up trial. Clinical Trials ID: NCT05306158.
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Affiliation(s)
- Bryce Clausen
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Mike Rinck
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, TX, United States of America; HEALTH Institute, University of Houston, Houston, TX, United States of America
| | - Cameron T Matoska
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Christopher Zappi
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States of America; HEALTH Institute, University of Houston, Houston, TX, United States of America; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States of America.
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12
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Schmitter M, Vanderhasselt MA, Spijker J, Smits JAJ, Vrijsen JN. Working it out: can an acute exercise bout alleviate memory bias, rumination and negative mood? Cogn Behav Ther 2023; 52:232-245. [PMID: 36779437 DOI: 10.1080/16506073.2022.2164349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Although it is well known that exercise reduces depressive symptoms, the underlying psychological mechanisms remain unclear. This experimental study examined the acute effect of exercise on mood, and depressotypic memory bias and state rumination. Trait rumination was tested as a possible moderator. A sample of non-regular exercisers (N = 100) was randomized to exercise or rest. After a negative mood induction, the exercise condition cycled for 24 min at moderate intensity, while the rest condition rested. Negative and overgeneral memory bias, as well as positive and negative affect were assessed after exercise/rest. To capture the lingering of negative mood and state rumination, both were assessed multiple times throughout the study. The exercise (as compared to rest) condition reported more positive affect. However, no differences were found on overgeneral memory bias, as well as depression-specific mood or state rumination measured throughout the study. Interestingly, the exercise condition showed more negative memory bias at higher levels of rumination. Individual differences in trait rumination moderated the exercise-memory bias relation, such that exercise increased negative memory bias at higher levels of rumination. It is possible that long-term exercise protocols are necessary to change cognitive processes related to depression.
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Affiliation(s)
- Michèle Schmitter
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen 6525 GD, The Netherlands.,Depression Expertise Center, Pro Persona Mental Health Care, Nijmeegsebaan 61, Nijmegen 6525 DX, The Netherlands
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Jan Spijker
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen 6525 GD, The Netherlands.,Depression Expertise Center, Pro Persona Mental Health Care, Nijmeegsebaan 61, Nijmegen 6525 DX, The Netherlands
| | - Jasper A J Smits
- Department of Psychology & Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712, USA
| | - Janna N Vrijsen
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen 6525 GD, The Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 10, Nijmegen 6525 GC, The Netherlands
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13
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Smits JAJ, Monfils MH, Otto MW, Telch MJ, Shumake J, Feinstein JS, Khalsa SS, Cobb AR, Parsons EM, Long LJ, McSpadden B, Johnson D, Greenberg A. CO 2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC Psychiatry 2022; 22:831. [PMID: 36575425 PMCID: PMC9793569 DOI: 10.1186/s12888-022-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
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Affiliation(s)
- Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Marie-H. Monfils
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Michael W. Otto
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Michael J. Telch
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Jason Shumake
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Justin S. Feinstein
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Adam R. Cobb
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Ralph H. Johnson VAHCS, 67 President Street MSC 862, Charleston, SC 29425 USA
| | - E. Marie Parsons
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Laura J. Long
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Bryan McSpadden
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - David Johnson
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Alma Greenberg
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
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14
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Smits JAJ, Rinck M, Rosenfield D, Beevers CG, Brown RA, Conroy Busch HE, Dutcher CD, Perrone A, Zvolensky MJ, Garey L. Approach bias retraining to augment smoking cessation: A pilot randomized controlled trial. Drug Alcohol Depend 2022; 238:109579. [PMID: 35917763 PMCID: PMC10041775 DOI: 10.1016/j.drugalcdep.2022.109579] [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: 04/22/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approach tendency to smoking-related cues has been associated with greater cravings, nicotine dependence, and the likelihood of relapse. In this pilot randomized clinical trial, we examined the efficacy of approach bias retraining (ABR; i.e., increasing avoidance tendency) for enhancing standard smoking cessation treatment (ST). METHODS Adult smokers (N = 96) motivated to quit were randomly assigned to 7 weekly in-person treatment sessions consisting of either (1) cognitive-behavioral therapy for smoking cessation (ST) and ABR (ST+ABR) or ST and sham retraining (ST+Sham). All participants also received optional nicotine replacement therapy for up to 8 weeks following the scheduled quit date (week 6). We measured avoidance tendency from weeks 1-7. Point prevalence abstinence (PPA) and prolonged abstinence (PA) were measured up to 3 months following the quit attempt (week 18 follow-up). RESULTS Consistent with our hypothesis, participants in ST+ABR evidenced higher abstinence rates than those in ST+Sham at the final follow-up (b=0.71, 95 % CI: [0.14, 1.27], t[1721]=2.46, p = 0.014, OR=2.03, 95 % CI: [1.15, 3.57]). Specifically, PPA and PA rates were 50 % and 66 % in ST+ABR compared to 31 % and 47 % in ST+Sham. As expected, participants assigned to the ST+ABR condition also showed a greater training-compatible increase in avoidance tendency scores relative to those assigned to the ST+Sham condition (b=248.06, 95 % CI: [148.51, 347,62], t[84]=4.96, p < .001). CONCLUSIONS The current pilot randomized clinical trial provides initial evidence for the efficacy of integrating standard smoking cessation with ABR. These findings encourage the testing of the long-term efficacy and mechanisms of action of this integrated intervention.
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Affiliation(s)
- Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA.
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, USA
| | - Christopher G Beevers
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Richard A Brown
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | | | - Christina D Dutcher
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Alex Perrone
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, USA
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15
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Papini S, Jacquart J, Zaizar ED, Telch MJ, A. J. Smits J. Targeting Anxiety Sensitivity With Evidence-Based Psychoeducation: A Randomized Waitlist-Controlled Trial of a Brief Standalone Digital Intervention. Cognitive and Behavioral Practice 2022. [DOI: 10.1016/j.cbpra.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Fitzgerald HE, Hoyt DL, Kredlow MA, Smits JAJ, Schmidt NB, Edmondson D, Otto MW. Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions. Clin Psychol (New York) 2021; 28:323-337. [PMID: 35300171 PMCID: PMC8923531 DOI: 10.1037/cps0000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 07/26/2023]
Abstract
Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.
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Affiliation(s)
- Hayley E Fitzgerald
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - Danielle L Hoyt
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02140
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23 St., Austin, TX 78712
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | | | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
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17
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Beevers CG, Hsu KJ, Schnyer DM, Smits JAJ, Shumake J. Change in negative attention bias mediates the association between attention bias modification training and depression symptom improvement. J Consult Clin Psychol 2021; 89:816-829. [PMID: 34807657 DOI: 10.1037/ccp0000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Attention bias modification training (ABMT) is purported to reduce depression by targeting and modifying an attentional bias for sadness-related stimuli. However, few tests of this hypothesis have been completed. METHOD The present study examined whether change in attentional bias mediated a previously reported association between ABMT condition (active ABMT, sham ABMT, assessments only; N = 145) and depression symptom change among depressed adults. The preregistered, primary measure of attention bias was a discretized eye-tracking metric that quantified the proportion of trials where gaze time was greater for sad stimuli than neutral stimuli. RESULTS Contemporaneous longitudinal simplex mediation indicated that change in attentional bias early in treatment partially mediated the effect of ABMT on depression symptoms. Specificity analyses indicated that in contrast to the eye-tracking mediator, reaction time assessments of attentional bias for sad stimuli (mean bias and trial level variability) and lapses in sustained attention did not mediate the association between ABMT and depression change. Results also suggested that mediation effects were limited to a degree by suboptimal measurement of attentional bias for sad stimuli. CONCLUSION When effective, ABMT may improve depression in part by reducing an attentional bias for sad stimuli, particularly early on during ABMT. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Kean J Hsu
- Department of Psychiatry, Georgetown University Medical Center
| | | | | | - Jason Shumake
- Department of Psychology, University of Texas at Austin
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18
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Hsu KJ, Carl E, DiVita A, Feldman T, Foulser AA, Freihart B, Madole J, McNamara ME, Rubin M, Stein AT, Tretyak V, Smits JAJ. Rising to the Occasion of This COVID-19-Impacted Nation: Development, Implementation, and Feasibility of the Brief Assessment-Informed Skills Intervention for COVID-19 (BASIC). Cogn Behav Pract 2021; 28:468-480. [PMID: 33814877 PMCID: PMC7997150 DOI: 10.1016/j.cbpra.2021.02.003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/08/2021] [Indexed: 11/21/2022]
Abstract
The COVID-19 pandemic has had a profound impact on the global economy, physical health, and mental health. This pandemic, like previous viral outbreaks, has resulted in spikes in anxiety, depression, and stress. Even though millions of individuals face the physical health consequences of infection by COVID-19, even more individuals are confronted with the mental health consequences of this pandemic. This significantly increased demand for mental health services cannot be easily met by existing mental health systems, which often rely on courses of therapy to be delivered over months. Single session interventions (SSIs) may be one important approach to meeting this increased demand, as they are treatments designed to be delivered over the course of a single meeting. SSIs have been found to be effective for a range of mental health challenges, with durable effects lasting months to years later. Here, we describe an SSI designed for the COVID-19 pandemic. This Brief Assessment-informed Skills Intervention for COVID-19 (BASIC) program draws upon therapeutic skills from existing empirically supported treatments to target common presenting complaints due to this pandemic. We discuss the process of developing and implementing this intervention, as well as explore feasibility and initial clinical insights. In short, BASIC is an easy-to-adopt intervention that is designed to be effective in a single session, making it well-suited for handling the increased demand for mental health services due to COVID-19.
