Showing papers by "Stefan G. Hofmann published in 2014"

Interpersonal Emotion Regulation Model of Mood and Anxiety Disorders.

Abstract: Although social factors are of critical importance in the development and maintenance of emotional disorders, the contemporary view of emotion regulation has been primarily limited to intrapersonal processes Based on diverse perspectives pointing to the communicative function of emotions, the social processes in self-regulation, and the role of social support, this article presents an interpersonal model of emotion regulation of mood and anxiety disorders This model provides a theoretical framework to understand and explain how mood and anxiety disorders are regulated and maintained through others The literature, which provides support for the model, is reviewed and the clinical implications are discussed

Attention Bias Modification Training Via Smartphone to Reduce Social Anxiety: A Randomized, Controlled Multi-Session Experiment

Abstract: Testing feasibility and efficacy of psychological treatment via mobile devices is important, given its potential benefits for high-dosage treatment delivery, widespread and inexpensive dissemination, and efficient research methods. We conducted the first randomized controlled trial of attention bias modification training delivered via smartphones, comparing this training to control training in a double-blind design, also including a waitlist condition. All participants performed a variant of dot-probe training involving faces with neutral and disgust (representative of social threat) expressions in brief sessions three times daily over 4 weeks on their own smartphones, at home or anywhere they chose. Attention bias modification, also known as cognitive bias modification of attention, training included a contingency to induce attentional deployment away from disgust faces, whereas the control training included no contingency. Participants completed weekly Internet-based self-report symptom assessments as well as smartphone-delivered dot-probe attention bias assessments, whose reliability findings supported the viability of using smartphones for reaction-time based assessments. The between-groups training effect on attention bias scores was small, showing statistical significance in some analyses and not in others. On measures of social anxiety, intention-to-treat analyses (n = 326) revealed significant pre–post treatment declines with medium to large effect sizes in both training groups, whereas small declines in a waitlist group were nonsignificant. Both training groups showed greater reductions in social anxiety than did waitlist; however, the benefits under these two training conditions were statistically indistinguishable. Improvements in the two training conditions beyond those of waitlist could be attributable to any factors common to them, but not to the contingency training specific to active attention bias modification training.

Advancing psychotherapy and evidence-based psychological interventions

Abstract: Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, “component analyses” aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support “real time” clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

Effect of Cognitive Behavioral Therapy for Anxiety Disorders on Quality of Life: A Meta-Analysis

