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Davis TE, Brennan J. Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD. Clin Child Fam Psychol Rev 2024:10.1007/s10567-024-00475-6. [PMID: 38632150 DOI: 10.1007/s10567-024-00475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/19/2024]
Abstract
Fears and phobias are a common mental health concern for youth, and particularly for autistic youth. The following review briefly summarizes the extant literature on specific phobias and specific phobias in autistic youth. The evidence base is briefly highlighted pointing to the strong base behind behavioral and cognitive-behavioral treatments and techniques. A broad discussion of key evidence-based treatment findings is presented, leading up to the impactful work of Thomas H. Ollendick in researching Öst's One-Session Treatment (OST) with children and adolescents. OST for child specific phobias is discussed, and particular emphasis is given to this treatment's ongoing adaptation for use with youth on the autism spectrum.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA.
| | - Justine Brennan
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA
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2
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Roesmann K, Leehr EJ, Böhnlein J, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Dannlowski U, Lueken U. Mechanisms of action underlying virtual reality exposure treatment in spider phobia: Pivotal role of within-session fear reduction. J Anxiety Disord 2023; 100:102790. [PMID: 37879242 DOI: 10.1016/j.janxdis.2023.102790] [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: 11/07/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Although virtual-reality exposure treatment (VRET) for anxiety disorders is an efficient treatment option for specific phobia, mechanisms of action for immediate and sustained treatment response need to be elucidated. Towards this aim, core therapy process variables were assessed as predictors for short- and long-term VR treatment outcomes. In a bi-centric study, n = 186 patients with spider phobia completed a baseline-assessment, a one-session VRET, a post-therapy assessment, and a 6-month-follow-up assessment (ClinicalTrials.gov, ID: NCT03208400). Short- and long-term outcomes regarding self-reported symptoms in the spider phobia questionnaire (SPQ) and final patient-spider distance in the behavioral avoidance test (BAT) were predicted via logistic regression models with the corresponding baseline score, age, initial fear activation, within-session fear reduction and fear expectancy violation as predictors. To predict long-term remission status at 6-month-follow-up, dimensional short-term changes in the SPQ and BAT were additionally included. Higher within-session fear reductions predicted better treatment outcomes (long-term SPQ; short- and long-term BAT). Lower initial fear activation tended to be associated with better long-term outcomes (SPQ), while fear expectancy violation was not associated with any outcome measure. Short-term change in the SPQ predicted remission status. Findings highlight that in VRET for spider phobia, the experience of fear reduction is central for short- and long-term treatment success and should be focused by therapists.
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Affiliation(s)
- Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Psychology, Unit for Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany.
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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3
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de Jong R, Lommen MJJ, van Hout WJPJ, Kuijpers RCWM, Stone L, de Jong P, Nauta MH. Better together? A randomized controlled microtrial comparing different levels of therapist and parental involvement in exposure-based treatment of childhood specific phobia. J Anxiety Disord 2023; 100:102785. [PMID: 37832323 DOI: 10.1016/j.janxdis.2023.102785] [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: 12/10/2022] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Exposure is often limited to homework assignments in routine clinical care. The current study compares minimally-guided (MGE) and parent-guided (PGE) out-session homework formats to the 'golden standard' of therapist-guided in-session exposure with minimally-guided exposure at home (TGE). METHODS Children with specific phobia (N = 55, age 8-12, 56% girls) participated in a single-blind, randomized controlled microtrial with a four-week baseline-treatment period design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS TGE resulted in a larger decline of specific phobia severity from baseline to post-treatment compared to MGE but not compared to PGE. Parental anxiety was found to be a moderator of less treatment efficacy of PGE from baseline to post-treatment. Overall, there was no meaningful difference in efficacy of TGE versus MGE or PGE from baseline to follow-up. CONCLUSIONS These findings suggest that for improving short-term treatment gains, exposure exercises can best be conducted with the help of a therapist within the therapy session before they are conducted as homework assignments outside the therapy session. However, for long-term treatment gains exposure exercises can be handled by the child itself or with help of its parents.
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Affiliation(s)
- Rachel de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands.
| | - Miriam J J Lommen
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Wiljo J P J van Hout
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | | | - Lisanne Stone
- Karakter Child and Youth Psychiatry, Nijmegen, the Netherlands
| | - Peter de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands; Radboud University Nijmegen, Department of Pedagogical Sciences, the Netherlands; Karakter Child and Youth Psychiatry, Nijmegen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
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Meinlschmidt G, Stalujanis E, Grisar L, Borrmann M, Tegethoff M. Anticipated fear and anxiety of Automated Driving Systems: Estimating the prevalence in a national representative survey. Int J Clin Health Psychol 2023; 23:100371. [PMID: 36937334 PMCID: PMC10018559 DOI: 10.1016/j.ijchp.2023.100371] [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: 10/27/2022] [Accepted: 01/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Automated Driving Systems (ADS) may reshape mobility. Yet, related fear and anxiety are largely unknown. We estimated the prevalence and risk factors of anticipated anxiety towards ADS. Method In a nationally representative face-to-face household survey, we assessed anticipated levels of anxiety towards ADS based on DSM-5 specific phobia criteria, using structured diagnostic interviews. We estimated weighted prevalences and conducted adjusted logistic regression models. Results Of N = 2076 respondents, 40.82% (95%-confidence interval (CI) 37.73-43.98) anticipated experiencing some symptoms of phobia of ADS, 15.22% (CI 13.19-17.51) anticipated subthreshold phobia, and 3.39% (CI 2.42-4.75) anticipated full-blown phobia of ADS. Of subjects anticipating subthreshold phobia, 74.02% showed no strong, enduring fears of driving non-automated cars and 65.07% presented no other specific phobias (full-blown anticipated phobia: 50.37% and 50.03%, respectively). Anticipated phobia highly overlapped with anticipating marked or strong fears of passively encountering ADS in traffic (odds ratio 312.4-1982.2). Conclusion About 20% of subjects anticipated at least subthreshold and 4% of subjects anticipated full-blown phobia of ADS. It appears to be distinct from fears related to non-automated driving and other specific phobias. Our findings call for prevention and treatment of phobia of ADS as they become increasingly ubiquitous.
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Affiliation(s)
- Gunther Meinlschmidt
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
- Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 60/62, CH-4055, Basel, Switzerland
| | - Esther Stalujanis
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse 60/62, CH-4055, Basel, Switzerland
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Culmannstrasse 8, 8091 Zürich, Switzerland
| | - Laura Grisar
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
| | - Moritz Borrmann
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 3b, D-10555, Berlin, Germany
| | - Marion Tegethoff
- Institute of Psychology, RWTH Aachen, Jägerstrasse 17-19, D-52056 Aachen, Germany
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Jong RD, Hofs A, Lommen MJJ, van Hout WJPJ, Jong PJD, Nauta MH. Treating specific phobia in youth: A randomized controlled microtrial comparing gradual exposure in large steps to exposure in small steps. J Anxiety Disord 2023; 96:102712. [PMID: 37043895 DOI: 10.1016/j.janxdis.2023.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Exposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE). METHODS Children and young people with a specific phobia (SP) (N = 50, age 8-17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS Within exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one's individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises. DISCUSSION SmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.
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Affiliation(s)
- Rachel de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Annemieke Hofs
- Accare Child Study Center, University Center for Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Miriam J J Lommen
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Wiljo J P J van Hout
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Peter J De Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands; Accare Child Study Center, University Center for Child and Adolescent Psychiatry, Groningen, the Netherlands.
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6
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Woronko SE, Jessup SC, Armstrong T, Anwyl-Irvine AL, Dalmaijer ES, Olatunji BO. A novel probe of attentional bias for threat in specific phobia: Application of the "MouseView.js" approach. J Anxiety Disord 2023; 96:102700. [PMID: 36965222 DOI: 10.1016/j.janxdis.2023.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Although attentional bias for threat has been implicated in anxiety disorders, traditional attentional bias measures have been criticized for lack of reliability and validity, and eye tracking technologies can be cost-prohibitive. MouseView.js was recently developed to mimic eye tracking online by using the computer cursor as a proxy for gaze, and although it is equally reliable, MouseView.js' utility for capturing attentional bias for threat in anxiety-related disorders remains unclear. To fill this knowledge gap, snake phobic and non-phobic participants (N = 62) completed a behavioral avoidance task (BAT) and the MouseView.js task which consisted of 10-second exposures to blurred, side-by-side images of either pleasant-neutral or threat-neutral pairings and were instructed to freely move the mouse to reveal the images. Results demonstrated that snake phobic participants had significantly shorter average mouse dwell time on threat images than non-phobic individuals and showed a significant reduction in average dwell time on threat images following the first presentation of the threat-neutral pairing. Additionally, dwell time on threat images significantly mediated the group differences in steps completed on the BAT. Results highlight the utility of MouseView.js in capturing avoidant patterns of attentional bias for threat that may also partially drive avoidance in snake phobia. Implications for capturing attentional bias for threat in anxiety disorders more broadly are discussed.
