Showing papers by "Michelle G. Craske published in 2018"
TL;DR: The conclusions drawn in the original meta-analysis of internet-delivered CBT RCTs are supported: iCBT for the anxiety and depressive disorders is effective, acceptable and practical health care.
563 citations
Karolinska Institutet1, University of Oxford2, Warneford Hospital3, Centre for Mental Health4, Public Health Research Institute5, University of Manchester6, University College London7, University of Amsterdam8, University of Glasgow9, University of New South Wales10, University of California, Los Angeles11
TL;DR: This Commission proposes opportunities to improve training in interdisciplinary mental health sciences, and outlines an area in which it sees substantial opportunity and scope for advancements that will move psychological treatments research forward.
390 citations
TL;DR: Persistent and severe PND substantially raises the risk for adverse outcome on all child measures, and meeting criteria for depression both early and late in the postnatal year should alert health care professionals to a depression that is likely to be persistent and to be associated with an especially elevated risk of multiple adverse child outcomes.
Abstract: Importance Maternal postnatal depression (PND) is common and associated with adverse child outcomes. These effects are not inevitable, and it is critical to identify those most at risk. Previous work suggests that the risks of adverse outcomes are increased when PND is severe and persistent, but this has not been systematically studied. Objective To examine the association between differing levels of persistence and severity of PND and long-term child outcomes. Design, Setting, and Participants The sample for this observational study comprised participants in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Three thresholds of PND severity—moderate, marked, and severe—were defined using the self-rated Edinburgh Postnatal Depression Scale (EPDS). Depression was defined as persistent when the EPDS score was above the threshold level at both 2 and 8 months after childbirth. For each of these severity and persistence categories, the following were examined: (1) the trajectories of later EPDS scores (6 time points between 21 months and 11 years after childbirth) and (2) child outcomes—behavioral problems at 3.5 years of age, school-leaving mathematics grades at 16 years of age, and depression at 18 years of age. Data analysis was conducted from July 12, 2016, to February 8, 2017. Main Outcomes and Measures Child behavioral problems at 3.5 years of age using the Rutter total problems scale, school-leaving mathematics grades at 16 years of age extracted from records of external national public examinations, and offspring depression at 18 years of age using the Clinical Interview Schedule–Revised. Results For the 9848 mothers in the sample, the mean (SD) age at delivery was 28.5 (4.7) years. Of the 8287 children, 4227 (51%) were boys and 4060 (49%) were girls. Compared with women with PND that was not persistent and women who did not score above the EPDS threshold, for all 3 severity levels, women with persistent PND showed elevated depressive symptoms up to 11 years after childbirth. Whether persistent or not, PND doubled the risk of child behavior disturbance. The odds ratio (OR) for child behavioral disturbance for mothers with moderate PND was 2.22 (95% CI, 1.74-2.83), for mothers with marked PND was 1.91 (95% CI, 1.36-2.68), and for mothers with severe PND was 2.39 (95% CI, 1.78-3.22). Persistence of severe PND was particularly important to child development, substantially increasing the risk for behavioral problems at 3.5 years of age (OR, 4.84; 95% CI, 2.94-7.98), lower mathematics grades at 16 years of age (OR, 2.65; 95% CI, 1.26-5.57), and higher prevalence of depression at 18 years of age (OR, 7.44; 95% CI, 2.89-19.11). Conclusions and Relevance Persistent and severe PND substantially raises the risk for adverse outcome on all child measures. Meeting criteria for depression both early and late in the postnatal year, especially when the mood disturbance is severe, should alert health care professionals to a depression that is likely to be persistent and to be associated with an especially elevated risk of multiple adverse child outcomes. Treatment for this group should be prioritized.
343 citations
TL;DR: The translational value of extinction will be increased by more investigation of elements central to extinction itself, such as extinction generalization, and interactions with other learning processes,such as instrumental avoidance reward learning, and with other clinically relevant cognitive–emotional processes,Such as self-efficacy, threat appraisal and emotion regulation, will add translationalvalue.