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19
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Smits JAJ, Zvolensky MJ, Rosenfield D, Brown RA, Otto MW, Dutcher CD, Papini S, Freeman SZ, DiVita A, Perrone A, Garey L. Community-based smoking cessation treatment for adults with high anxiety sensitivity: a randomized clinical trial. Addiction 2021; 116:3188-3197. [PMID: 34033178 PMCID: PMC10091508 DOI: 10.1111/add.15586] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/02/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS People with anxiety disorders are more likely to smoke and less likely to succeed when they try to quit. Anxiety sensitivity may underlie both phenomena, such that people with high anxiety sensitivity react to interoceptive distress by avoidance. This study aimed to test the efficacy of an exercise program that induced interoceptive distress and thereby created tolerance to this distress in a safe environment. DESIGN, SETTING AND PARTICIPANTS Randomized clinical trial at four YMCA branches in Austin, Texas, USA. Participants [n = 150; 130 (86.7%) white; 101 (67.3%) female; meanage = 38.6, standard deviation (SD)age = 10.4] were adult, daily smokers with high anxiety sensitivity motivated to quit smoking, who reported no regular moderate-intensity exercise. INTERVENTIONS Participants were assigned a YMCA personal trainer who guided them through a 15-week intervention aerobic exercise program. Participants assigned to the personalized intervention trained at 60-85% of their heart rate reserve (HRR), whereas participants assigned to the control intervention trained at 20-40% of their HRR. Participants in both groups received standard behavioral support and nicotine replacement therapy. MEASUREMENTS The primary outcome was biologically verified 7-day point prevalence abstinence (PPA) at 6-month follow-up. FINDINGS Sixty-one per cent of participants were available at the 6-month follow-up. PPA at 6 months was higher in the personalized intervention than the control intervention [27.6 versus 14.8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.28, 3.80, P = 0.005], assuming missing at random. Anxiety sensitivity declined in both groups with no evidence that this differed between groups. CONCLUSIONS An exercise program of high intensity increased abstinence from smoking in people with high anxiety sensitivity, but may not have done so by reducing anxiety sensitivity.
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Affiliation(s)
- Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Richard A Brown
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Christina D Dutcher
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Santiago Papini
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Slaton Z Freeman
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Annabelle DiVita
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Alex Perrone
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
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20
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Dutcher CD, Dowd SM, Zalta AK, Taylor DJ, Rosenfield D, Perrone A, Otto MW, Pollack MH, Hofmann SG, Smits JAJ. Sleep quality and outcome of exposure therapy in adults with social anxiety disorder. Depress Anxiety 2021; 38:1182-1190. [PMID: 34010494 PMCID: PMC8560555 DOI: 10.1002/da.23167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/28/2020] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship. METHODS Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions. RESULTS Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. CONCLUSIONS We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.
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Affiliation(s)
- Christina D. Dutcher
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Sheila M. Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Alyson K. Zalta
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
- Department of Psychological Science, University of California, Irvine, USA
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, USA
| | - Alexander Perrone
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Mark H. Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Jasper A. J. Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
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21
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Powers MB, Carl E, Levihn-Coon A, Van Veldhuizen M, Caven A, Pogue J, Fresnedo M, Turner ED, Adams M, Leonard K, Conroy H, Lantrip C, Caven T, Isbell C, Regner J, Garmon E, Foreman M, Miller W, Fares LA, Carlbring P, Otto MW, Weiss DN, Hughes J, Bernhardt JM, Roy R, Oh J, Copt R, MacClements J, Warren AM, Rosenfield B, Rosenfield D, Minns S, Telch MJ, Smits JAJ. Nonpharmacologic Pain Management Among Hospitalized Inpatients: A Randomized Waitlist-Controlled Trial of Standard Virtual Reality (CGI VR) Versus Video Capture VR (360 degrees 3D/Stereoscopic Video Capture VR). Clin J Pain 2021; 37:678-687. [PMID: 34265789 DOI: 10.1097/ajp.0000000000000958] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group. MATERIALS AND METHODS Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up. RESULTS Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002). DISCUSSION Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Crystal Lantrip
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Health Care System
| | - Thomas Caven
- The University of Texas at Austin Dell Medical School
- Department of Psychology and Neuroscience, Baylor University, Waco
| | - Claire Isbell
- Baylor Scott and White Medical Center Temple, Temple, TX
| | - Justin Regner
- Baylor Scott and White Medical Center Temple, Temple, TX
| | - Emily Garmon
- Baylor Scott and White Medical Center Temple, Temple, TX
| | | | | | - Lorie A Fares
- Baylor Scott and White Medical Center Temple, Temple, TX
| | | | | | | | | | | | - Rob Roy
- Boston University, Boston, MA
| | | | - Ryan Copt
- Bongiovi Medical, Port Saint Lucie, FL
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22
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Rubin M, Papini S, Dainer-Best J, Zaizar ED, Smits JAJ, Telch MJ. Exploratory and Confirmatory Bayesian Networks Identify the Central Role of Non-judging in Symptoms of Depression. Mindfulness (N Y) 2021; 12:2544-2551. [PMID: 34426752 PMCID: PMC8374114 DOI: 10.1007/s12671-021-01726-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Objectives Depression is a highly heterogeneous disorder, and meta-analyses of mindfulness-based interventions show moderate efficacy for reducing depressive symptoms. However, the mechanisms governing their efficacy remain unclear, highlighting the need for hypothesis-generating analyses to guide future research. Methods We used Bayesian network analysis in three cross-sectional samples (N = 1135) of undergraduates and participants from the community to identify links between individual symptoms of depression and specific facets of mindfulness. In two exploratory studies, we assessed depression using the Patient Health Questionnaire (n = 384) or the Depression Anxiety and Stress Scale (n = 350) and mindfulness using the Five-Facet Mindfulness Scale. Results Across these samples and measures, exploratory analyses indicated that non-judging was a central bridge between facets of mindfulness and symptoms of depression. We confirmed this finding in a pre-registered replication (n = 401) using a recently developed confirmatory testing framework for network analysis. Non-judging was consistently a central bridge in the networks and specifically linked to the symptoms of depression related to feelings of failure and worthlessness. Conclusions These findings provide strong evidence that non-judging is an essential feature of mindfulness in the context of depression and provides direction for future research testing mindfulness-oriented treatment prescriptions for depression. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-021-01726-1.