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Affiliation(s)
- Sarah E Woronko
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sarah C Jessup
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | | | | | - Edwin S Dalmaijer
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; School of Psychological Science, University of Bristol, Bristol, UK
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
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7
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Scheveneels S, De Witte N, Van Daele T. The first steps in facing your fears: The acceptability of virtual reality and in vivo exposure treatment for specific fears. J Anxiety Disord 2023; 95:102695. [PMID: 36921510 DOI: 10.1016/j.janxdis.2023.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Phobic individuals are often reluctant to engage in exposure in vivo (IVE). We examined whether providing exposure in virtual reality (VRE) can increase the acceptability. In Study 1, we provided 186 fearful participants with (hypothetical) VRE and IVE treatment offers and examined their willingness to engage in treatment, estimated success, negative beliefs, acceptance/refusal and their preference. Almost 70 % preferred VRE over IVE and acceptance rates were higher for the VRE offer (58 %) than for IVE (35 %). Although participants held fewer negative beliefs about VRE, they did rate IVE as slightly more successful. In Study 2, we examined whether VRE can serve as a stepping stone to IVE in a sample of 102 spider fearful individuals. Willingness to engage, estimated success and negative beliefs about IVE were assessed before and after VRE. After VRE, participants rated IVE as more successful, but were not more willing to engage in IVE, nor were they more inclined to accept an IVE offer. No decreases in negative beliefs were observed. In conclusion, VRE is deemed more acceptable than IVE and could lower refusal rates, hereby resulting in more phobic individuals receiving treatment. Future research should shed light on underlying motivations and associations.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
| | - Nele De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tom Van Daele
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
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Flasbeck V, Engelmann J, Klostermann B, Juckel G, Mavrogiorgou P. Relationships between fear of flying, loudness dependence of auditory evoked potentials and frontal alpha asymmetry. J Psychiatr Res 2023; 159:145-152. [PMID: 36724673 DOI: 10.1016/j.jpsychires.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/27/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
Previous research has suggested that fear of flying, which is defined as a situational, specific phobia, could overlap with depressive and anxiety disorders. Whether the neuronal dysfunctions including altered serotonergic activity in the brain and altered neural oscillations observed for depressive and anxiety disorders also overlap with alterations in fear of flying is unclear. Here, thirty-six participants with self-reported fear of flying (FF) and forty-one unaffected participants (NFF) were recruited. The participants completed the Beck Depression Inventory (BDI-II), the State-trait Anxiety Inventory (STAI) and the Fear of Flying Scale (FFS). EEG-recording was conducted during resting-state and during presentation of auditory stimuli with varying loudness levels for analysis of the Loudness Dependence of Auditory Evoked Potentials (LDAEP), which is suggested to be inversely related to central serotonergic activity. Participants with fear of flying did not differ from the control group with regard to BDI-II and STAI data. The LDAEP was higher over F4 electrode in the FF group compared to controls, whereas exploratory analysis suggest that differences between groups were conveyed by female participants. Moreover, the FF group showed relatively higher right frontal alpha activity compared to the control group, whereas no difference in frequency power (alpha, beta and theta) was observed. Thus, this study brought the first hint for reduced serotonergic activity in individuals with fear of flying and relatively higher right frontal activity. Thus, based on the preliminary findings, future research should aim to examine the boundaries with anxiety and depressive disorders and to clarify the distinct neural mechanisms.
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Affiliation(s)
- Vera Flasbeck
- Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
| | - Josefina Engelmann
- Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
| | - Bettina Klostermann
- Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
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Wright B, Tindall L, Scott AJ, Lee E, Cooper C, Biggs K, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Wilson J, Lovell K, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial. J Child Psychol Psychiatry 2023; 64:39-49. [PMID: 35915056 PMCID: PMC10087411 DOI: 10.1111/jcpp.13665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP. METHODS ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months. RESULTS 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT. CONCLUSIONS One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.
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Affiliation(s)
- Barry Wright
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | - Lucy Tindall
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | - Ellen Lee
- University of Sheffield, Sheffield, UK
| | | | | | - Penny Bee
- University of Manchester, Manchester, UK
| | | | | | - Emily Hayward
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | | | - Amy Barr
- University of Sheffield, Sheffield, UK
| | - Hannah Edwards
- Leeds and York Partnership NHS Foundation Trust, York, UK
| | | | | | | | - Catarina Teige
- Leeds and York Partnership NHS Foundation Trust, York, UK
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10
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Lor CS, Zhang M, Karner A, Steyrl D, Sladky R, Scharnowski F, Haugg A. Pre- and post-task resting-state differs in clinical populations. Neuroimage Clin 2023; 37:103345. [PMID: 36780835 PMCID: PMC9925974 DOI: 10.1016/j.nicl.2023.103345] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/30/2022] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
Resting-state functional connectivity has generated great hopes as a potential brain biomarker for improving prevention, diagnosis, and treatment in psychiatry. This neuroimaging protocol can routinely be performed by patients and does not depend on the specificities of a task. Thus, it seems ideal for big data approaches that require aggregating data across multiple studies and sites. However, technical variability, diverging data analysis approaches, and differences in data acquisition protocols introduce heterogeneity to the aggregated data. Besides these technical aspects, a prior task that changes the psychological state of participants might also contribute to heterogeneity. In healthy participants, studies have shown that behavioral tasks can influence resting-state measures, but such effects have not yet been reported in clinical populations. Here, we fill this knowledge gap by comparing resting-state functional connectivity before and after clinically relevant tasks in two clinical conditions, namely substance use disorders and phobias. The tasks consisted of viewing craving-inducing and spider anxiety provoking pictures that are frequently used in cue-reactivity studies and exposure therapy. We found distinct pre- vs post-task resting-state connectivity differences in each group, as well as decreased thalamo-cortical and increased intra-thalamic connectivity which might be associated with decreased vigilance in both groups. Our results confirm that resting-state measures can be strongly influenced by prior emotion-inducing tasks that need to be taken into account when pooling resting-state scans for clinical biomarker detection. This demands that resting-state datasets should include a complete description of the experimental design, especially when a task preceded data collection.
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Affiliation(s)
- Cindy Sumaly Lor
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Mengfan Zhang
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Alexander Karner
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Ronald Sladky
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Amelie Haugg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Neumünsterallee 9, 8032 Zürich, Switzerland
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Odgers K, Kershaw KA, Li SH, Graham BM. The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behav Res Ther 2022; 159:104203. [PMID: 36323055 DOI: 10.1016/j.brat.2022.104203] [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: 04/27/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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Affiliation(s)
- Katarzyna Odgers
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Kelly A Kershaw
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Sophie H Li
- Black Dog Institute, University Of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University Of New South Wales, Sydney, Australia.
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Husky MM, Bitfoi A, Chan-Chee C, Carta MG, Goelitz D, Koç C, Lesinskiene S, Mihova Z, Otten R, Shojaei T, Kovess-Masfety V. Self-reported fears and mental health in elementary school children across Europe. Eur Child Adolesc Psychiatry 2022; 31:1909-1919. [PMID: 34125282 DOI: 10.1007/s00787-021-01823-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/08/2021] [Indexed: 01/26/2023]
Abstract
Fears are common in the general population and particularly among children. The number of fear subtypes (animals, natural environment, situational, blood-injection-injury or other type) has been shown to be associated with psychopathology. Furthermore, there is evidence suggesting that some subtypes may be more often associated with mental disorders than others. The present study uses data from a large cross sectional survey, the School Children Mental Health in Europe (SCMHE) study, conducted in eight European countries on children ages 6 through 13-years-old attending elementary school (n = 9613). Fear subtypes and self-reported mental health were assessed using the Dominic Interactive (DI), a self-administered computerized image-based questionnaire. The findings show that the number of fear subtypes is strongly associated with self-reported internalizing and externalizing problems. In addition, adjusting for the number of subtypes, fear of animals was less likely than other fears to be associated with psychopathology. The findings support the notion that children who report excessive and generalized fear should be targeted for prevention, consistent with research identifying childhood onset generalized specific phobia as a probable precursor to subsequent psychopathology.