Abstract: Through advances in both basic and clinical scientific research, Pavlovian fear conditioning and extinction have become an exemplary translational model for understanding and treating anxiety disorders. Discoveries in associative and neurobiological mechanisms underlying extinction have informed techniques for optimizing exposure therapy that enhance the formation of inhibitory associations and their consolidation and retrieval over time and context. Strategies that enhance formation include maximizing prediction-error correction by violating expectancies, deepened extinction, occasional reinforced extinction, attentional control and removal of safety signals/behaviours. Strategies that enhance consolidation include pharmacological agonists of NMDA (i.e. d-cycloserine) and mental rehearsal. Strategies that enhance retrieval include multiple contexts, retrieval cues, and pharmacological blockade of contextual encoding. Stimulus variability and positive affect are posited to influence the formation and the retrieval of inhibitory associations. Inhibitory regulation through affect labelling is considered a complement to extinction. The translational value of extinction will be increased by more investigation of elements central to extinction itself, such as extinction generalization, and interactions with other learning processes, such as instrumental avoidance reward learning, and with other clinically relevant cognitive-emotional processes, such as self-efficacy, threat appraisal and emotion regulation, will add translational value. Moreover, framing fear extinction and related processes within a developmental context will increase their clinical relevance.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
209 citations
TL;DR: Overall, the extant literature supports a key role of aversive associative learning in the development and treatment of anxiety disorders, however, research targeting specific mechanisms such as extinction generalization and avoidance, the fragility of extinction, and moderating influences of individual differences pertinent to anxiety disorders is needed.
177 citations
TL;DR: It is suggested that mindfulness interventions are associated with changes in functioning of the insula, plausibly impacting awareness of internal reactions ‘in‐the‐moment’.
116 citations
TL;DR: It is concluded that inflammation likely plays a role in exaggerated reactivity to negative information, altered reward reactivity, and somatic symptoms as well as less evidence supporting an effect of inflammation on cognitive control as assessed by standard neuropsychological measures.
103 citations
TL;DR: This trial aimed to examine whether a parenting video-feedback therapy (VFT) intervention versus a control treatment of progressive muscle relaxation (PMR) for persistent postnatal depression, would lead to improved child outcomes at age 2 years.
84 citations
TL;DR: The promise of shedding light on causal mechanisms of AN is considered by interrogating the role of fear-related learning, deficits in discriminating safety cues, and extinction of acquired fear by considering fear as a translational mechanism in the psychopathology of AN.
46 citations
TL;DR: The observation of meal related “visceral illusions” provides further evidence that AN is associated with abnormal interoceptive representation of the heartbeat and suggests that meal consumption, particularly when anticipated, preferentially alters the processing of interoception related signals in AN.
Abstract: Individuals with anorexia nervosa (AN) typically display anxious traits prior to the onset of food avoidance and weight loss that characterize the disorder Meal associated anxiety is an especially common clinical feature in these patients, and heightened sensitivity to sympathetically mediated interoceptive sensations has also been observed However, it remains unclear how heightened interoceptive sensitivity relates to experiences of anxiety before and after meals To investigate this relationship, we experimentally induced anxiety and panic symptoms with isoproterenol, a peripheral sympathetic agonist similar to adrenaline, across several different conditions: during panic provocation, during anticipation of a 1,000 Calorie meal, and after meal consumption Fifteen AN and 15 age- and sex-matched healthy comparisons received bolus infusions of isoproterenol and saline in a double-blinded, randomized design Participants rated anxiety symptoms after each infusion, completed panic rating scales, and traced the location of perceived palpitations on a manikin to index interoceptive "body map" representation The AN group reported significantly elevated anxiety relative to healthy comparisons during infusions before and after the meal, but surprisingly, not during panic provocation These symptoms were accompanied by geographical differences in patterns of perceived heartbeat sensations across each condition In particular, the AN group localized heartbeat sensations disproportionately to the chest during meal related saline infusions, when no cardiorespiratory modulation actually occurred The AN group also showed a trend toward higher panic attack rates during the meal anticipation period Correcting for anxiety levels reported during saline infusions abolished group differences in anxiety change across all conditions, suggesting a significant contribution of anxious traits in AN The observation of meal related "visceral illusions" provides further evidence that AN is associated with abnormal interoceptive representation of the heartbeat and suggests that meal consumption, particularly when anticipated, preferentially alters the processing of interoception related signals in AN
39 citations
TL;DR: Findings suggest more similarities than differences in types and levels of anxiety and anxiety-related impairment, with some important exceptions, including greater levels of somatization and physical functional impairment among Latinx patients.
TL;DR: Findings highlight neural responsiveness to reward as both a mechanism and a predictor of depressive symptom change that may be used serve as an objective index of symptom improvement.