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Affiliation(s)
- Mikael Rubin
- Department of Psychology and Institute for Mental Health Research, The University of Texas At Austin, 108 E. Dean Keeton, A8000, Austin, TX 78712 USA
| | - Santiago Papini
- Department of Psychology and Institute for Mental Health Research, The University of Texas At Austin, 108 E. Dean Keeton, A8000, Austin, TX 78712 USA
| | | | - Eric D Zaizar
- Department of Psychology and Institute for Mental Health Research, The University of Texas At Austin, 108 E. Dean Keeton, A8000, Austin, TX 78712 USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas At Austin, 108 E. Dean Keeton, A8000, Austin, TX 78712 USA
| | - Michael J Telch
- Department of Psychology and Institute for Mental Health Research, The University of Texas At Austin, 108 E. Dean Keeton, A8000, Austin, TX 78712 USA
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23
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Brown RA, Minami H, Hecht J, Kahler CW, Price LH, Kjome KL, Bloom EL, Levy DE, Carpenter KM, Smith A, Smits JAJ, Rigotti NA. Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial. JAMA Psychiatry 2021; 78:839-847. [PMID: 33950156 PMCID: PMC8100915 DOI: 10.1001/jamapsychiatry.2021.0707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting. OBJECTIVE To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care. DESIGN, SETTING, AND PARTICIPANTS The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019. INTERVENTIONS The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge. RESULTS A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02204956.
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Affiliation(s)
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York
| | - Jacki Hecht
- School of Nursing, University of Texas at Austin, Austin
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Lawrence H. Price
- Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kimberly L. Kjome
- Seton Shoal Creek Hospital, Austin, Texas,Department of Psychiatry, Dell Medical School at the University of Texas at Austin, Austin
| | - Erika Litvin Bloom
- Rhode Island Hospital, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston,Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts Medical School, Harvard Medical School, Boston
| | | | - Ashleigh Smith
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin,Department of Health Social Work, Steve Hicks School of Social Work, University of Texas at Austin, Austin
| | | | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston
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24
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Stein AT, Carl E, Cuijpers P, Karyotaki E, Smits JAJ. Looking beyond depression: a meta-analysis of the effect of behavioral activation on depression, anxiety, and activation. Psychol Med 2021; 51:1491-1504. [PMID: 32138802 DOI: 10.1017/s0033291720000239] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 11/07/2022]
Abstract
BACKGROUND Depression is a prevalent and impairing condition. Behavioral activation (BA) is a parsimonious, cost-effective, and easily disseminated psychological intervention for depression. The current meta-analysis expands on the existing literature supporting the efficacy of BA for depression by examining the effects of BA on additional relevant outcomes for patients with depression, namely the reduction in anxiety symptoms and increase in activation. METHODS Randomized controlled trials of BA for depression compared to active and inactive control were identified via a systematic review. Effect sizes using Hedges's g were calculated for each outcome compared to both active and inactive control using random effects models. Subgroup analyses were used to examine the inclusion of a discussion of values as a moderator of depression symptom outcome in BA. RESULTS Twenty-eight studies were included. Meta-analyses of symptom change between groups from baseline-to-post intervention indicated that BA outperformed inactive control conditions for improvements in depression (g = 0.83), anxiety (g = 0.37), and activation (g = 0.64). The difference between BA and active control conditions was not significant for improvements in depression (g = 0.15), anxiety (g = 0.03), and activation (g = 0.04). There was no evidence for a discussion of values augmenting BA efficacy. Study quality was generally low, and there was evidence of publication bias. CONCLUSIONS In addition to improving depression, BA shows efficacy for reducing symptoms of anxiety and increasing activation. BA may not offer better outcomes relative to other active interventions. There is room for improvement in the quality of research in this area.
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Affiliation(s)
| | - Emily Carl
- University of Texas at Austin, Austin, TX, USA
| | - Pim Cuijpers
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Harvard Medical School, Boston, MA, USA
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25
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Garey L, Wirtz MR, Labbe AK, Zvolensky MJ, Smits JAJ, Giordano TP, Rosenfield D, Robbins GK, Levy DE, McKetchnie SM, Bell T, O'Cleirigh C. Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 106:106420. [PMID: 33933667 PMCID: PMC10080995 DOI: 10.1016/j.cct.2021.106420] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Interventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH). OBJECTIVE To evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition. METHODS SLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help. CONCLUSIONS QUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into "real-world" behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Megan R Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Allison K Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, United States of America
| | - Gregory K Robbins
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Tanisha Bell
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America.
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26
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Hsu KJ, Shumake J, Caffey K, Risom S, Labrada J, Smits JAJ, Schnyer DM, Beevers CG. Efficacy of attention bias modification training for depressed adults: a randomized clinical trial. Psychol Med 2021; 52:1-9. [PMID: 33766151 PMCID: PMC8464627 DOI: 10.1017/s0033291721000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study examined the efficacy of attention bias modification training (ABMT) for the treatment of depression. METHODS In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity [i.e. self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ⩾13] and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. The training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for 4 weeks (2224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. RESULTS Intent-to-treat analyses indicated that, relative to assessment-only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = 0.008, d = -0.57) and 0.74 ± 0.31 (p = 0.021, d = -0.49) points per week. Similar results were observed for active v. sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = 0.067, d = -0.41) and 0.69 ± 0.32 HRSD (p = 0.033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales. CONCLUSION Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.
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Affiliation(s)
- Kean J. Hsu
- Georgetown University Medical Center, Washington, DC, USA
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jason Shumake
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Kayla Caffey
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Semeon Risom
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jocelyn Labrada
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jasper A. J. Smits
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - David M. Schnyer
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Christopher G. Beevers
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, TX, USA
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27
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Papini S, Dunsmoor JE, Smits JAJ. The impact of prior and ongoing threat on the false alarm threshold for facial discrimination. J Behav Ther Exp Psychiatry 2021; 70:101619. [PMID: 33049424 DOI: 10.1016/j.jbtep.2020.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Perceptual adaptations that facilitate rapid responses to threats can also lead to false alarms, or the failure to discriminate safe stimuli from signals of threat. We examined the impact of varying degrees of threat on false alarms in the perceptual discrimination of faces along the dimension of emotion (Experiment 1) or identity (Experiment 2). METHODS Participants first trained to discriminate between a target and nontarget face. Next, we tested their ability to identify the target in randomized presentations of the target, the nontarget, and nine novel stimuli morphed in 10% increments of similarity from the target to the nontarget. The task was completed under one of three randomized conditions: 1) Ongoing-Threat paired the target with an aversive outcome in both phases; 2) Prior-Threat paired the target with an aversive outcome in the training phase only; and 3) No-Threat paired the target with a neutral outcome in the training phase only. RESULTS In Experiment 1 (N = 90), Ongoing-Threat lowered the false alarm threshold for facial discrimination based on anger intensity compared to Prior-Threat and No-Threat. In Experiment 2 (N = 90), Ongoing-Threat and Prior-Threat each lowered the false alarm threshold for identity-based discrimination compared to No-Threat. LIMITATIONS The experiment did not measure generalization of threat responses. CONCLUSION Associating a facial expression or identity with threat leads to faster but less accurate discrimination of faces with similar features, particularly under conditions of ongoing threat. These experiments provide an avenue for examining the parameters that impact false alarms, which play a key role in anxiety disorders.
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28
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Dutcher CD, Papini S, Gebhardt CS, Smits JAJ. Network analysis reveals the associations of past quit experiences on current smoking behavior and motivation to quit. Addict Behav 2021; 113:106689. [PMID: 33053454 PMCID: PMC7736500 DOI: 10.1016/j.addbeh.2020.106689] [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: 06/11/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Smoking is a leading cause of morbidity and mortality in the United States. While most smokers endorse a desire to quit, achieving abstinence is notoriously difficult. Network analysis is a method for understanding the complex relationships of factors that maintain smoking behavior and impact motivation to quit. METHODS This study examined self-report prescreen data from treatment-seeking smokers (N = 3913). The number of prior quit attempts and withdrawal symptoms experienced, as well as current smoking behavior and motivation to quit were modeled as interconnected nodes in a network. Two key network metrics were examined: 1) edge weights, which quantify the strength and direction of the associations of interest, and 2) the sum of each node's edge weights, which quantifies the expected influence of a node on the overall network. RESULTS The withdrawal symptom of craving, r = 0.10, 95% CI [0.07, 0.13] and digestive problems, r = -0.06, 95% CI [-0.09, -0.03], had the strongest positive and negative association with daily cigarettes, respectively. The number of prior quit attempts, r = 0.17, 95% CI [0.14, 0.20], concentration problems, r = -0.04, 95% CI [-0.027, -0.01], showed the strongest positive and negative associations, respectively, with current motivation to quit. Nodes with significant links to current smoking and motivation to quit were also among the most influential in the overall network. CONCLUSIONS Findings suggest prior quit experiences and consequences associated with withdrawal symptoms may differentially relate to maintenance of smoking behavior and motivation to quit in treatment-seeking smokers. Interventions targeting key withdrawal symptoms may enhance motivation to quit.