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Affiliation(s)
- Mathilde M Husky
- Laboratoire de Psychologie, EA4139, Université de Bordeaux, 3 ter, place de la Victoire, 33076, Bordeaux, France.
| | - Adina Bitfoi
- The Romanian League for Mental Health, Bucharest, Romania
| | | | - Mauro Giovanni Carta
- Centro Di Psichiatria Di Consulenza E Psicosomatica Azienda Ospedaliero, Universitaria Di Cagliari, Cagliari, Italy
| | - Dietmar Goelitz
- Department of Humanities, Social Sciences and Theology, Friedrich-Alexander-University, Erlangen-Nuernberg, Germany
| | - Ceren Koç
- Yeniden Health and Education Society, Istanbul, Turkey
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Roy Otten
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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Abstract
OBJECTIVE Mobile health applications for mental health are widely accessible but most have had limited research evaluation. Virtual reality exposure therapy is an emerging treatment for specific phobias. Most virtual reality studies have investigated high-end virtual reality devices, typically only available in research and limited clinical settings for a single phobia. This study evaluated the effectiveness of oVRcome, a mobile health application combining self-guided virtual reality exposure and cognitive behaviour therapy, for five specific phobias. METHODS This is a 2-arm 6-week randomised controlled trial, with a waitlist control group and follow-up at week 12. Participants were required to live in New Zealand; be aged 18-64 years; have a fear of flying, heights, spiders, dogs and needles; score above 4 on the Brief Standard Self-rating scale for phobic patients; and have access to a smartphone and Internet. oVRcome consists of six modules of psychoeducation, relaxation, mindfulness, cognitive techniques, exposure through virtual reality and relapse prevention over 6 weeks. The primary outcome was the change from baseline to week 6 on the Severity Measures for Specific Phobia - Adults. All analyses were performed on intention-to-treat set. RESULTS A total of 126 participants were randomised, and 109 completed the follow-up at week 6, for a retention rate of 86.5%. The mean change in Severity Measures for Specific Phobia - Adults score from baseline to week 6 was greater in the active group compared with the waitlist group (active group -20.53 [standard deviation = 8.24]; waitlist group: - 12.31 [standard deviation = 10.66]; p < 0.001). The effect size for this difference was 0.86. CONCLUSION Self-guided use of the oVRcome app was effective at reducing severity of specific phobia symptoms in a sample of people with a self-reported fear of flying, heights, spiders, dogs or needles.Trial registry clinicaltrials.gov NCT04909177.
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Affiliation(s)
- Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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14
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Wittfoth D, Beise J, Manuel J, Bohne M, Wittfoth M. Bifocal emotion regulation through acupoint tapping in fear of flying. Neuroimage Clin 2022; 34:102996. [PMID: 35378497 PMCID: PMC8980501 DOI: 10.1016/j.nicl.2022.102996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
Bifocal emotion regulation successfully mitigates aversive reactions to phobic stimuli. Acupoint tapping increases amygdala activation and decreases hippocampus activation. Responses to phobia and fear differ during picture viewing but not acupoint tapping. A one-time bifocal-multisensory intervention decreases measures of fear of flying. Fewer individuals meet the criteria for fear of flying after the intervention.
Very few studies have investigated the neural underpinnings of bifocal-multisensory interventions such as acupoint tapping (tapping) despite their well-documented efficacy. The present study aims to investigate the neural and behavioral responses to tapping during the perception of phobic and generally fear-inducing stimulation in a group of participants with fear of flying. We studied 29 flight-phobic participants who were exposed to phobia-related, fear-inducing and neutral stimulation while undergoing fMRI and a bifocal-multisensory intervention session consisting of tapping plus cognitive restructuring in a within-subject design. During tapping we found an up-regulation of neural activation in the amygdala, and a down-regulation in the hippocampus and temporal pole. These effects were different from automatic emotion regulatory processes which entailed down-regulation in the amygdala, hippocampus, and temporal pole. Mean scores (±SD) on the Fear of Flying scale dropped from 2.51(±0.65) before the intervention to 1.27(±0.68) after the intervention (p <.001). The proportion of participants meeting the criteria for fear of flying also dropped from 89.7 percent before the intervention to 24.0 percent after the intervention (p <.001). Taken together, our results lend support to the effectiveness of tapping as a means of emotion regulation across multiple contexts and add to previous findings of increased amygdala activation during tapping, as opposed to amygdala down-regulation found in other emotion regulation techniques. They expand on previous knowledge by suggesting that tapping might modulate the processing of complex visual scene representations and their binding with visceral emotional reponses, reflected by the down-regulation of activation in the hippocampus and temporal pole. Bifocal emotion regulation was useful in ameliorating aversive reactions to phobic stimuli in people with fear of flying.
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Affiliation(s)
- Dina Wittfoth
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Jelena Beise
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jorge Manuel
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany; Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Michael Bohne
- Fortbildungsinstitut für PEP, Tiedgestrasse 5, Hannover, Germany
| | - Matthias Wittfoth
- Institut für Diagnostische und Interventionelle Neuroradiologie, Medizinische Hochschule Hannover, Hannover, Germany
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15
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Roesmann K, Toelle J, Leehr EJ, Wessing I, Böhnlein J, Seeger F, Schwarzmeier H, Siminski N, Herrmann MJ, Dannlowski U, Lueken U, Klucken T, Straube T, Junghöfer M. Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia - Evidence from magnetoencephalography. Neuroimage Clin 2022; 35:103046. [PMID: 35609411 PMCID: PMC9125677 DOI: 10.1016/j.nicl.2022.103046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022]
Abstract
Magnetoencephalographic effects of fear conditioning predict exposure outcomes. No associations between fear ratings of conditioned stimuli and exposure outcomes. Prefrontal correlates of safety processing and/or fear inhibition are treatment-relevant. Individual neural differences might be a promising predictor of exposure success.
Background Models of anxiety disorders and the rationale of exposure therapy (ET) are grounded on classical fear conditioning. Yet, it is unclear whether lower fear ratings of conditioned safety versus threat cues and corresponding neural markers of safety-learning and/or fear inhibition assessed before treatment would predict better outcomes of behavioral exposure. Methods Sixty-six patients with spider phobia completed pre-treatment clinical and experimental fear conditioning assessments, one session of virtual reality ET, a post-treatment clinical assessment, and a 6-month follow-up assessment. Tilted Gabor gratings served as conditioned stimuli (CS) that were either paired (CS+) or remained unpaired (CS-) with an aversive phobia-related and phobia-unrelated unconditioned stimulus (UCS). CS+/CS- differences in fear ratings and magnetoencephalographic event-related fields (ERFs) were related to percentual symptom reductions from pre- to post-treatment, as assessed via spider phobia questionnaire (SPQ), behavioral avoidance test (BAT), and remission status at 6-month follow-up. Results We observed no associations between pre-treatment CS+/CS- differences in fear ratings and any treatment outcome. CS+/CS- differences in source estimations of ERFs revealed that higher CS- activity in bilateral dorsolateral prefrontal cortex (dlPFC) was related with SPQ- and BAT-reductions. Associations between CS+/CS- differences and treatment outcomes were also observed in left ventromedial prefrontal cortex (vmPFC) regions, which additionally revealed associations with the follow-up remission status. Conclusions Results provide initial evidence that neural pre-treatment CS+/CS- differences may hold predictive information regarding outcomes of behavioral exposure. Our findings highlight a key role of neural responses to safety cues with potentially inhibitory effects on affect-generating structures during fear conditioning.
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Affiliation(s)
- Kati Roesmann
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany.
| | - Julius Toelle
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
| | | | - Ida Wessing
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Department of Child and Adolescent Psychiatry, University of Münster, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Fabian Seeger
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany; Department of General Psychiatry, University of Heidelberg, Germany
| | - Hanna Schwarzmeier
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Niklas Siminski
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Tim Klucken
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
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16
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Müller UWD, Gerdes ABM, Alpers GW. You see what you avoid: Fear of spiders and avoidance are associated with predominance of spiders in binocular rivalry. J Anxiety Disord 2022; 86:102513. [PMID: 34942504 DOI: 10.1016/j.janxdis.2021.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
What we see is the result of an efficient selection of cues in the visual stream. In addition to physical characteristics this process is also influenced by emotional salience of the cues. Previously, we showed in spider phobic patients that fear-related pictures gain preferential access to consciousness in binocular rivalry. We set out to replicate this in an independent unselected sample and examine the relationship of this perceptual bias with a range of symptom clusters. To this end, we recruited 79 participants with variable degrees of fear of spiders. To induce binocular rivalry, a picture of either a spider or a flower was projected to one eye, and a neutral geometric pattern to the other eye. Participants continuously reported what they saw. We correlated indices of perceptual dominance (first percept, dominance duration) with individual fear of spiders and with scores on specific symptom clusters of fear of spiders (i.e., vigilance, fixation, and avoidance coping). Overall, higher fear of spiders correlates with more predominace of spider pictures. In addition, this perceptual bias is uniquely associated with avoidance coping. Interestingly, this demonstrates that a perceptual bias, which is not intentionally controlled, is linked with an instrumental coping behavior, that has been implicated in the maintenance of pathological fear.
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17
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Siegel P, Cohen B, Warren R. Nothing to Fear but Fear Itself: A Mechanistic Test of Unconscious Exposure. Biol Psychiatry 2022; 91:294-302. [PMID: 34763847 DOI: 10.1016/j.biopsych.2021.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND While effective, exposure therapy can be distressing, which creates problems with treatment acceptance. Can exposure be effectively delivered unconsciously-and thus without causing phobic people to experience distress? No study has tested this hypothesis in a sufficiently rigorous experiment that selected between mechanisms for reducing fear unconsciously. METHODS We conducted a psychophysiological experiment of an unconscious exposure intervention to discern its mechanism of therapeutic action. We identified 98 highly spider-phobic participants with a validated fear questionnaire and a Behavioral Avoidance Test in which they gradually approached and exhibited impairment of a live tarantula, which was indicative of a DSM-5 diagnosis of specific phobia. These participants were randomized to viewing unconscious exposure to spiders, visible exposure to spiders, or unconscious exposure to flowers (control). In a novel psychophysiological design, concurrent changes in sympathetic arousal and subjective fear were monitored throughout exposure. Shortly thereafter, phobic participants approached the tarantula again in order to measure exposure-induced changes in real-life avoidance behavior and experienced fear. RESULTS Unconscious exposure did not induce concurrent changes in sympathetic arousal or subjective fear, and subsequently reduced fear of the tarantula. Visible exposure to the same phobic stimuli, by contrast, induced significant arousal and fear, but did not affect fear of the tarantula. Levels of arousal during exposure moderated effects on fear of the tarantula: lower arousal during unconscious exposure, but not during conscious exposure, predicted greater fear reduction. CONCLUSIONS Unconscious exposure reduces fear by generating new implicit learning of nonaversive, stimulus-response associations that facilitate fear extinction in phobic persons.