Abstract: Anxiety disorders are the most prevalent psychiatric disorders, with a lifetime prevalence rate of 28.8% (Kessler et al., 2005). These disorders are associated with high personal and economic costs (DuPont et al., 1996) and low quality of life (Cramer, Torgersen & Kringlen, 2005; Mendlowicz, & Stein, 2000; Olatunji, Cisler, & Tolin, 2007; Rapaport, Clary, Fayyad, & Endicott, 2005). For example, it has been reported that obsessive-compulsive disorder (Koran, Thienemann, & Davenport 1996), panic disorder (Candilis et al.,1999; Rubin et al., 2000) and social anxiety disorder (Safren, Heimberg, Brown, & Holle, 1996–1997; Wittchen & Beloch, 1996) have substantially poorer quality of life than community samples. In some cases, anxiety disorders have an even greater impact on quality of life than chronic medical disorders (Spitzer et al., 1995; Sherbourne, Wells, & Judd, 1996). Quality of life (QOL) is difficult to define. It includes subjective well-being, life satisfaction, perceptions of social relationships, physical health, economic status, and functioning in daily activities and work (Angermeyer & Kilian, 1997; Mendlowitz & Stein, 2000). Accordingly, the assessment of QOL typically includes subjective views of one’s life circumstances, perceptions of mental and physical health, social and family relationships, and functioning at work and home (DuPont et al., 1996). Cognitive behavioral therapy (CBT) is an effective treatment for reducing symptoms of anxiety disorders (Hofmann & Smits, 2008). Although symptom reduction is an important goal of treatment, some authors have urged investigators to include QOL as another important indicator of treatment efficacy (Frisch, 1998; Gladis, Gosh, Sishuk, & Crits-Christoph, 1999). The objective of this study was to conduct a quantitative review of the effect of CBT on QOL in patients with anxiety disorders. Although there are different emphases of the various cognitive and behavioral techniques for the range of anxiety disorders, one important commonality of all of these treatment protocols is the premise that cognitions causally influence fear and anxiety, and that the dysfunctional beliefs and cognitive distortions contribute to the maintenance of anxiety disorder (Hofmann, Asmundson, & Beck, 2013). This premise and one of the defining features of a variety of different treatment protocols and include more traditional CBT protocols as well as more modern mindfulness-based cognitive therapy, At the same time, this core assumption is the primary distinguishing feature to other treatments, such as Acceptance and Commitment Therapy and mindfulness-based stress reduction. Our review focuses only on CBT protocols that share the core premise of the centrality of maladaptive cognitions. We examined controlled and within-group random effect sizes of changes in QOL during the course of CBT for specific phobias, panic disorder with and without agoraphobia, social anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder and posttraumatic stress disorder. To examine whether study quality moderated the effect of CBT on QOL, we quantified study quality by using Effective Public Health Practice Project criteria (EPHPP; Thomas, Ciliska, Dobbins & Micucci, 2004). The effects of study quality and publication year are two important reporting items identified by the PRISMA group (Moher et al., 2009). In a large-scale analysis of 2,400 patients, treatment length has been demonstrated to positively correlate with efficacy of cognitive-behavioral treatment (Howard, Kopta, Krause, & Orlinsky, 1986). Furthermore, internet-based delivery of cognitive behavioral therapy for anxiety disorders has proven to be promising but not uniformly efficacious across extant trials (Andersson, 2009). Therefore, we also examined whether treatment administration modality (individual face-to-face, group face-to-face, and internet-delivered) moderated the effect of the treatment on quality of life.

Social anxiety disorder in DSM-5

Abstract: With the publication of DSM-5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues.