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Affiliation(s)
- Christina D Dutcher
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23td Street, Austin, TX 78712, United States.
| | - Santiago Papini
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23td Street, Austin, TX 78712, United States.
| | - Catherine S Gebhardt
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23td Street, Austin, TX 78712, United States.
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23td Street, Austin, TX 78712, United States.
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29
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Schmitter M, Spijker J, Smit F, Tendolkar I, Derksen AM, Oostelbos P, Wijnen BFM, van Doesum TJ, Smits JAJ, Vrijsen JN. Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation. BMC Psychiatry 2020; 20:585. [PMID: 33298013 PMCID: PMC7724825 DOI: 10.1186/s12888-020-02989-z] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a considerable public health concern. In spite of evidence-based treatments for MDD, many patients do not improve and relapse is common. Therefore, improving treatment outcomes is much needed and adjunct exercise treatment may have great potential. Exercise was shown to be effective as monotherapy for depression and as augmentation strategy, with evidence for increasing neuroplasticity. Data on the cost-effectiveness and the long-term effects of adjunct exercise treatment are missing. Similarly, the cognitive pathways toward remission are not well understood. METHODS The present study is designed as a multicenter randomized superiority trial in two parallel groups with follow-up assessments up to 15 months. Currently depressed outpatients (N = 120) are randomized to guideline concordant Standard Care (gcSC) alone or gcSC with adjunct exercise treatment for 12 weeks. Randomization is stratified by gender and setting, using a four, six, and eight block design. Exercise treatment is offered in accordance with the NICE guidelines and empirical evidence, consisting of one supervised and two at-home exercise sessions per week at moderate intensity. We expect that gcSC with adjunct exercise treatment is more (cost-)effective in decreasing depressive symptoms compared to gcSC alone. Moreover, we will investigate the effect of adjunct exercise treatment on other health-related outcomes (i.e. functioning, fitness, physical activity, health-related quality of life, and motivation and energy). In addition, the mechanisms of change will be studied by exploring any change in rumination, self-esteem, and memory bias as possible mediators between exercise treatment and depression outcomes. DISCUSSION The present trial aims to inform the scientific and clinical community about the (cost-)effectiveness and psychosocial mechanisms of change of adjunct exercise treatment when implemented in the mental health service setting. Results of the present study may improve treatment outcomes in MDD and facilitate implementation of prescriptive exercise treatment in outpatient settings. TRIAL REGISTRATION This trial is registered within the Netherlands Trial Register (code: NL8432 , date: 6th March, 2020).
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Affiliation(s)
- Michèle Schmitter
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands. .,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Jan Spijker
- grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Filip Smit
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Biostatistics & Department of Clinical Psychology, Amsterdam Public Health Research Institute, University Medical Centers Amsterdam (location VUmc), Amsterdam, The Netherlands
| | - Indira Tendolkar
- grid.5590.90000000122931605Department of Psychiatry, Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Peter Oostelbos
- grid.491119.5Dutch Depression Association, Amersfoort, The Netherlands and De Hartenboom, Randwijk, The Netherlands
| | - Ben F. M. Wijnen
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tessa J. van Doesum
- grid.416017.50000 0001 0835 8259Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology & Institute for Mental Health Research, University of Texas at Austin, Austin, TX USA
| | - Janna N. Vrijsen
- grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Department of Psychiatry, Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Carl JR, Miller CB, Henry AL, Davis ML, Stott R, Smits JAJ, Emsley R, Gu J, Shin O, Otto MW, Craske MG, Saunders KEA, Goodwin GM, Espie CA. Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depress Anxiety 2020; 37:1168-1178. [PMID: 32725848 DOI: 10.1002/da.23079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/11/2020] [Revised: 06/09/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an efficacious intervention for generalized anxiety disorder (GAD). Digital CBT may provide a scalable means of delivering CBT at a population level. We investigated the efficacy of a novel digital CBT program in those with GAD for outcomes of anxiety, worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life. METHODS This online, two-arm parallel-group superiority randomized controlled trial compared digital CBT with waitlist control in 256 participants with moderate-to-severe symptoms of GAD. Digital CBT (Daylight), was delivered using participants' own smartphones. Online assessments took place at baseline (Week 0; immediately preceding randomization), mid-intervention (Week 3; from randomization), post-intervention (Week 6; primary endpoint), and follow-up (Week 10). RESULTS Overall, 256 participants were randomized and intention-to-treat analysis found Daylight reduced symptoms of anxiety compared with waitlist control at post-intervention, reflecting a large effect size (adjusted difference [95% CI]: 3.22 [2.14, 4.31], d = 1.08). Significant improvements were found for measures of worry; depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life. CONCLUSION Digital CBT (Daylight) appears to be safe and efficacious for symptoms of anxiety, worry, and further measures of mental health compared with waitlist control in individuals with GAD.
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Affiliation(s)
- Jenna R Carl
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Christopher B Miller
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michelle L Davis
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Richard Stott
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, Texas
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Jenny Gu
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Olivia Shin
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michelle G Craske
- Anxiety and Depression Research Centre (ADRC), University of California, Los Angeles, California
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
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Otto MW, Zvolensky MJ, Rosenfield D, Hoyt DL, Witkiewitz K, McKee SA, Bickel WK, Smits JAJ. A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults. Health Psychol 2020; 39:815-825. [PMID: 32833483 PMCID: PMC8489738 DOI: 10.1037/hea0000858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/08/2022]
Abstract
Low income and low educational attainment are among the strongest predictors of both smoking prevalence and lapse (i.e., return) to smoking after cessation attempts. Treatment refinement is limited by inadequate knowledge of the specific lapse- or relapse-relevant vulnerabilities characteristic of populations that should be the target of treatment. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the role of 2 specific lapse-relevant targets relative to the higher stress characteristic of low-socioeconomic contexts: low distress tolerance and low working memory capacity. Furthermore, we use an innovative approach for understanding risk of smoking lapse in smokers undergoing a quit attempt to examine candidate mechanistic targets assessed not only during nicotine use, but also during the conditions smokers will face upon a cessation attempt-during stressful nicotine-deprivation windows. This study is designed to show the incremental value of assessments during deprivation windows, in part because of the way in which specific vulnerabilities are modified by, and interact with, the heightened stress and withdrawal symptoms inherent to nicotine-deprivation states. Specifically, the study is designed to evaluate whether a novel mindfulness intervention (mindfulness combined with interoceptive exposure) can improve upon existing mindfulness interventions and extend therapeutic gains to the modification of mechanistic targets assessed in high-stress or negative affectivity contexts. The overall goal is to validate mechanistic targets and associated interventions for the purpose of expanding treatment options for at-risk smokers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University
| | | | | | - Danielle L. Hoyt
- Department of Psychological and Brain Sciences, Boston University
| | | | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
| | - Warren K. Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute
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Conroy HE, Jacquart J, Baird SO, Rosenfield D, Davis ML, Powers MB, Frierson GM, Marcus BH, Otto MW, Zvolensky MJ, Smits JAJ. Age and pre quit-day attrition during smoking cessation treatment. Cogn Behav Ther 2020; 49:361-373. [PMID: 32343190 PMCID: PMC10823766 DOI: 10.1080/16506073.2020.1751262] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (Mage = 44.2 years, SD = 11.3 years; age = 22-64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.