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18
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Weiss A, Canetti L, David SB, Reuveni I, Ekstein D. Seizure phobia: A distinct psychiatric disorder among people with epilepsy. Seizure 2021; 95:26-32. [PMID: 34974230 DOI: 10.1016/j.seizure.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Epilepsy is characterized by unpredictable attacks. Hence, people with epilepsy (PWE) may develop anxious anticipation of upcoming seizures. Seizure phobia is an anxiety disorder wherein seizure anticipatory situations trigger fear, accompanied by avoidance behaviors. Research on seizure phobia among PWE is scarce. Therefore, we aimed to describe the diagnosis of seizure phobia and its association with demographic, psychiatric and neurological variables. METHODS This is a cross-sectional study of adult PWE in a tertiary epilepsy outpatient clinic. Data were collected from semi-structured interviews, demographic questionnaires and medical records. Patients with and without seizure phobia were compared in terms of sociodemographic, psychiatric, and neurological variables. A logistic regression analysis was performed to identify variables that predicted seizure phobia. RESULTS Among 69 PWE included in the study, 19 (27.5%) were diagnosed with seizure phobia. In comparison with PWE without seizure phobia, PWE with seizure phobia were predominantly female (84.2% vs 44.2%, p = 0.005), and had more comorbid anxiety disorders (84.2% vs 34.9%, p = 0.01), past major depressive episode (MDE) (63.2% vs 20.9%, p = 0.003), and post-traumatic stress disorder (26.3% vs 7%, p = 0.05). There was a significant association between seizure phobia and comorbid psychogenic non-epileptic seizures (36.8% vs 11.6%, p = 0.034). However, no significant association was found with epilepsy-related variables. A multivariate logistic regression model indicated anxiety and a past MDE as predictive factors for seizure phobia (R2 = 0.43). CONCLUSION Seizure phobia is a distinct psychiatric entity among PWE. Further research is required to understand its etiology, risk factors, and potential interventions for these patients.
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Affiliation(s)
- Aviva Weiss
- Psychiatric Hostels affiliated with Kidum Rehabilitation Projects, Jerusalem, Israel; Alma Center for Treatment of Sexually Abused Patients, Jerusalem, Israel
| | - Laura Canetti
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel; Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shiri Ben David
- Neuropsychiatry Clinic, Hadassah Medical Center, Jerusalem, Israel; Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dana Ekstein
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Neurology, Ginges Center for Neurogenetics, Hadassah Medical Center, Jerusalem, Israel.
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Leehr EJ, Roesmann K, Böhnlein J, Dannlowski U, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Lueken U, Hilbert K. Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach. J Anxiety Disord 2021; 83:102448. [PMID: 34298236 DOI: 10.1016/j.janxdis.2021.102448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/07/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP). N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation. Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.
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Mor S, Grimaldos J, Tur C, Miguel C, Cuijpers P, Botella C, Quero S. Internet- and mobile-based interventions for the treatment of specific phobia: A systematic review and preliminary meta-analysis. Internet Interv 2021; 26:100462. [PMID: 34646752 PMCID: PMC8501502 DOI: 10.1016/j.invent.2021.100462] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022] Open
Abstract
Internet- and mobile-based interventions (IMIs) are being developed for a wide range of psychological disorders and they showed their effectiveness in multiple studies. Specific phobia (SP) is one of the most common anxiety disorders, and research about IMIs for their treatment has also been conducted in recent years. The aim of this paper was to conduct a systematic review and preliminary meta-analysis exploring IMIs for the treatment of SP. A comprehensive search conducted in five different databases identified 9 studies (4 pre-post studies, 5 randomized controlled trials) with 7 Internet-based interventions and 2 mobile-based interventions. Results showed that exposure was the main component of all interventions, and that animal phobia was the most common subtype. Samples included children, adolescents, and adults. A preliminary meta-analysis of the included studies showed that participants receiving IMIs experienced a significant reduction of SP symptoms from pre- to post-treatment (g = 1.15). This systematic review found that there is already some evidence in the literature supporting the potential benefits of IMIs for SP. However, the number of studies included is small and more research should be carried out in the field.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Jorge Grimaldos
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, (Spain).
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Zimmer A, Wang N, Ibach MK, Fehlmann B, Schicktanz NS, Bentz D, Michael T, Papassotiropoulos A, de Quervain DJF. Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial. J Anxiety Disord 2021; 82:102442. [PMID: 34246153 DOI: 10.1016/j.janxdis.2021.102442] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/25/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet. We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up. Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen's d = 0.57, p = 0.010). The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.
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de Vries YA, Harris MG, Vigo D, Chiu WT, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Benjet C, Bruffaerts R, Bunting B, de Almeida JMC, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Moskalewicz J, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Scott K, Torres Y, Zarkov Z, Nierenberg A, Kessler RC, de Jonge P. Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys. J Affect Disord 2021; 288:199-209. [PMID: 33940429 PMCID: PMC8154701 DOI: 10.1016/j.jad.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiatrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Región de Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia (Cundinamarca University, calle 28 # 5B 02, Bogotá, 11001000 (zip), Colombia)
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Andrew Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, NL
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Mahmud MS, Rahman MM, Masud-Ul-Hasan M, Islam MA. Does 'COVID-19 phobia' stimulate career anxiety?: Experience from a developing country. Heliyon 2021; 7:e06346. [PMID: 33869821 DOI: 10.1016/j.heliyon.2021.e06346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
Due to the outbreak of COVID-19 different forms of anxiety disorder have been seen in the mindset of people all around the world. This study aims to examine a structural relationship between ‘COVID-19 phobia’ and career anxiety among the workforce from the perspective of a developing country. This study collected survey data using a structured questionnaire by applying the scales of ‘COVID-19 Phobia’ and career anxiety. Study results reveal that the factors of the ‘COVID-19 phobia’ have a substantial influence on generating career-related anxiety among the workforce. Study results can play a vital role for the policymakers to formulate long-term policies to retrieve the world's economy. This study combined the concept of specific phobia and general anxiety disorder (GAD) to figure out how the global pandemic impacted peoples' mindsets and create career anxiety. The study results have theoretical and practical implications in many folds.
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Ozaki A, Matsubara H, Sugimoto M, Kuze M, Kondo M, Shiroyama T. Efficacy of Psychiatric Treatment to Treat a Specific Phobia of Intravitreal Injections in a Patient with Neovascular Age-Related Macular Degeneration. Case Rep Ophthalmol 2021; 12:48-56. [PMID: 33613250 PMCID: PMC7879321 DOI: 10.1159/000510330] [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] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is essential for the treatment of macular diseases such as wet age-related macular degeneration and macular edema. Although continued treatment is needed to maintain good vision, some patients cannot continue such injections for various reasons, including specific phobias. Here, we report a case of a patient with a specific phobia of intravitreal injections who could resume treatment after undergoing combined drug and cognitive-behavioral therapy (CBT). A 74-year-old Japanese man diagnosed with retinal angiomatous proliferation by fluorescein angiography and indocyanine green angiography was treated with intravitreal anti-VEGF injection. However, at 8 months after the first treatment, he became difficult to treat because of a phobia of injections. He was treated with photodynamic therapy, but his macular edema did not improve. After a psychiatric consultation, he was diagnosed with a specific phobia of intravitreal injections. Combined drug and CBT enabled him to resume receiving intravitreal injections. This case demonstrates that a specific phobia of intravitreal injections may benefit from combined drug and CBT. In this regard, some patients with high anxiety and fear of intravitreal injections should be referred to a psychiatrist at an early stage.
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Affiliation(s)
- Atsuta Ozaki
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Manami Kuze
- Department of Ophthalmology, Matsusakachuo General Hospital, Matsusaka, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takashi Shiroyama
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu, Japan
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Williams ZJ, He JL, Cascio CJ, Woynaroski TG. A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neurosci Biobehav Rev 2021; 121:1-17. [PMID: 33285160 PMCID: PMC7855558 DOI: 10.1016/j.neubiorev.2020.11.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 221 Eskind Biomedical Library and Learning Center, 2209 Garland Ave., Nashville, TN, 37240, United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States.