Abstract: OBJECTIVE Reward positivity (RewP), a neurophysiologic index of reward responsivity, is consistently reduced in participants with depression and, to a lesser extent, anxiety. It remains unknown, however, whether RewP can be altered as psychiatric symptoms change with treatment. The current study addressed this question by examining differences in RewP within patients before and after 12 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI) or cognitive-behavioral therapy (CBT). We also examined the utility of RewP as a predictor of symptom change during CBT and SSRI treatment. METHODS Participants were recruited between 2014 and 2017 and included adults with a primary DSM-5 anxiety or depressive disorder (n = 63) and healthy controls (n = 25). At baseline and 12 weeks, participants completed a monetary award task while electroencephalogram (EEG) was recorded. Between EEG sessions, patients completed CBT or SSRI treatment. RESULTS At baseline, higher levels of depressive symptoms were associated with a more attenuated RewP. We found no significant differences between patients and healthy controls in the degree of RewP change across the 12 weeks; however, among patients, the extent of increase in RewP robustly correlated with the extent of decline in depressive (t = -2.21, P = .03) and anxiety (t = -2.57, P = .02) symptoms following CBT and SSRI treatment. Additionally, a more attenuated RewP at baseline predicted a greater reduction in depressive symptoms following treatment with SSRIs (t = -2.04, P < .05), but not after CBT. CONCLUSIONS These findings highlight neural responsiveness to reward as both a mechanism and a predictor of depressive symptom change that may be used serve as an objective index of symptom improvement. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01903447.
TL;DR: Two distinct effects of losartan on emotional processing are suggested, including an improvement of early discrimination of stimuli as threatening versus safe, and facilitation of threat processing.
TL;DR: Adding CALM ARC to UC for patients with comorbid anxiety disorders and substance use disorders is superior to UC alone, and implications for future research and clinical practice are discussed.
Abstract: OBJECTIVE Anxiety and substance use disorders are highly comorbid and mutually maintain each other. Treatments for anxiety disorders that are well integrated into substance use disorder treatment have the potential to improve both anxiety and substance use outcomes. METHOD Ninety-seven individuals seeking treatment at a community-based, evidence-based intensive outpatient program for substance use disorders who also had anxiety disorders were randomized to either (a) usual care (UC) at the intensive outpatient program; or (b) UC + coordinated anxiety learning and management for addiction recovery centers (CALM ARC), a 7-session, group-based, computer-assisted but therapist-directed treatment for anxiety disorders adapted for individuals with anxiety disorder and substance use disorder comorbidity. RESULTS CALM ARC + UC outperformed UC on measures of anxiety and substance use at posttreatment and at a 6-month follow-up. CONCLUSIONS Adding CALM ARC to UC for patients with comorbid anxiety disorders and substance use disorders is superior to UC alone. Implications for future research and clinical practice are discussed. (PsycINFO Database Record
TL;DR: The results suggest that conducting extinction to the CS+ lessens conditional fear of the CS + more than extinction with GSs, and extinction with a variety of GSs lessens fear of those GSs more than repeated extinction with one GS.
TL;DR: Examination of the relationships between trait anxiety, discrimination learning, spontaneous recovery and context renewal in healthy volunteers found that elevated trait anxiety was associated with poorer discrimination, which in turn wasassociated with increased fear at test phases.
Abstract: Individuals with anxiety disorders show deficits in the discrimination between a cue that predicts an aversive outcome and a safe stimulus that predicts the absence of that outcome. This impairment...
TL;DR: In this article, the authors assess whether the ERN is a treatment moderator and index of symptom change during cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs).
TL;DR: Occasional CS-US pairings during extinction may protect against return of fear effects, and as measured by valence ratings, it was unclear whether partially reinforced extinction provided protection from fear recovery effects.
TL;DR: Findings provide preliminary evidence suggesting alcohol use outcomes were related to decreasing anxiety sensitivity rather than decreasing coping motives, and suggest declines in coping motives did not mediate substance use after treatment.
TL;DR: Examination of baseline patient characteristics that predict differential outcome between typical treatment for substance use disorders (UC) compared to that treatment combined with cognitive behavioral therapy for anxiety disorders (CALM ARC) found several pre-treatment characteristics are associated with a return of symptoms for those who receive only UC, whereas the addition of CALM ARC prevented the return of Symptoms.
TL;DR: Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults, and the importance of physical health, social support, and comorbid MDD in this association is revealed.
Abstract: Objectives: The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.Method: Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and/or social anxiety disorder (SAD).Results: Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared with younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared with older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association.Conclusion...