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Affiliation(s)
- Haley E. Conroy
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jolene Jacquart
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | | | - Mark B. Powers
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
| | - Georita M. Frierson
- School of Arts, Sciences, and Education, D’Youville College, Buffalo, NY, USA
| | - Bess H. Marcus
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Michael W. Otto
- Department of Psychology and Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jasper A. J. Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, USA
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33
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Smits JAJ, Pollack MH, Rosenfield D, Otto MW, Dowd S, Carpenter J, Dutcher CD, Lewis EM, Witcraft SM, Papini S, Curtiss J, Andrews L, Kind S, Conroy K, Hofmann SG. Dose Timing of D-Cycloserine to Augment Exposure Therapy for Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206777. [PMID: 32496566 PMCID: PMC7273198 DOI: 10.1001/jamanetworkopen.2020.6777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Findings suggest that the efficacy of D-cycloserine (DCS) for enhancing exposure therapy may be strongest when administered after sessions marked by low fear at the conclusion of exposure practice. These findings have prompted investigation of DCS dosing tailored to results of exposure sessions. OBJECTIVE To compare tailored postsession DCS administration with presession DCS administration, postsession DCS administration, and placebo augmentation of exposure therapy for social anxiety disorder. DESIGN, SETTING, AND PARTICIPANTS This double-blind randomized clinical trial involved adults with social anxiety disorder enrolled at 3 US university centers. Symptom severity was assessed at baseline, weekly during treatment, and at 1-week and 3-month follow-up. Data analysis was performed from September 2019 to March 2020. INTERVENTIONS Participants completed a 5-session treatment and received pills commensurate with their condition assignment at sessions 2 through 5, which emphasized exposure practice. MAIN OUTCOMES AND MEASURES Symptom severity was evaluated by the Liebowitz Social Anxiety Scale and Social Phobic Disorders-Severity Form as administered by independent evaluators. RESULTS A total of 152 participants were enrolled (mean [SD] age, 29.24 [10.16] years; 84 men [55.26%]). Compared with placebo, presession and postsession conditions showed greater symptom improvement (b = -0.25; 95% CI, -0.37 to -0.13; P < .001; d = 1.07; and b = -0.20; 95% CI, -0.32 to -0.07; P = .002; d = 0.85) and lower symptom severity (b = -0.51; 95% CI, -0.81 to -0.21; P < .001; d = 0.76; and b = -0.49; 95% CI, -0.80 to -0.18; P = .002; d = 0.72) at 3-month follow-up. No differences were found between presession and postsession conditions. The tailored condition showed no advantage over placebo. Compared with the tailored condition, presession and postsession conditions evidenced greater decreases (b = -0.22; 95% CI, -0.34 to -0.10; P < .001; d = 0.94; and b = -0.17, 95% CI, -0.29 to -0.04; P = .008; d = 0.72) and lower symptom severity (b = -0.44, 95% CI, -0.73 to -0.14; P = .004; d = 0.64; and b = -0.41, 95% CI, -0.72 to -0.11; P = .008; d = 0.61) at 3-month follow-up. CONCLUSIONS AND RELEVANCE Administration of DCS enhanced exposure therapy for social anxiety disorder when given before or after the exposure session. However, the study failed to achieve the aim to develop a tailored clinical application. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02066792.
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Affiliation(s)
- Jasper A J Smits
- Institute for Mental Health Research, Department of Psychology, The University of Texas at Austin, Austin
| | - Mark H Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
- Now with Myriad Genetics, Salt Lake City, Utah
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Sheila Dowd
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
| | - Joseph Carpenter
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Christina D Dutcher
- Institute for Mental Health Research, Department of Psychology, The University of Texas at Austin, Austin
| | - Elizabeth M Lewis
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
- Department of Psychology, Louisiana State University, Baton Rouge
| | - Sara M Witcraft
- Institute for Mental Health Research, Department of Psychology, The University of Texas at Austin, Austin
- Department of Psychology, University of Mississippi, Oxford
| | - Santiago Papini
- Institute for Mental Health Research, Department of Psychology, The University of Texas at Austin, Austin
| | - Joshua Curtiss
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Leigh Andrews
- Department of Psychology, Southern Methodist University, Dallas, Texas
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - Shelley Kind
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychology, Suffolk University, Boston, Massachusetts
| | - Kristina Conroy
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychology, Florida International University, Coral Gables
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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Papini S, Young CC, Gebhardt CS, Perrone A, Morikawa H, Otto MW, Roache JD, Smits JAJ. Isradipine enhancement of virtual reality cue exposure for smoking cessation: Rationale and study protocol for a double-blind randomized controlled trial. Contemp Clin Trials 2020; 94:106013. [PMID: 32335287 DOI: 10.1016/j.cct.2020.106013] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
Abstract
Cigarette smoking remains a leading cause of preventable death in the United States, contributing to over 480,000 deaths each year. Although significant strides have been made in the development of effective smoking cessation treatments, most established interventions are associated with high relapse rates. One avenue for increasing the effectiveness of smoking cessation interventions is to design focused, efficient, and rigorous experiments testing engagement of well-defined mechanistic targets. Toward this aim, the current protocol will apply a pharmacologic augmentation strategy informed by basic research in animal models of addiction. Our goal is to evaluate the enhancing effect of isradipine, an FDA-approved calcium channel blocker, on the extinction of craving-a key mechanism of drug relapse after periods of abstinence. To activate craving robustly in human participants, we will use multimodal smoking cues including novel 360° video environments developed for this project and delivered through consumer virtual reality headsets. Adult smokers will take either isradipine or placebo and complete the cue exposure protocol in a double-blind randomized control trial. In order to test the hypothesis that isradipine will enhance retention of craving extinction, participants will repeat cue exposure 24 h later without the administration of isradipine or placebo. The study will be implemented in a primary care setting where adult smokers receive healthcare, and smoking behavior will be tracked throughout the trial with ecological momentary assessment.
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Affiliation(s)
- Santiago Papini
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA.
| | - Cara C Young
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Catherine S Gebhardt
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Alex Perrone
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
| | - Hitoshi Morikawa
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States.; Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA
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Gu J, Miller CB, Henry AL, Espie CA, Davis ML, Stott R, Emsley R, Smits JAJ, Craske M, Saunders KEA, Goodwin G, Carl JR. Efficacy of digital cognitive behavioural therapy for symptoms of generalised anxiety disorder: a study protocol for a randomised controlled trial. Trials 2020; 21:357. [PMID: 32326980 PMCID: PMC7181570 DOI: 10.1186/s13063-020-4230-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/04/2020] [Indexed: 12/28/2022] Open
Abstract
Background Generalised anxiety disorder (GAD) is a chronic and disabling condition with considerable personal and economic impact. Cognitive behavioural therapy (CBT) is a recommended psychological therapy for GAD; however, there are substantial barriers to accessing treatment. Digital CBT, in particular smartphone-delivered CBT, has the potential to improve accessibility and increase dissemination of CBT. Despite the emerging evidence of smartphone-based psychological interventions for reducing anxiety, effect size scores are typically smaller than in-person interventions, and there is a lack of research assessing the efficacy of smartphone-delivered digital interventions specifically for GAD. Methods In the DeLTA trial (DigitaL Therapy for Anxiety), we plan to conduct a parallel-group superiority randomised controlled trial examining the efficacy of a novel smartphone-based digital CBT intervention for GAD compared to a waitlist control. We aim to recruit 242 adults (aged 18 years or above) with moderate-to-severe symptoms of GAD. This trial will be conducted entirely online and will involve assessments at baseline (week 0; immediately preceding randomisation), mid-intervention (week 3), post-intervention (week 6; primary end point) and follow-up (week 10). The primary objective is to evaluate the efficacy of the intervention on GAD symptom severity compared to a waitlist control at post-intervention. Secondary objectives are to examine between-group effects on GAD at follow-up, and to examine the following secondary outcomes at both post-intervention and follow-up: 1) worry; 2) depressive symptoms; 3) wellbeing; 4) quality of life; and 5) sleep difficulty. Discussion This trial will report findings on the initial efficacy of a novel digital CBT intervention for GAD. Results have the potential to contribute towards the evidence base for digital CBT for GAD and increase the dissemination of CBT. Trial registration ISRCTN, ISRCTN12765810. Registered on 11 January 2019.