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Strand Building, Strand Campus, Strand, London, WC2R 2LS, London, United Kingdom.
| | - Carissa J Cascio
- Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 2254 Village at Vanderbilt, 1500 21st Ave South, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
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26
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Jimenez DA, Bond RL, Requena-Komuro MC, Sivasathiaseelan H, Marshall CR, Russell LL, Greaves C, Moore KM, Woollacott IO, Shafei R, Hardy CJ, Rohrer JD, Warren JD. Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis. Cortex 2020; 130:100-110. [PMID: 32650059 PMCID: PMC7447974 DOI: 10.1016/j.cortex.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Abnormal behavioural and physiological reactivity to emotional stimuli is a hallmark of frontotemporal dementia (FTD), particularly the behavioural variant (bvFTD). As part of this repertoire, altered phobic responses have been reported in some patients with FTD but are poorly characterised. METHODS We collected data (based on caregiver reports) concerning the prevalence and nature of any behavioural changes related to specific phobias in a cohort of patients representing canonical syndromes of FTD and Alzheimer's disease (AD), relative to healthy older controls. Neuroanatomical correlates of altered phobic reactivity were assessed using voxel-based morphometry. RESULTS 46 patients with bvFTD, 20 with semantic variant primary progressive aphasia, 25 with non-fluent variant primary progressive aphasia, 29 with AD and 55 healthy age-matched individuals participated. Changes in specific phobia were significantly more prevalent in the combined FTD cohort (15.4% of cases) and in the bvFTD group (17.4%) compared both to healthy controls (3.6%) and patients with AD (3.5%). Attenuation of phobic reactivity was reported for individuals in all participant groups, however new phobias developed only in the FTD cohort. Altered phobic reactivity was significantly associated with relative preservation of grey matter in left posterior middle temporal gyrus, right temporo-occipital junction and right anterior cingulate gyrus, brain regions previously implicated in contextual decoding, salience processing and reward valuation. CONCLUSION Altered phobic reactivity is a relatively common issue in patients with FTD, particularly bvFTD. This novel paradigm of strong fear experience has broad implications: clinically, for diagnosis and patient well-being; and neurobiologically, for our understanding of the pathophysiology of aversive sensory signal processing in FTD and the neural mechanisms of fear more generally.
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Affiliation(s)
- Daniel A Jimenez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurological Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rebecca L Bond
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mai-Carmen Requena-Komuro
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Harri Sivasathiaseelan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Charles R Marshall
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Caroline Greaves
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Katrina M Moore
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ione Oc Woollacott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rachelle Shafei
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Chris Jd Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Kappelmann N, Suesse M, Steudte-Schmiedgen S, Kaldewaij R, Browning M, Michael T, Rinck M, Reinecke A. D-cycloserine as adjunct to brief computerised CBT for spider fear: Effects on fear, behaviour, and cognitive biases. J Behav Ther Exp Psychiatry 2020; 68:101546. [PMID: 31951819 DOI: 10.1016/j.jbtep.2019.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES In anxiety disorders, cognitive behavioural therapy (CBT) improves information-processing biases such as implicit fear evaluations and avoidance tendencies, which predicts treatment response. Thus, these cognitive biases might constitute important treatment targets. This study investigated (i) whether information-processing biases could be changed following single-session computerised CBT for spider fear, and (ii) whether this effect could be augmented by administration of D-cycloserine (DCS). METHODS Spider-fearful individuals were randomized to receiving either 250 mg of DCS (n = 21) or placebo (n = 17). Three hours after drug administration, they received single-session computerized CBT, characterized by psychoeducation and exposure elements. Spider fear was assessed using self-report, behavioural, and information processing (Extrinsic Affective Simon Task & Approach Avoidance Task) measures at baseline (before drug administration), post-treatment, 1-day, and 1-month follow-up. RESULTS Linear mixed-effects analyses indicated significant improvements on self-report and behavioural spider fear indices following CBT, but not on cognitive bias measures. There was no evidence of an augmentation effect of DCS on any outcome. Cognitive bias measures at 1-day were not predictive of 1-month follow-up spider fear in adjusted linear regression analyses. LIMITATIONS Results might be biased by limited representativeness of the sample (high education and intelligence, largely Caucasian ethnicity, young age). The study was also only powered for detection of medium-sized DCS effects. CONCLUSIONS These findings do not provide evidence for information-processing biases relating to treatment outcome following computerised CBT for spider fear or augmentation with DCS.
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Affiliation(s)
- Nils Kappelmann
- Department of Psychiatry, University of Oxford, Oxford, UK; Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Mareike Suesse
- Oxford Institute of Clinical Psychology Doctorate Training, University of Oxford, Oxford, UK
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Reinoud Kaldewaij
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust, Oxford, UK
| | - Tanja Michael
- Department of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Ollendick T, Muskett A, Radtke SR, Smith I. Adaptation of One-Session Treatment for Specific Phobias for Children with Autism Spectrum Disorder Using a Non-concurrent Multiple Baseline Design: A Preliminary Investigation. J Autism Dev Disord 2021; 51:1015-27. [PMID: 32613485 DOI: 10.1007/s10803-020-04582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anxiety disorders are among the most common co-occurring disorders for individuals with ASD. Several adaptations to cognitive behavioral approaches have been proposed for this population (Moree & Davis, 2010). The current study examined feasibility and preliminary efficacy of an ASD-specific adaptation of one-session treatment (OST) for specific phobia (SP). Standard OST consists of one 3-h session followed by four weekly phone calls. Modifications for ASD included increased parental involvement, use of visual aids, and inclusion of four 1-h booster sessions in place of the four weekly phone calls. Visual inspection and Friedman tests revealed significant reductions in fear ratings and phobia severity from pre- to post-treatment and follow-up assessments. Modest changes were observed in behavioral avoidance. These findings provide initial evidence that this treatment merits further study.
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Coelho CM, Gonçalves-Bradley D, Zsido AN. Who worries about specific phobias? - A population-based study of risk factors. J Psychiatr Res 2020; 126:67-72. [PMID: 32417598 DOI: 10.1016/j.jpsychires.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/23/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
Although specific phobia is one of the most prevalent lifetime anxiety disorders, little is known about the particular risk factors related to its development. The underlying goal of this study was to analyse the risk factors associated with worrying about specific phobias (SP) in a representative sample of community dwelling adults. The sample was composed of 8461 participants (mean age 47.68 years, range 18-85, 54.60% female), from the Australian National Mental Health Survey. A total of 188 participants (2.22%) reported worrying about SPs. Multivariate logistic regression analysis indicated that female sex (odds ratio (OR) = 1.98, p < 0.0001) and a comorbid diagnosis of lifetime major depression disorder (OR = 2.80, p < 0.0001) were the factors most strongly associated with worrying about SPs. Having experienced traumatic experiences involving significant others (OR = 1.18, p = 0.02), the number of chronic diseases (OR = 1.21, p < 0.01), and a comorbid diagnosis of substance use (OR = 2.80, p = 0.02) were also associated. Our results are in line with previous studies focusing on other anxiety disorders. We provide further evidence that substance dependence appears to serve as a unique risk factor for the subsequent onset of SP. Further empirical and clinical implications are discussed.
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Affiliation(s)
- Carlos M Coelho
- School of Psychology, ISMAI University Institute of Maia, Portugal; School of Health of Porto Polytechnic, Psychosocial Rehabilitation Lab, Center for Rehabilitation Research, Porto, Portugal; Department of Psychology, Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
| | | | - Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
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Kothgassner OD, Felnhofer A. Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents : A systematic review. Neuropsychiatr 2021; 35:68-75. [PMID: 32372291 DOI: 10.1007/s40211-020-00349-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Abstract
Anxiety disorders are one of the most prevalent mental disorders in children and adolescents which may effectively be treated by several forms of exposure therapy. An emerging approach to exposure is virtual reality exposure therapy (VRET), but a literature search synthesis focusing specifically on the use of VRET in children and adolescents is still lacking. This systematic review sets out to provide an overview concerning VRET for the treatment of anxiety disorders in this age group. Four published trials covering an overall sample of 100 participants between the ages of 8 and 16 years were found during a systematic literature search and were included in the current review. Results reveal that participants show clinical improvements regarding anxiety symptoms after VRET. Nevertheless, the high potential of virtual reality as a tool for treating children and adolescents with anxiety disorders is contrasted by a considerable lack of controlled trials. Despite the evidence of VRET in adult samples, there is a need for more research with younger cohorts in order to be able to support this promising field of application.
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Abstract
Specific phobia is highly prevalent worldwide. Although the body of intervention studies is expanding, there is a lack of reviews that summarise recent progress and discuss the challenges and direction of research in this area. Hence, this rapid review seeks to systematically evaluate the available evidence in the last five years in the treatment of specific phobias in adults. Studies published between January 2014 to December 2019 were identified through searches on the electronic databases of Medline and PsychINFO. In total, 33 studies were included. Evidence indicates that psychotherapy, and in particular cognitive behaviour therapy, when implemented independently or as an adjunctive, is a superior intervention with large effect sizes. Technology-assisted therapies seem to have a beneficial effect on alleviating fears and are described to be more tolerable than
in vivo exposure therapy. Pharmacological agents are investigated solely as adjuncts to exposure therapy, but the effects are inconsistent; propranolol and glucocorticoid may be promising. A handful of cognitive-based therapies designed to alter fear arousal and activation pathways of phobias have presented preliminary, positive outcomes. Challenges remain with the inherent heterogeneity of specific phobia as a disorder and the accompanying variability in outcome measures and intervention approaches to warrant a clear conclusion on efficacy.