Social anxiety : clinical, developmental, and social perspectives

Abstract: Part I - Delineation of Social Anxiety Chapter 1 - Conceptualizing and Describing Social Anxiety and Its Disorders Daniel W. McNeil and Cameron L. Randall Chapter 2 - Avoidant Personality Disorder and its Relationship to Social Anxiety Disorder James Reich Chapter 3 - Assessment of Social Anxiety and its Clinical Expressions James D. Herbert, Lynn L. Brandsma and Laura Fischer Chapter 4 - Shyness, Social Anxiety, and Social Phobia Lynne Henderson, Paul Gilbert and Philip Zimbardo Chapter 5 - Embarrassment and Social Anxiety Disorder: Fraternal Twins of Distant Cousins? Rowland S. Miller Chapter 6 - Social Anxiety and Social Anxiety Disorder Across Cultures Keila C. Brockveld, Sarah J. Perini and Ronald M. Rapee Chapter 7 - Perfectionism and Perfectionistic Self-Presentation in Social Anxiety Gordon L. Flett and Paul L. Hewitt Chapter 8 - Social Phobia as a Deficit in Social Skills Ariel Stravynski, Angela Kyparissis and Danielle Amado Chapter 9 - Social Anxiety Disorder and its Relation to Clinical Syndromes in Adulthood Amy Wenzel and Shari Jager-Hyman Chapter 10 - Social Anxiety in Children and Adolescents: Biological, Developmental, and Social Considerations Michael F. Detweiler, Jonathan S. Comer, Kathleen I. Crum and Anne Marie Albano Chapter 11 - Prevention and Early Intervention of Social Anxiety Disorder Paula Barrett and Marita Cooper Part II - Theoretical Perspectives Chapter 12 - Neuroendocrinology and Neuroimaging Studies of Social Anxiety Disorder K. Luan Phan and Heide Klumpp Chapter 13 - Temperamental Contributions to the Development of Psychological Profiles: I. Basic Issues Jerome Kagan Chapter 14 - Temperamental Contributions to the Development of Psychological Profiles: II. Two Candidates Chapter 15 - Mechanisms of Learning and Behavior Change in Social Anxiety Disorder Daniel W. McNeil, Cameron L. Randall, C. W. Lejuez, and John T. Sorrell Chapter 16 - Cognitive Biases in Social Anxiety Disorder Jennie M. Kuckertz and Nader Amir Chapter 17 - Emotion Regulation in Social Anxiety Disorder Philippe R. Goldin, Hooria Jazaieri and James J. Gross Chapter 18 - Social Anxiety and the Self Lynn E. Alden, Karen W. Auyeung and Leili Plasencia Chapter 19 - Positivity Deficits in Social Anxiety: Emotions, Events, and Cognitions Antonina S. Farmer, Todd B. Kashdan and Justin W. Weeks Chapter 20 - Social Anxiety as an Early Warning Sysztem: A Refinement and Extension of the Self-Presentation Theory of Social Anxiety Mark R. Leary and Katrina P. Jongman-Sereno Chapter 21 - Evolutionary Perspective on Social Anxiety Eva Gilboa-Schechtman, Iris Shachar and Liat Helpman Part III - Treatment Approaches Chapter 22 - Psychopharmacology for Social Anxiety Disorder Carlos Blanco, Laura Bragdon, Franklin R. Schneier and Michael R. Liebowitz Chapter 23 - Treatment of Adult Social Anxiety Disorder: A Treatments-by-Dimensions Review Kristin N. Anderson and Debra A. Hope Chapter 24 - A Cognitive-Behavioral Model of Social Anxiety Disorder Richard G. Heimberg, Faith A. Brozovich and Ronaldl M. Rapee Chapter 25 - Mindfulness-Based Therapy for Social Anxiety Disorder Bram Van Bockstaele and Susan M. Bogels Chapter 26 - A Comparison Between Psychosocial and Pharmacological Treatments Mark B. Powers, Brooke Y. Kauffman, Allison Diamond and Jasper A. J. Smits Chapter 27 - Mechanisms of Action in the Treatment of Social Anxiety Disorder Michael W. Otto, Steven A. Safren and Bridget A. Hearon

D-cycloserine for treating anxiety disorders: making good exposures better and bad exposures worse.

Abstract: In an attempt to improve the efficacy of psychotherapy for anxiety disorders, preclinical paradigms have recent been translated into novel treatment strategies.[1] Specifically, these studies have examined the role of glutamate, an excitatory neurotransmitter in the mammalian brain, in extinction learning. A receptor complex involved in this process is the N-methyl-D-aspartate (NMDA) receptor. Activation of the NMDA receptor requires binding of both glutamate and the co-agonist glycine. D-cycloserine (D-4-amino-3-isoxazolidone; DCS) is a partial agonist at the glycine recognition site of the glutamatergic NMDA receptor. Animal studies that employed fear-potentiated startle to a conditioned stimulus have demonstrated that this substance can augment extinction learning in rats.[1] The result of this translational work has shown for some studies that DCS can act as a cognitive enhancer to augment exposure strategies during cognitive-behavioral therapy of anxiety disorders.[2] This line of research has gathered a significant amount of attention because it is a prime example of translational research, whereby basic neuroscience directly informs clinical science by identifying a compound and mechanism of treatment change. Following the initial excitement surrounding early DCS augmentation trials, a number of studies have been conducted that provide a more refined picture. These studies further have clarified some of the limitations and indications of DCS as an augmentation strategy.

Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder.