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Affiliation(s)
- J Gu
- Big Health Inc., San Francisco, CA, USA, London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - C B Miller
- Big Health Inc., San Francisco, CA, USA, London, UK. .,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - A L Henry
- Big Health Inc., San Francisco, CA, USA, London, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - C A Espie
- Big Health Inc., San Francisco, CA, USA, London, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M L Davis
- Big Health Inc., San Francisco, CA, USA, London, UK
| | - R Stott
- Big Health Inc., San Francisco, CA, USA, London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - R Emsley
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
| | - J A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - M Craske
- Anxiety and Depression Research Centre (ADRC), University of California, Los Angeles, CA, USA
| | - K E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - G Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - J R Carl
- Big Health Inc., San Francisco, CA, USA, London, UK
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Smits JAJ, Zvolensky MJ, Otto MW, Piper ME, Baird SO, Kauffman BY, Lee-Furman E, Alavi N, Dutcher CD, Papini S, Rosenfield B, Rosenfield D. Enhancing panic and smoking reduction treatment with D-Cycloserine: A pilot randomized clinical trial. Drug Alcohol Depend 2020; 208:107877. [PMID: 32004998 PMCID: PMC7039743 DOI: 10.1016/j.drugalcdep.2020.107877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States
| | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe St. #200, Madison, WI, 53711, United States
| | - Scarlett O Baird
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States
| | - Eunjung Lee-Furman
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Noura Alavi
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Christina D Dutcher
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Santiago Papini
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, 75206, United States
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Papini S, Rubin M, Telch MJ, Smits JAJ, Hien DA. Pretreatment Posttraumatic Stress Disorder Symptom Network Metrics Predict the Strength of the Association Between Node Change and Network Change During Treatment. J Trauma Stress 2020; 33:64-71. [PMID: 31343789 DOI: 10.1002/jts.22379] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 01/14/2023]
Abstract
Network analysis has been increasingly applied in an effort to understand complex interactions among symptoms in posttraumatic stress disorder (PTSD). Although methods that initially focused on identifying central symptoms in cross-sectional networks have been extended to longitudinal data that can reveal the relative roles of acute symptoms in the emergence of the PTSD syndrome, the association between network metrics and symptom change during treatment have yet to be explored in PTSD. To address this gap, we estimated pretreatment PTSD symptom networks in a sample of patients from a multisite clinical trial for women with full or subthreshold PTSD and substance use. We tested the hypothesis that node metrics calculated in the pretreatment network would be predictive of the strength of the association between a symptom's change and the change in the severity of all other symptoms through the course of treatment. A symptom node's strength and predictability in the pretreatment network were each strongly correlated with the association between that symptom's change and overall change across the symptom network, r(15) = .79, p < .001 and r(15) = .75, p < .001, respectively, whereas a symptom's mean severity at pretreatment was not, r(15) = .27, p = .292. These findings suggest that a node's centrality prior to treatment engagement is a predictor of its association with overall symptom change throughout the treatment process.
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Affiliation(s)
- Santiago Papini
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Mikael Rubin
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Michael J Telch
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Denise A Hien
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.,Columbia University College of Physicians and Surgeons, New York, New York, USA
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Rosenfield D, Smits JAJ, Hofmann SG, Mataix-Cols D, de la Cruz LF, Andersson E, Rück C, Monzani B, Pérez-Vigil A, Frumento P, Davis M, de Kleine RA, Difede J, Dunlop BW, Farrell LJ, Geller D, Gerardi M, Guastella AJ, Hendriks GJ, Kushner MG, Lee FS, Lenze EJ, Levinson CA, McConnell H, Plag J, Pollack MH, Ressler KJ, Rodebaugh TL, Rothbaum BO, Storch EA, Ströhle A, Tart CD, Tolin DF, van Minnen A, Waters AM, Weems CF, Wilhelm S, Wyka K, Altemus M, Anderson P, Cukor J, Finck C, Geffken GR, Golfels F, Goodman WK, Gutner CA, Heyman I, Jovanovic T, Lewin AB, McNamara JP, Murphy TK, Norrholm S, Thuras P, Turner C, Otto MW. Changes in Dosing and Dose Timing of D-Cycloserine Explain Its Apparent Declining Efficacy for Augmenting Exposure Therapy for Anxiety-related Disorders: An Individual Participant-data Meta-analysis. J Anxiety Disord 2019; 68:102149. [PMID: 31698111 PMCID: PMC9119697 DOI: 10.1016/j.janxdis.2019.102149] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/25/2022]
Abstract
The apparent efficacy of d-cycloserine (DCS) for enhancing exposure treatment for anxiety disorders appears to have declined over the past 14 years. We examined whether variations in how DCS has been administered can account for this "declining effect". We also investigated the association between DCS administration characteristics and treatment outcome to find optimal dosing parameters. We conducted a secondary analysis of individual participant data obtained from 1047 participants in 21 studies testing the efficacy of DCS-augmented exposure treatments. Different outcome measures in different studies were harmonized to a 0-100 scale. Intent-to-treat analyses showed that, in participants randomized to DCS augmentation (n = 523), fewer DCS doses, later timing of DCS dose, and lower baseline severity appear to account for this decline effect. More DCS doses were related to better outcomes, but this advantage leveled-off at nine doses. Administering DCS more than 60 minutes before exposures was also related to better outcomes. These predictors were not significant in the placebo arm (n = 521). Results suggested that optimal DCS administration could increase pre-to-follow-up DCS effect size by 50%. In conclusion, the apparent declining effectiveness of DCS over time may be accounted for by how it has been administered. Optimal DCS administration may substantially improve outcomes. Registration: The analysis plan for this manuscript was registered on Open Science Framework (https://osf.io/c39p8/).
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Affiliation(s)
- David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, USA.
| | - Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas, Austin, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Benedetta Monzani
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ana Pérez-Vigil
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Davis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | | | - JoAnn Difede
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Brisbane, Australia; Menzies Health Institute of Queensland, Brisbane, Australia
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - Maryrose Gerardi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Adam J Guastella
- Brain and Mind Research Institute, Central Clinical School, University of Sydney, Sydney, Australia
| | - Gert-Jan Hendriks
- Behavioral Science Institute, Radboud University Nijmegen, The Netherlands; Overwaal Center of Expertise for Anxiety Disorders OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, the Netherlands
| | - Matt G Kushner
- Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis, USA
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Cheri A Levinson
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Harry McConnell
- Menzies Health Institute of Queensland, Brisbane, Australia; School of Medicine, Griffith University, Brisbane, Australia
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Germany
| | - Mark H Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, USA
| | - Kerry J Ressler
- Harvard Medical School, Boston, USA; McLean Hospital, Belmont, USA
| | - Thomas L Rodebaugh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Germany
| | | | - David F Tolin
- The Institute of Living, Hartford, USA; Yale University School of Medicine, New Haven, USA
| | - Agnes van Minnen
- Behavioral Science Institute, Radboud University Nijmegen, The Netherlands
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medical College, NY, USA; City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | | | - Page Anderson
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Judith Cukor
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Claudia Finck
- DRK Kliniken Berlin Wiegmann Klinik, Berlin, Germany
| | | | | | | | - Cassidy A Gutner
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | - Isobel Heyman
- Great Ormond Street Hospital for Children, London, UK; University College, London, UK
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, USA
| | | | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, USA
| | - Seth Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Paul Thuras
- Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis, USA
| | - Cynthia Turner
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
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Hofmann SG, Papini S, Carpenter JK, Otto MW, Rosenfield D, Dutcher CD, Dowd S, Lewis M, Witcraft S, Pollack MH, Smits JAJ. Effect of d-cycloserine on fear extinction training in adults with social anxiety disorder. PLoS One 2019; 14:e0223729. [PMID: 31622374 PMCID: PMC6797442 DOI: 10.1371/journal.pone.0223729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022] Open
Abstract
Preclinical and clinical data have shown that D-cycloserine (DCS), a partial agonist at the N-methyl-d-aspartate receptor complex, augments the retention of fear extinction in animals and the therapeutic learning from exposure therapy in humans. However, studies with non-clinical human samples in de novo fear conditioning paradigms have demonstrated minimal to no benefit of DCS. The aim of this study was to evaluate the effects of DCS on the retention of extinction learning following de novo fear conditioning in a clinical sample. Eighty-one patients with social anxiety disorder were recruited and underwent a previously validated de novo fear conditioning and extinction paradigm over the course of three days. Of those, only 43 (53%) provided analyzable data. During conditioning on Day 1, participants viewed images of differently colored lamps, two of which were followed by with electric shock (CS+) and a third which was not (CS-). On Day 2, participants were randomly assigned to receive either 50 mg DCS or placebo, administered in a double-blind manner 1 hour prior to extinction training with a single CS+ in a distinct context. Day 3 consisted of tests of extinction recall and renewal. The primary outcome was skin conductance response to conditioned stimuli, and shock expectancy ratings were examined as a secondary outcome. Results showed greater skin conductance and expectancy ratings in response to the CS+ compared to CS- at the end of conditioning. As expected, this difference was no longer present at the end of extinction training, but returned at early recall and renewal phases on Day 3, showing evidence of return of fear. In contrast to hypotheses, DCS had no moderating influence on skin conductance response or expectancy of shock during recall or renewal phases. We did not find evidence of an effect of DCS on the retention of extinction learning in humans in this fear conditioning and extinction paradigm.