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Affiliation(s)
- Christabel E W Thng
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Nikki S J Lim-Ashworth
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Brian Z Q Poh
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
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32
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Bou Khalil R, Bou-Orm IR, Tabet Y, Souaiby L, Azouri H. Disgust and fear: common emotions between eating and phobic disorders. Eat Weight Disord 2020; 25:79-86. [PMID: 29766462 DOI: 10.1007/s40519-018-0512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022] Open
Abstract
Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
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Abstract
Oxytocin, a neuropeptide synthesized by the hypothalamus, plays a central role in human social behavior, social cognition, anxiety, mood, stress modulation, and fear learning and extinction. The relationships between oxytocin and psychiatric disorders including depression, anxiety, schizophrenia, and autism spectrum disorder have been extensively studied. In this chapter, we focus on the current knowledge about oxytocin and anxiety disorder. We discuss the anxiolytic effects of oxytocin in preclinical and clinical findings, possible related neurobehavioral mechanisms (social cognition, fear learning, and extinction), related neurotransmitter and neuroendocrine systems (hypothalamus-pituitary-adrenal axis, serotoninergic, and GABAergic systems), and studies regarding plasma levels of oxytocin, genetic and epigenetic findings, and effects of intranasal oxytocin in DSM-5 anxiety disorder (primarily social anxiety disorder and separation anxiety disorder) patients.
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Raeder F, Heidemann F, Schedlowski M, Margraf J, Zlomuzica A. No pills, more skills: The adverse effect of hormonal contraceptive use on exposure therapy benefit. J Psychiatr Res 2019; 119:95-101. [PMID: 31590077 DOI: 10.1016/j.jpsychires.2019.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/24/2022]
Abstract
Hormonal contraceptive use can aggravate existing symptoms of anxiety and depression and influence the response to pharmacologic treatment. The impact of hormonal contraceptive use on non-pharmacological treatment efficacy in anxiety disorders is less well explored. Oral contraceptives, which suppress endogenous sex hormone secretion, can alter fear extinction learning. Fear extinction is considered the laboratory proxy of exposure therapy in anxiety disorders. This study set out to examine whether oral contraceptive use is related to exposure-based treatment response in specific phobia. We recruited spider-phobic women (n = 28) using oral contraceptives (OC) and free-cycling women (n =26, No-OC). All participants were subjected to an identical in-vivo exposure. Exposure-based symptom improvement was assessed with several behavioral and subjective indices at pre-treatment, post-treatment and six-weeks follow-up. No-OC women showed higher pre-exposure fear levels on the FSQ and SPQ. OC women showed slightly less pronounced exposure benefit compared to their free-cycling counterparts (No-OC woman) as reflected by lower levels of fear reduction from pre-treatment to follow-up on the subjective level. After correction for multiple testing, OC and No-OC women showed differences in self-report measures (SPQ, FAS and SBQ) from pre- to follow-up treatment but not from pre-to post-treatment. These findings implicate that oral contraceptive use can account for differential exposure-based fear symptom improvement. Our study highlights the importance of monitoring and managing hormonal contraceptives use in the context of non-pharmacological exposure-based interventions.
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Nath S, Busuulwa P, Ryan EG, Challacombe FL, Howard LM. The characteristics and prevalence of phobias in pregnancy. Midwifery 2020; 82:102590. [PMID: 31864080 DOI: 10.1016/j.midw.2019.102590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 10/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The primary objective was to estimate the population prevalence of specific phobias (including pregnancy related specific phobias) and associated mental disorders. The secondary objective was to investigate the effectiveness of routinely collected screening tools (depression and anxiety screens, Whooley and GAD-2 respectively) in identifying specific phobias. Specific phobias are the most common anxiety disorder to occur during pregnancy, but studies on prevalence and clinical correlates of specific phobias, including pregnancy related specific phobias are lacking. DESIGN Cross-sectional survey using a two-phase sampling design stratified according to being positive or negative on the Whooley questions routinely asked by midwives. Approaching all whooley positive women and drawing a random sample of Whooley negative women. Sampling weights were used to account for the bias induced by the stratified sampling. PARTICIPANTS 545 pregnant women attending their first antenatal appointment. Language interpreters were used where required. SETTING Inner-city maternity service, London, UK. MEASUREMENTS The Structured Clinical Interview for DSM-IV Axis I Mental Disorders were administered to assess mental disorders and 544 women responded to the anxiety module on specific phobias. RESULTS The maternity population prevalence estimate for specific phobias was 8.4% (95%CI: 5.8-12.1%) and for pregnancy related phobias was 1.5% (95%CI: 0.6-3.7%), most of which were needle phobias. The prevalence estimate of tokophobia was 0.032% (95%CI: 0.0044-0.23%). Over half (52.4%) the women with specific phobias had comorbid mental disorders. Routinely administered screening tools (Whooley and GAD-2) were not helpful in identifying phobias. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Phobias in pregnancy are common but pregnancy related phobias are rare, particularly tokophobia. As routinely administered screening tools were not helpful in identifying phobias, other indicators could be considered, such as avoidance of blood tests and requests for caesarean sections.
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Papalini S, Lange I, Bakker J, Michielse S, Marcelis M, Wichers M, Vervliet B, van Os J, Van Amelsvoort T, Goossens L, Schruers K. The predictive value of neural reward processing on exposure therapy outcome: Results from a randomized controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:339-346. [PMID: 30763673 DOI: 10.1016/j.pnpbp.2019.02.002] [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] [Received: 10/14/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exposure is the gold standard treatment for phobic anxiety and is thought to represent the clinical application of extinction learning. Reward sensitivity might however also represent a predictive factor for exposure therapy outcome, as this therapy promotes positive experiences and involves positive comments by the therapist. We hypothesized that high reward sensitivity, as expressed by elevated reward expectancy and reward value, can be associated with better outcome to exposure therapy specifically. METHODS Forty-four participants with a specific phobia for spiders were included in the current study. Participants were randomly assigned to exposure therapy (n = 25) or progressive muscle relaxation (PMR) (n = 19). Treatment outcome was defined as pre- versus post-therapy phobia symptoms. Before treatment, functional brain responses and behavioral responses (i.e. reaction time and accuracy) during reward anticipation and consumption were assessed with the Monetary Incentive Delay task (MID). Behavioral and neural responses in regions of interest (i.e. nucleus accumbens, ventromedial prefrontal cortex and the ventral tegmental area) as well as across the whole-brain were subsequently regressed on treatment outcomes. RESULTS Exposure therapy was more effective in reducing phobia symptoms than PMR. Longer reaction times to reward cues and lower activation in the left posterior cingulate cortex during reward consumption were selectively associated with symptoms reductions following exposure therapy but not following PMR. Only within the exposure therapy group, greater symptom reduction was related to increased activation in the ventrolateral prefrontal cortex during reward anticipation, and decreased activation in the medial prefrontal cortex during reward consumption. CONCLUSION Results indicate that individual differences in reward sensitivity can specifically predict exposure therapy outcome. Although activation in regions of interest were not related to therapy outcome, regions involved in attentional processing of reward cues were predictive of phobic symptom change following exposure therapy but not PMR.
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Affiliation(s)
- Silvia Papalini
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
| | - Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jindra Bakker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Vervliet
- Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Therese Van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
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de Vries YA, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Cia AH, De Girolamo G, Dinolova RV, Esan O, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Karam A, Kawakami N, Kiejna A, Kovess-Masfety V, Lee S, Mneimneh Z, Navarro-Mateu F, Piazza M, Scott K, ten Have M, Torres Y, Viana MC, Kessler RC, de Jonge P. Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys. BMC Med 2019; 17:101. [PMID: 31122269 PMCID: PMC6533738 DOI: 10.1186/s12916-019-1328-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Specific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders. METHODS We conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (< 13 years) SP. RESULTS Among 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR = 2.4, 95% CI 2.3-2.5, p < 0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR = 1.4, 95% CI 1.4-1.5, p < 0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5 days out of role in the past month) than those without childhood SP (1.1 days) or with only 1 subtype (1.8 days) (B = 0.56, SE 0.06, p < 0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR = 1.7, 95% CI 1.7-1.8, p < 0.001). CONCLUSIONS This large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
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Affiliation(s)
- Ymkje Anna de Vries
- Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | | | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo H. Cia
- Anxiety Clinic and Research Center, Buenos Aires, Argentina
| | | | | | - Oluyomi Esan
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Aimee Karam
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Andrzej Kiejna
- Wroclaw Medical University, Wrocław, Poland
- University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, Murcia, Spain
- Centro de Investigación Biomédica en ERed en Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
| | - Marina Piazza
- Instituto Nacional de Salud, Lima, Peru
- Universidad Cayetano Heredia, Lima, Peru
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Margreet ten Have
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Peter de Jonge
- Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Lange I, Goossens L, Bakker J, Michielse S, Marcelis M, Wichers M, van Os J, van Amelsvoort T, Schruers K. Functional neuroimaging of associative learning and generalization in specific phobia. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:275-285. [PMID: 30266438 DOI: 10.1016/j.pnpbp.2018.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Theoretical models have implicated classical fear conditioning, fear generalization, and extinction learning in the development of anxiety disorders. To date, it is largely unknown to what extent these mechanisms and the underlying neurobiology may be altered in specific phobia, a disorder characterized by focal fears. The current study systematically examined fear conditioning, fear generalization, extinction learning, and extinction recall in a sample of individuals with a specific phobia. METHODS Participants with a specific phobia (SP) of spiders (n = 46) and healthy controls (HC) (n = 48) underwent a 3-day fMRI cue-conditioning protocol, including a fear acquisition and a fear generalization phase (day 1), an extinction learning phase (day 2), and an extinction recall phase (day 3). Stimuli were phobia-irrelevant, as geometrical shapes served as conditioned threat (CS+) and safety stimuli (CS-), and an electrical shock as the unconditioned stimulus (US). Self-reported fear, US expectancy, and blood-oxygen-level dependent responses were measured. RESULTS Behavioral results only revealed enhanced CS+/CS-differentiation in fear scores during acquisition retention in SP. Some neural differences were observed during other task phases. During early fear acquisition, SP showed enhanced differential activation in the angular gyrus and lateral occipital cortex, and during extinction recall, more precuneus deactivation was found in SP compared to HC. There were no clear indications of altered neural fear generalization or extinction learning mechanisms in the SP group. CONCLUSIONS Results indicate that spider phobia may be characterized by enhanced differential fear retention and altered brain activation patterns during fear acquisition and extinction recall. The findings provide insight into the nature of fear learning alterations in specific phobia, and how these may differ from those found in disorders characterized by broad anxious distress.