Abstract: Although cognitive-behavioral therapies (CBT) for the treatment of panic disorder with or without additional agoraphobia are effective (e.g., Aaronson et al., 2008; Barlow & Craske, 2007; Hofmann & Smits, 2008), there is still considerable room for improvement. Further knowledge about individual differences in patterns of change for specific subgroups of patients might enable researchers and clinicians to maximize treatment outcome in individual patients (Barlow, 2010; Lambert, 2007; Lutz, 2002). The investigation of patterns of change in psychological treatments has recently emerged as a topic in the research literature. Different methods have been applied to isolate subgroups of patients with similar treatment response. A common strategy for the identification of patient subgroups has been classification based on pre to post treatment comparisons (e.g. Aaronson et al., 2008). This approach defines change patterns based on the assumption that those patients who experience positive outcome at the end of the treatment have followed a positive response pattern. On the other hand, those who experience negative outcome at the end of the treatment have followed a negative path. As a result, groups are combined that reach similar treatment outcome criteria, despite potentially very distinct treatment courses (Morral, Iguchi, Belding, & Lamb, 1997). The pathways to improvement could be very diverse and this diversity might be clinically meaningful and might be a useful predictor of treatment outcome. These individual differences in treatment change might reflect different change mechanisms and processes (Kazdin, 2007). Such pattern recognition based on the similarities of the change trajectories shared by a group of patients can be identified via growth mixture modeling (GMM) (e.g., Nagin & Odgers, 2010; Muthen, 2006). GMM is an advanced cluster analytic method that allows categorizing individuals into subgroups following similar change trajectories over a defined time period. It isolates groups of patients with similar treatment response patterns or profiles over time. Although GMM is still a relatively new method, it has already stimulated much research in clinical psychology and other areas of the social sciences (Nagin & Odgers, 2010). For example, Cuijpers, van Lier, van Straten and Donker (2005) compared CBT with a treatment as usual control group in a sample of depressed patients using GMM. The average patient trajectories in the two conditions were statistically equivalent. However, large differences between the two treatments were detected for subgroups that were identified with GMM. For two highly impaired subgroups, CBT was substantially more effective than treatment as usual (d = 0.75 and 0.86). Additional studies have used a similar approach in different settings and disorders (e.g., Stulz, Gallop, Lutz, Wrenn, & Crits-Christoph, 2010). However, these and other studies have only classified patients on the basis of shared response curves over the entire treatment period. The objective of the present study was to predict outcome for specific subgroups based on patients’ change patterns during the early stage of treatment using GMM. Studies on early response in psychological treatments have tracked treatment response on a weekly basis and found that quick, positive treatment response within the first three sessions related to positive outcome at termination and follow-up (e.g., Haas, Hill, Lambert & Morell, 2002). Furthermore, Haas et al. (2002) found that early responders needed fewer sessions to achieve stable improvement and were, therefore, more likely to terminate treatment earlier. Early response has been shown to be a powerful predictor of outcome in different samples (e.g., adolescents, adults, and elderly patients; e.g., Gunlicks-Stoessel & Mufson, 2011), modalities (psychological and pharmacological treatments; e.g., Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006; Uher et al., 2010; van Calker et al., 2009), and diagnostic groups (depression, anxiety, and eating disorders; e.g., Aderka, Nickerson, Boe, & Hofmann, 2012; Gunlicks-Stoessel & Mufson, 2011; Lutz, Stulz, & Kock, 2009). This literature has been primarily concerned with identifying patients who show rapid early improvement. Other change trajectories have not been the primary focus of research attention, although they might also have important clinical implications (see Lutz et al., 2013). Moreover, relatively few studies have utilized GMM in this context. In one of the first studies investigating early change patterns with GMM, Stulz, Lutz, Leach, Lucock, and Barkham (2007) clustered 192 naturalistic outpatient psychotherapy patients on the basis of shared response trajectories over the first 6 sessions. Five distinct trajectory classes best described the individual early change courses; 11% of the patients showed a pattern that was characterized by high initial impairment and a rapid substantial improvement over the first 6 sessions. Over 90% of these early responders still remained substantially improved at the end of treatment. A second cluster consisting of 23.1% of patients was characterized by high impairment with little or no early change. Another cluster (14.6%) comprising little or no change over the first 6 sessions began treatment with a relatively low level of impairment. The remaining clusters were two moderately impaired groups with similar average growth curves, but very different individual treatment courses around the group mean trajectories. Whereas the patients in one group showed relatively continuous individual change trajectories (27.6%), patients’ change courses in the other subgroup (23.6%) were characterized by higher levels of discontinuity, with higher variation in session-to-session assessments. The first study that used a specific diagnostic group, major depression, was conducted by Lutz and colleagues (2009), using data from the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP). The results of the completer data (N=162) revealed three typical patterns of early change over the first 8 weeks of treatment, irrespective of the type of treatment protocol provided: (a) moderate to severe depression with moderate early improvement, (b) moderate to severe depression with rapid early improvement, and (c) mild to moderate depression with moderate early improvement. These differential patterns of early response (together with overall pre-treatment symptom severity) predicted outcome (depression severity) at treatment termination and over the 1.5-year follow-up period. In this study, we analyzed data from a multisite clinical trial examining long-term strategies in the treatment of panic disorder with and without agoraphobia. In the initial study phase, all patients were treated with CBT (Aaronson et al., 2008; White et al., 2010). Based on the rating of response status by a trained independent evaluator, patients were then triaged into two clinical trials. Responders were randomized to nine months of monthly booster sessions or no booster sessions, and then followed for one year (White et al., 2013). Non-responders were randomized to either three months of continued CBT or to three months of paroxetine, and then followed for an additional nine months (Payne et al., 2012). In this study, data were analyzed from the initial treatment phase only where all patients received CBT. In the present study, the Panic Disorder Severity Scale – Self Report version (PDSS-SR; Shear et al., 1997) was used to identify patterns of change over the course of treatment. Based on the existing literature, we predicted the existence of distinct patient response clusters. We further hypothesized that these clusters would predict treatment response and treatment length. Moreover, we examined patient intake characteristics as predictors of class membership.