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Affiliation(s)
- Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
- * E-mail:
| | - Santiago Papini
- Department of Psychology, University of Texas at Austin, Austin, Texas, United States of America
| | - Joseph K. Carpenter
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas, United States of America
| | - Christina D. Dutcher
- Department of Psychology, University of Texas at Austin, Austin, Texas, United States of America
| | - Sheila Dowd
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Mara Lewis
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
| | - Sara Witcraft
- Department of Psychology, University of Mississippi, Oxford, Mississippi, United States of America
| | - Mark H. Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Jasper A. J. Smits
- Department of Psychology, University of Texas at Austin, Austin, Texas, United States of America
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Kosiba JD, Hughes MT, LaRowe LR, Zvolensky MJ, Norton PJ, Smits JAJ, Buckner JD, Ditre JW. Menthol cigarette use and pain reporting among African American adults seeking treatment for smoking cessation. Exp Clin Psychopharmacol 2019; 27:276-282. [PMID: 30688504 PMCID: PMC6733399 DOI: 10.1037/pha0000254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nicotine has acute pain-relieving properties, and tobacco smokers often report using cigarettes to cope with pain. The proportion of smokers using menthol cigarettes has increased in recent years, and there is reason to suspect that menthol may enhance the analgesic effects of nicotine. Up to 90% of African American smokers report using menthol cigarettes, and African Americans tend to report more severe pain and greater difficulty quitting. Yet no known research has examined the relationship between menthol cigarette use and pain reporting. Thus, the goal of the current study was to test associations between menthol (vs. nonmenthol) cigarette use and pain among a sample of African American smokers. Current daily cigarette smokers (N = 115; 70% male; Mage = 47.05; MCPD = 15.2) were recruited to participate in a smoking cessation study. These data were collected at the baseline session. Daily menthol (vs. nonmenthol) cigarette use was associated with lower current pain intensity, lower average and worst pain over the past 3 months, and less pain-related physical impairment over the past 3 months. This study demonstrates that menthol (vs. nonmenthol) cigarette use is associated with less pain and pain-related functional interference among African American smokers seeking tobacco cessation treatment. Future research is needed to examine the potential acute analgesic effects of menthol versus nonmenthol cigarette use, examine temporal covariation between menthol cigarette use and pain reporting, and test whether pain-relevant processes contribute to the maintenance of menthol cigarette smoking among those with and without chronic pain. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Labbe AK, Wilner JG, Coleman JN, Marquez SM, Kosiba JD, Zvolensky MJ, Smits JAJ, Norton PJ, Rosenfield D, O'Cleirigh C. A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation. AIDS Care 2019; 31:609-615. [PMID: 30350712 PMCID: PMC6408255 DOI: 10.1080/09540121.2018.1533225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/02/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022]
Abstract
Despite high rates of co-occurring tobacco use and anxiety among persons living with HIV, evidence-based interventions for these individuals are limited. An existing cognitive-behavioral treatment protocol for smoking cessation and anxiety (Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874-882. https://doi.org/10.1002/da.21974) was modified to address transdiagnostic constructs, such as anxiety sensitivity, distress tolerance, and depressive symptomatology (Labbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., … O'Cleirigh, C. (2017). Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People with HIV: A Clinical Case Study. Cognitive and Behavioral Practice, 24(2), 200-214. https://doi.org/10.1016/j.cbpra.2016.03.009). This study examines the feasibility and acceptability of the intervention as determined from qualitative data from structured exit interviews from 10 participants who completed treatment. Results demonstrated that participants were very motivated to quit smoking and enrolled in the program for health-related reasons and to be able to quit. Participants found nearly all the treatment components to be useful for reaching their smoking cessation goal and in managing emotional dysregulation. Last, all participants stated that they would strongly recommend the treatment program. This qualitative study provides initial evidence for the feasibility and acceptability of a modified smoking cessation treatment protocol for HIV+ individuals with anxiety and emotional dysregulation. Future research will focus on evaluating the efficacy of the protocol in a full-scale randomized controlled trial, as well as working to collect qualitative data from participants who discontinue treatment to better understand reasons for treatment attrition.
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Affiliation(s)
- A K Labbe
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - J G Wilner
- b Dept. of Psychology , Boston University , Boston , MA , USA
| | - J N Coleman
- c Dept. of Psychology , Duke University , Raleigh , NC , USA
| | - S M Marquez
- d The Fenway Institute , Fenway Health , Boston , MA , USA
| | - J D Kosiba
- e Dept. of Psychology , Syracuse University , Syracuse , NY , USA
| | - M J Zvolensky
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - J A J Smits
- g Dept. of Psychology , University of Texas at Austin , Austin , TX , USA
| | - P J Norton
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - D Rosenfield
- h Dept. of Psychology , Southern Methodist University , Dallas , TX , USA
| | - C O'Cleirigh
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
- d The Fenway Institute , Fenway Health , Boston , MA , USA
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42
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Jones J, Kauffman B, Rosenfield D, Smits JAJ, Zvolensky MJ. Emotion dysregulation and body mass index: The explanatory role of emotional eating among adult smokers. Eat Behav 2019; 33:97-101. [PMID: 31078948 PMCID: PMC6535346 DOI: 10.1016/j.eatbeh.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
There is limited understanding of the relationship between emotion dysregulation and weight gain among smokers, although available data suggest there are potential relationships that may be of clinical importance. The present study explored a potential mechanism in the relationship between emotion dysregulation and body mass index (BMI). Specifically, the current study examined the indirect effects of emotional eating on the association between emotion dysregulation and BMI among smokers. Participants included 136 (52.2% female; Mage = 42.25, SD = 11.24) adults who were treatment-seeking smokers. Primary analysis included one regression-based model, wherein emotion dysregulation served as the predictor, emotional eating as the intermediary variable, and BMI as the criterion variable. Covariates were age and gender. Results indicated that emotional dysregulation was significantly associated with BMI through emotional eating (a*b = 0.02, SE = 0.01, CI95% = 0.002, 0.042). The current findings provide initial empirical evidence that greater reported levels of emotion dysregulation may be associated with greater reported levels of emotional eating, which in turn, may be related to higher BMI.
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Affiliation(s)
- Jenna Jones
- Department of Psychology, University of Houston
| | | | | | - Jasper A. J. Smits
- Department of Psychology and Institute of Mental Health Research, The University of Texas at Austin
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,HEALTH Institute, University of Houston, Houston, TX, USA
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Becker ES, Barth A, Smits JAJ, Beisel S, Lindenmeyer J, Rinck M. Positivity-approach training for depressive symptoms: A randomized controlled trial. J Affect Disord 2019; 245:297-304. [PMID: 30439675 DOI: 10.1016/j.jad.2018.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/19/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is highly comorbid and depressive symptoms are very common. Symptom severity adversely affects treatment outcome and later health status. Established interventions for depression leave ample room for improvement. Short interventions that target specific vulnerabilities emerge as plausible augmentation strategies. In this study, we tested the efficacy of a computerized general positivity-approach training and its effect on depressive symptoms. METHODS Patients (N = 240) with various diagnoses of mental disorders who received treatment-as-usual in an inpatient setting were randomly assigned to also receive either 4 sessions of a positivity-approach training or 4 sessions of sham training. Depression severity was assessed at baseline and post-treatment. Training data were analyzed for a subset of 111 patients. RESULTS Depressive symptoms were reduced more after positivity-approach training than after sham training. Initial depression symptom severity moderated the intervention effects, such that approach tendencies and depression symptoms were only affected positively among patients with higher levels of initial depression symptom severity. CONCLUSIONS The findings provide preliminary support for positivity-approach training as an add-on treatment option for depressive symptoms.