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Affiliation(s)
- Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jindra Bakker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, England, United Kingdom; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Psychology, Center for Experimental and Learning Psychology, KU Leuven, Leuven, Belgium
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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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Halonen H, Nissinen J, Lehtiniemi H, Salo T, Riipinen P, Miettunen J. The Association Between Dental Anxiety And Psychiatric Disorders And Symptoms: A Systematic Review. Clin Pract Epidemiol Ment Health 2018; 14:207-222. [PMID: 30288171 PMCID: PMC6142663 DOI: 10.2174/1745017901814010207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/04/2018] [Revised: 07/20/2018] [Accepted: 08/19/2018] [Indexed: 12/19/2022]
Abstract
Background A growing amount of evidence suggests that dental anxiety is associated with other psychiatric disorders and symptoms. A systematic review was conducted to critically evaluate the studies of comorbidity of dental anxiety with other specific phobias and other Axis I psychiatric disorders. Objective The aim of the review was to explore how dental anxiety is associated with other psychiatric disorders and to estimate the level of comorbid symptoms in dental anxiety patients. Methods The review was conducted and reported in accordance with the MOOSE statement. Data sources included PubMed, PsycInfo, Web of Science and Scopus. Results The search produced 631 hits, of which 16 unique records fulfilled the inclusion criteria. The number of eligible papers was low. Study populations were heterogeneous including 6,486 participants, and a total of 25 tests and in few cases clinical interviews were used in the evaluation processes. The results enhanced the idea about the comorbidity between dental anxiety and other psychiatric disorders. The effect was found strong in several studies. Conclusion Patients with a high level of dental anxiety are more prone to have a high level of comorbid phobias, depression, mood disorders and other psychiatric disorders and symptoms.
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Affiliation(s)
- Harri Halonen
- Oulu University Hospital, Department of Psychiatry, 90230 Oulu, Finland
| | - Jenna Nissinen
- Center for Life Course Health Research, University of Oulu, 90230 Oulu, Finland
| | - Heli Lehtiniemi
- Center for Life Course Health Research, University of Oulu, 90230 Oulu, Finland
| | - Tuula Salo
- Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu, 90230 Oulu, Finland
| | - Pirkko Riipinen
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, 90230 Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, 90230 Oulu, Finland
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Donker T, Van Esveld S, Fischer N, Van Straten A. 0Phobia - towards a virtual cure for acrophobia: study protocol for a randomized controlled trial. Trials 2018; 19:433. [PMID: 30092844 PMCID: PMC6085658 DOI: 10.1186/s13063-018-2704-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/24/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Virtual reality exposure therapy (VRET) has been shown to be as effective as traditional forms of in vivo exposure therapy for the treatment of specific phobias. However, as with in vivo exposure, VRET still involves relatively high costs and limited accessibility which makes it prohibitive for a large part of the population. Innovative methods using smartphone applications (apps) may improve accessibility and scalability of VRET. The aim of this study is to evaluate 0Phobia, a gamified self-guided VRET for acrophobia that is delivered through a smartphone app in combination with rudimentary cardboard virtual reality (VR) goggles. METHODS/DESIGN Participants (N = 180, aged 18-65 years) with acrophobia symptoms will be recruited from the Dutch general population and randomized to either 0Phobia (n = 90) or a waitlist control condition (n = 90). 0Phobia will be delivered over a period of 3 weeks and includes psychoeducation, VR exposure, cognitive techniques, monitoring of symptoms, and relapse prevention. The primary outcome measure will be the Acrophobia Questionnaire. Secondary outcome measures will include user-friendliness, symptoms of anxiety, depression, and mastery. Assessments will take place online at baseline, directly after the intervention (post test) and at follow-up (3 months). DISCUSSION This study capitalizes on novel technology and recent scientific advances to develop an affordable and scalable treatment modality. TRIAL REGISTRATION Netherlands Trial Register: NTR6442 . Registered on 29 June 2017.
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Affiliation(s)
- T Donker
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement- and Behavioral Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - S Van Esveld
- Faculty Governance and Global Affairs, Leiden University, Leiden, The Netherlands
| | - N Fischer
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement- and Behavioral Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A Van Straten
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Movement- and Behavioral Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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42
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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 2018; 58:1-7. [PMID: 29909286 DOI: 10.1016/j.janxdis.2018.05.006] [Citation(s) in RCA: 17] [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: 01/12/2018] [Revised: 05/17/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
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-min exposures) delivered through a virtual reality headset or a psychoeducation only control condition that watched a 30-min 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 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
- 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
| | - 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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Farrell LJ, Kershaw H, Ollendick T. Play-Modified One-Session Treatment for Young Children with a Specific Phobia of Dogs: A Multiple Baseline Case Series. Child Psychiatry Hum Dev 2018; 49:317-29. [PMID: 28766176 DOI: 10.1007/s10578-017-0752-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The one-session treatment (OST) approach for SPs is deemed well-established, and has been found to be highly effective for older children and adults; however, has not yet been trialled with very young children. The present study examines the preliminary effectiveness of play-modified OST for young children with a SP of dogs, using a multiple baseline controlled case series design. Treatment involved play modified one-session of intensive cognitive-behavioural therapy (OST plus Play) which was followed by brief telephone delivered maintenance calls over the 3 weeks immediately following treatment. Four young children (4 years of age) participated and symptoms were assessed at pre-treatment, across a 1-3 week baseline phase, immediately following the OST plus Play, and at 1 and 3 months follow-up. Visual inspection provided evidence for stability of symptoms across the baseline phase, followed by reductions in symptoms over the course of treatment and follow-up. Non-parametric analyses offered further support, with significant improvements in following the intensive OST plus Play intervention.
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44
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Zsido AN, Arato N, Inhof O, Janszky J, Darnai G. Short versions of two specific phobia measures: The snake and the spider questionnaires. J Anxiety Disord 2018; 54:11-16. [PMID: 29306023 DOI: 10.1016/j.janxdis.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/27/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
Zoophobias are the most prevalent form of specific phobia worldwide. Two of the most widely used measures, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ) are good indicators of specific fears, but researchers have recognised that shorter, yet nevertheless reliable measures are needed. Hence the aims of this research were to develop short forms of the SNAQ and SPQ using item response theory and to use receiver operating characteristic (ROC) curve analyses to determine cut-offs for use in future research. Twelve-item versions of both scales (SNAQ-12 and SPQ-12) demonstrated excellent discrimination along the latent continuum in a sample of 1354 people. The SNAQ-12 and SPQ-12 showed excellent reliability and were highly correlated with the corresponding full-length scale. The scales discriminated between participants who reported snake (3.25%) or spider (8.05%) phobia and those who did not. Further analyses revealed that non-phobic women report higher fear of both snakes and spiders than do men, but this difference was not present in phobics. These findings suggest that the SNAQ-12 and SPQ-12 have considerable strengths, including shorter assessment and scoring times, whilst retaining high reliability and potential utility as a clinical screening tool.