TL;DR: This paper presents a meta-analyses of the determinants of remission of Alzheimer's disease in mice over a 12-month period over a period of 12 weeks and shows clear patterns in response to vaccination and in particular the use of canine coronavirus.
Abstract: Phil. Trans. R. Soc. B 373 , 20170025. (Published 19 January 2018) ([doi:10.1098/rstb.2017.0025][1])
Owing to a clerical error …
[1]: http://dx.doi.org/10.1098/rstb.2017.0025
TL;DR: Greater concordance between neuroscience and clinical researchers would allow more focused investigation of treatment-specific and treatment-general mechanisms, and more standardization in study design would facilitate the ability to compare effects across studies.
Abstract: Psychological treatments for anxiety and depression are not universally effective, with many individuals continuing to experience symptoms after treatment. A better understanding of how these treatments work has the potential to inform treatment development and optimization. Neuroimaging studies provide one level of analysis to investigate mechanisms of treatment action. Here, we review recent studies using this approach to assess mechanisms of psychological treatments. Cognitive behavioral therapy for anxiety and depression was associated with changes in activation of amygdala, ACC, and medial/inferior prefrontal cortices. Changes in connectivity between amygdala and prefrontal cortical regions were also demonstrated highlighting a role for altered functioning of neural circuitry implicated in emotion regulation. Greater concordance between neuroscience and clinical researchers would allow more focused investigation of treatment-specific and treatment-general mechanisms. More standardization in study design would facilitate the ability to compare effects across studies.
TL;DR: An iterative approach was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention.
Abstract: Background: A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective: The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods: An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results: Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions: The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.
TL;DR: Results showed pre- to post-treatment reductions in anxiety symptoms and neural reactivity to emotional faces within a broad neural network linking frontal, temporal, parietal and occipital regions and integrative functions linking emotion, memory, sensory and motor processes and attention control.
TL;DR: Investigation of how positive valence systems contribute to maladaptive learning processes, and how effects vary across individuals with different diagnoses and subclinical presentations, will be important for the development of future neuroscientifically-informed evidence-based treatments for affective disorders.
Abstract: Neuroscientific investigation of maladaptive learning in affective disorders has highlighted aberrant functioning of corticolimbic survival circuits. In particular, altered functioning of amygdala-prefrontal cortex circuitry has been demonstrated during acquisition and extinction of maladaptive conditional fears. Studies of psychological and pharmacological treatments for affective disorders demonstrate altered activation within overlapping circuitries but suggest that the mechanisms of different treatments target different ‘access points’ within these circuits. Moving beyond the traditional boundaries of fear conditioning research, recent work has begun to investigate how positive valence systems (i.e., reward circuitry) contribute to maladaptive learning processes, and how effects vary across individuals with different diagnoses and subclinical presentations. Advances in this domain will be important for the development of future neuroscientifically-informed evidence-based treatments for affective disorders.
TL;DR: This pilot study provides initial support for the acceptability and efficacy of computerized imaginal exposure training for PTSD.
06 Dec 2018
TL;DR: Temporally sensitive neuroimaging techniques are beginning to illuminate the dynamic nature of activity among these regions, with findings demonstrating early identification of infant cries in the periaqueductal grey and orbitofrontal cortex that may support rapid orientating responses.
Abstract: Infant vocalizations are uniquely salient sounds in our auditory environment. They attract attention and compel the listener to respond quickly and carefully. These sounds prompt a range of effortful and complex behaviours in parents, with the goal of providing life-sustaining care for their infant. The neurobiological underpinnings of this motivational state are of much interest to auditory and parenting researchers alike. Neuroimaging has afforded the opportunity to examine the biological substrates of these complex states. Functional MRI (fMRI) studies have identified a network of cortical and subcortical regions that are reactive to infant cries. This ‘parental brain’ is a combination of regions of the ‘social brain’ (temporal and frontal lobe areas) and subcortical ‘survival’ regions. Temporally sensitive neuroimaging techniques (magnetoencephalography, MEG and local field potentials, LFPs) are beginning to illuminate the dynamic nature of activity among these regions, with findings demonstrating early (50–200 ms) identification of infant cries in the periaqueductal grey and orbitofrontal cortex that may support rapid orientating responses. Emerging work investigating parental experience-dependent brain plasticity suggests associations between various aspects of parenting behaviour and adaptations in fronto-amygdala circuitry. Future work combining levels of analyses in longitudinal designs may lead to a better understanding of caregiving behaviour in health and disease.