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Affiliation(s)
- Eni S Becker
- Behavioural Science Institute, Radboud University, The Netherlands.
| | - Anja Barth
- Behavioural Science Institute, Radboud University, The Netherlands
| | | | | | | | - Mike Rinck
- Behavioural Science Institute, Radboud University, The Netherlands.
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Carl E, Witcraft SM, Kauffman BY, Gillespie EM, Becker ES, Cuijpers P, Van Ameringen M, Smits JAJ, Powers MB. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cogn Behav Ther 2019; 49:1-21. [PMID: 30760112 DOI: 10.1080/16506073.2018.1560358] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (g = 0.76) and medication showed a small effect size (g = 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (g = 0.64) as did medications (g = 0.59). Younger age was associated with a larger effect size for psychotherapy (p < 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.
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Affiliation(s)
- Emily Carl
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Sara M Witcraft
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Eilis M Gillespie
- School of Psychology, National University of Ireland Galway & Ireland's Health Services, Galway, Ireland
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Mark B Powers
- Department of Psychology, University of Texas at Austin, Austin, TX, USA.,Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center, Dallas, TX, USA
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Smits JAJ, Zvolensky MJ, Rosenfield D, Brown RA, Freeman SZ, Dutcher CD, Conroy HE, Alavi N. YMCA exercise intervention to augment smoking cessation treatment in adults with high anxiety sensitivity: Study protocol for a randomized controlled trial. Contemp Clin Trials 2019; 77:1-7. [PMID: 30557623 DOI: 10.1016/j.cct.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/10/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022]
Abstract
Extant evidence suggests that exercise can reduce anxiety related vulnerability factors, such as anxiety sensitivity (AS), or fear of bodily sensations related to anxiety, that negatively impact smoking cessation outcomes. Building upon emerging evidence supporting the efficacy of exercise as an aid for smoking cessation in adults with high AS, we are conducting a trial to examine the efficacy and feasibility of this clinical application when implemented in a community setting. Partnering with the YMCA, this study aims to enroll 150 adults in a standard smoking cessation protocol (i.e. counseling and nicotine replacement therapy) and randomly assign them to either 15 weeks of programmed vigorous-intensity or low-intensity exercise. Smoking abstinence data will be collected up to 6 months following the quit attempt.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States.
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Richard A Brown
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | - Slaton Z Freeman
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States
| | - Christina D Dutcher
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States
| | - Haley E Conroy
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States
| | - Noura Alavi
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, Austin, TX, United States
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Stein AT, Freeman SZ, Smits JAJ. Cognitive Mechanisms Underlying the Link Between Anxiety, Health Behaviors, and Illness Outcomes: Commentary on a Special Issue. Cogn Ther Res 2019. [DOI: 10.1007/s10608-019-09999-6] [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: 10/27/2022]
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47
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Zvolensky MJ, Smits JAJ, Garey L. Behavioral medicine and behavioral health research and practice: An introduction to the Special Issue. Behav Res Ther 2019; 115:1-3. [PMID: 30660326 DOI: 10.1016/j.brat.2019.01.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The field of behavioral medicine continues to have a major impact on psychological science and public health. Presently, the field of behavioral medicine is undergoing rapid development and continues to evolve as a sub-discipline in allied disciplines. This Special Issue highlights emerging work that contributes to the evolution of behavioral medicine as pertaining to behavioral, psychosocial, and biomedical science integration to prevent, diagnose, and treat illness and disease. The present introductory article calls attention to research in behavioral medicine in the larger context of behavioral health research and practice and encourages continued research in this area. Research presented in this Special Issue covers a variety of topics, ranging from the role of cognition and emotion in behavioral disorders, development and refinement of novel technological and integrated interventions, substance use comorbidity, sexual health across special populations, and social determinants of health. This Special Issue is organized into three parts classified as transdiagnostic processes in health behavior and physical illness; personalization of health-specific therapeutic tactics in modern day healthcare in behavioral medicine; and social determinants of health and health disparities in behavioral medicine among special populations. It is hoped that this issue will alert readers to the significance of this work, illustrate the many domains currently being explored via innovative approaches, and identify promising and impactful areas for research.
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Affiliation(s)
- Michael J Zvolensky
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, TX, 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX, 77030, USA; Health Institute, Houston, TX, 77204, USA.
| | | | - Lorra Garey
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, TX, 77204, USA
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Vittengl JR, Clark LA, Smits JAJ, Thase ME, Jarrett RB. Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression? J Affect Disord 2019; 242:150-158. [PMID: 30176494 PMCID: PMC6151272 DOI: 10.1016/j.jad.2018.08.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. METHODS Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. RESULTS Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. LIMITATIONS Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. CONCLUSIONS Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.
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Affiliation(s)
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Asutin, TX, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Minns S, Levihn-Coon A, Carl E, Smits JAJ, Miller W, Howard D, Papini S, Quiroz S, Lee-Furman E, Telch M, Carlbring P, Xanthopoulos D, Powers MB. Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial. J Anxiety Disord 2019; 61:37-44. [PMID: 30580896 DOI: 10.1016/j.janxdis.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stereoscopic 3D gives the viewer the same shape, size, perspective and depth they would experience viewing the real world and could mimic the perceptual threat cues present in real life. This is the first study to investigate whether an immersive stereoscopic 3D video exposure-based treatment would be effective in reducing fear of spiders. Participants with a fear of spiders (N = 77) watched two psychoeducational videos with facts about spiders and phobias. They were then randomized to a treatment condition that watched a single session of a stereoscopic 3D immersive video exposure-based treatment (six 5-minute exposures) delivered through a virtual reality headset or a psychoeducation only control condition that watched a 30-minute neutral video (2D documentary) presented on a computer monitor. Assessments of spider fear (Fear of Spiders Questionnaire [FSQ], Behavioral Approach Task [BAT], & subjective ratings of fear) were completed pre- and post-treatment. Consistent with prediction, the stereoscopic 3D video condition outperformed the control condition in reducing fear of spiders showing a large between-group change effect size on the FSQ (Cohen's d = 0.85) and a medium between-group effect size on the BAT (Cohen's d = 0.47). This provides initial support for stereoscopic 3D video in treating phobias.
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Affiliation(s)
- Sean Minns
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Andrew Levihn-Coon
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Emily Carl
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA.
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Wayne Miller
- UT3D Program, 2504 Whitis Ave, Austin, TX, 78705, USA
| | - Don Howard
- Department of Radio-Television-Film, The University of Texas at Austin, 2504 Whitis Ave, Austin, TX, 78705, USA; UT3D Program, 2504 Whitis Ave, Austin, TX, 78705, USA
| | - Santiago Papini
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Simon Quiroz
- UT3D Program, 2504 Whitis Ave, Austin, TX, 78705, USA; Department of Radio-Television-Film, The University of Texas at Austin, 2504 Whitis Ave, Austin, TX, 78705, USA
| | - Eunjung Lee-Furman
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Michael Telch
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | | | - Drew Xanthopoulos
- UT3D Program, 2504 Whitis Ave, Austin, TX, 78705, USA; Department of Radio-Television-Film, The University of Texas at Austin, 2504 Whitis Ave, Austin, TX, 78705, USA
| | - Mark B Powers
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA; Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA
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50
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Stein AT, Medina JL, Rosenfield D, Otto MW, Smits JAJ. Examining experiential avoidance as a mediator of the relation between anxiety sensitivity and depressive symptoms. Cogn Behav Ther 2018; 49:41-54. [DOI: 10.1080/16506073.2018.1546768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Johnna L. Medina
- Stanford University School of Medicine, Stanford, California, USA
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