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Affiliation(s)
- Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
| | - Nikolett Arato
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Orsolya Inhof
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Jozsef Janszky
- Department of Neurology, University of Pécs, Medical School, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Gergely Darnai
- Institute of Psychology, University of Pécs, Pécs, Hungary; Department of Neurology, University of Pécs, Medical School, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Zsido AN. The spider and the snake - A psychometric study of two phobias and insights from the Hungarian validation. Psychiatry Res 2017; 257:61-6. [PMID: 28734237 DOI: 10.1016/j.psychres.2017.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/20/2017] [Accepted: 07/12/2017] [Indexed: 11/22/2022]
Abstract
Specific phobias-particularly zoophobias-are prevalent worldwide and can have fairly dramatic health consequences. Self-report measurements play a crucial role in phobia research studies; thus, it is important to have a reliable tool in different languages. The present investigation examined the psychometric properties of the Hungarian version of two commonly used measures of fear: the Spider Phobia Questionnaire (i.e. SPQ) and the Snake Questionnaire (i.e. SNAQ). The SPQ and SNAQ scores both demonstrated excellent reliability, including a test-retest over a 4-week period. Supportive evidence for the validity of the SPQ and SNAQ scores was found using questions assessing fainting and avoidance history, regarding snakes and spiders, based on DSM-V criteria. Both questionnaires could discriminate between participants who reported such an event and those who did not. Further analyses also revealed a sex difference, with women scoring higher than men on both scales. Moreover, 9.5% and 4.24% of the respondents reached the cut-off point, set by previous studies, for spider and snake phobias, respectively. These findings suggest that the SPQ and SNAQ have excellent psychometric properties, making them suitable for use in further cross-cultural research and epidemiological studies.
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Stefanescu MR, Endres RJ, Hilbert K, Wittchen HU, Lueken U. Networks of phobic fear: Functional connectivity shifts in two subtypes of specific phobia. Neurosci Lett 2017; 662:167-172. [PMID: 29054435 DOI: 10.1016/j.neulet.2017.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]
Abstract
Anxiety disorders can be conceptualized by an abnormal interplay of emotion-processing brain circuits; however, knowledge of brain connectivity measures in specific phobia is still limited. To explore functional interactions within selected fear-circuitry structures (anterior cingulate cortex (ACC), amygdala, insula), we re-examined three task-based fMRI studies using a symptom provocation approach (n=94 subjects in total) on two different phobia subtypes (animal subtype as represented by snake phobia (SP) and blood-injection-injury subtype as represented by dental phobia (DP)), and a non-phobic healthy control group (HC). Functional connectivity (FC) analyses detected a negative coupling between the amygdala and the ACC in HC for both classes of phobic stimuli, while SP and DP lacked this inhibitory relationship during visual stimulus presentation. However, a negative FC between the insula and the amygdala was observed in DP during visual symptom provocation, which reversed to a positive FC under auditory symptom provocation pointing to effects depending on stimulus modality in DP. SP showed significantly higher FC towards snake-anxiety eliciting stimuli than HC on an average measure of FC, while DP showed a similar pattern under auditory stimulation only. These findings altogether indicate FC shifts during symptom provocation in specific phobia possibly reflecting impaired emotion regulation processes within fear-circuitry networks. FC hence could represent a prime target for neuroscience-informed augmentation strategies when treating pathological forms of fear.
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Affiliation(s)
- Maria R Stefanescu
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Ralph J Endres
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Kevin Hilbert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany; Neuroimaging Center, Technische Universität Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Neuroimaging Center, Technische Universität Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany; Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy,Ludwig-Maximilians-Universitaet, Nussbaumstrasse 7, 80336 Munich, Germany.
| | - Ulrike Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany; Neuroimaging Center, Technische Universität Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
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47
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Rivero F, Herrero M, Viña C, Álvarez-Pérez Y, Peñate W. Neuroimaging in cockroach phobia: An experimental study. Int J Clin Health Psychol 2017; 17:207-215. [PMID: 30487896 PMCID: PMC6220927 DOI: 10.1016/j.ijchp.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 01/03/2023] Open
Abstract
In this study we explored the neuroimaging characteristics of persons with specific small animal (cockroach) phobia to determine whether there are differences in cerebral activity between persons with and without cockroach phobia under conditions of phobic and non-phobic stimulation. Method: 24 adult persons (12 with phobia) were studied. The diagnosis of phobia was obtained with a structured interview and questionnaires. All participants were exposed to a 3D video presentation during an fMRI session. Results: The phobic group showed significant differential activations that were congruent with a dual route model of fear processing through the thalamus-amygdala (route I) and the thalamus-sensory and association cortex-entorhinal cortex-hippocampus-subiculum-amygdala (route II). Apart from this dual route, we also found differential activations in the globus pallidum, parahippocampal gyrus, insula, pars orbitalis, triangularis and opercularis of the frontal cortex, and cerebellum. Respect to non-phobic group, no activations were found in the insula or the anterior cingulate cortex. Conclusions: There seems to be a dual route depending on how persons with phobia to cockroaches process phobic stimuli. This double processing can have implications for the psychological treatment of specific phobias.
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Affiliation(s)
- Francisco Rivero
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | - Manuel Herrero
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | - Conrado Viña
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
| | | | - Wenceslao Peñate
- Universidad de La Laguna and University Institute of Neurosciences (IUNE), Spain
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Diemer J, Zwanzger P, Fohrbeck I, Zavorotnyy M, Notzon S, Silling K, Arolt V, Domschke K, Pfleiderer B. Influence of single-dose quetiapine on fear network activity - A pharmaco-imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2017; 76:80-87. [PMID: 28259723 DOI: 10.1016/j.pnpbp.2017.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network. METHODS In a randomized, double-blind, placebo-controlled proof-of-concept study, n=58 arachnophobic patients underwent an fMRI scan while looking at phobia-related and neutral stimuli. Subjective anxiety was evaluated retrospectively in questionnaires. RESULTS The functional imaging data revealed that patients showed stronger amygdala activation to phobia-related than to neutral stimuli. However, no effect of quetiapine on fear network activity was detected. Further, on questionnaire measures, quetiapine significantly reduced somatic anxiety symptoms, but had no effect on general psychological anxiety. CONCLUSION Viewing phobic pictures resulted in a robust amygdala activation in arachnophobic patients. Quetiapine seems to have no influence on activation in anxiety-related brain areas but appears to reduce acute somatic anxiety symptoms in patients with specific phobia. The central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies.
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Affiliation(s)
- J Diemer
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - P Zwanzger
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - I Fohrbeck
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany
| | - M Zavorotnyy
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - S Notzon
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - K Silling
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - V Arolt
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - K Domschke
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080 Wuerzburg, Germany.
| | - B Pfleiderer
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Campus 1, Building A16, 48129 Muenster, Germany.
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Healey A, Mansell W, Tai S. An experimental test of the role of control in spider fear. J Anxiety Disord 2017; 49:12-20. [PMID: 28371702 DOI: 10.1016/j.janxdis.2017.03.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/07/2017] [Accepted: 03/10/2017] [Indexed: 11/20/2022]
Abstract
It is well established that uncontrollable adverse experiences lead to increased distress, but the role of client control during psychological interventions such as exposure is less clear. Earlier studies reported inconsistent findings, most likely owing to variations in the way client control was manipulated, degree of exposure, the outcome variables chosen and the follow-up periods used. Importantly, studies to date had suggested to participants that approaching their fears was beneficial thereby biasing their choices and these studies had not measured change beyond the laboratory. We recruited 96 spider-fearful student participants (mean age=22; SD=5.9; Range=18-45; 86 female). The experimental design allowed full choice over their degree of exposure, and manipulated the degree of control as the extent to which their movement of a joystick influenced their virtual distance from a moving spider image. Those with high control were yoked with a low control counterpart to ensure equal amounts of exposure. Measures were elicited at baseline, post-exposure, and at follow-up. As predicted, compared to low control participants, those with high control over exposure approached closer toward a spider post-exposure and reported less spider avoidance after an average of 17days. No group differences were found in physiological or subjective distress during the task, nor in distress and dysfunction.
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Abstract
In the present chapter, we review the literature focusing on oxytocin (OT)-centered research in anxiety spectrum conditions, comprising separation anxiety disorder, specific phobias, social anxiety disorder (SAD), panic disorder, generalized anxiety disorder, and anxiety-related endophenotypes (e.g., trust behavior, behavioral inhibition, neuroticism, and state/trait anxiety). OT receptor gene (OXTR) polymorphisms have been implicated in gene-environment interactions with attachment style and childhood maltreatment and to influence clinical outcomes, including SAD intensity and limbic responsiveness. Epigenetic OXTR DNA methylation patterns have emerged as a link between categorical, dimensional, neuroendocrinological, and neuroimaging SAD correlates, highlighting them as potential peripheral surrogates of the central oxytocinergic tone. A pathophysiological framework of OT integrating the dynamic nature of epigenetic biomarkers and the summarized genetic and peripheral evidence is proposed. Finally, we emphasize opportunities and challenges of OT as a key network node of social interaction and fear learning in social contexts. In conjunction with multi-level investigations incorporating a dimensional understanding of social affiliation and avoidance in anxiety spectrum disorders, these concepts will help to promote research for diagnostic, state, and treatment response biomarkers of the OT system, advancing towards indicated preventive interventions and personalized treatment approaches.
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Affiliation(s)
- Michael G Gottschalk
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Margarete-Höppel-Platz 1, Würzburg, 97080, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, Freiburg im Breisgau, 79104, Germany.
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