Cross-Cultural Aspects of Anxiety Disorders

Abstract: A person's cultural background influences the experience and expression of emotions In reviewing the recent literature on cross-cultural aspects of anxiety disorders, we identified some culturally related ethnopsychology/ethnophysiology factors (the culture's conceptualizations of how the mind and body function) and contextual factors that influence anxiety disorders Ethnopsychology/ethnophysiology factors include the person's ideas about the mental and bodily processes (and their interaction), whereas contextual factors are associated with the social norms and rules that may contribute to anxiety, including individualism vs collectivism and self-construals From the perspective of ethnopsychology/ethnophysiology and contextual factors, we will discuss "khyâl cap" ("wind attacks"), taijin kyofusho, and ataques de nervios, three prominent examples of culture-specific expressions of anxiety disorders that have all been included in the DSM-5 list of cultural concepts of distress

Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis

Abstract: Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges’ g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14–0.36, I 2 = 0%, 95% CI 0–58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00–12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

Hyper-Connectivity of Subcortical Resting-State Networks in Social Anxiety Disorder

Abstract: Social anxiety disorder-related alterations in basal ganglia regions, such as striatum and globus pallidus, though evident from metabolic imaging, remain to be explored using seed-based resting-state functional connectivity magnetic resonance imaging. Capitalizing on the enhanced sensitivity of a multichannel array coil, we collected high-resolution (2-mm isotropic) data from medication-naive patients and healthy control participants. Subcortical resting-state networks from structures including the striatum (caudate and putamen), globus pallidus, thalamus, amygdala, and periaqueductal gray were compared between the two groups. When compared with controls, the caudate seed revealed significantly higher functional connectivity (hyper-connectivity) in the patient group in medial frontal, prefrontal (anterior and dorsolateral), orbito-frontal, and anterior cingulate cortices, which are regions that are typically associated with emotional processing. In addition, with the putamen seed, the patient data exhibited increased connectivity in the fronto-parietal regions (executive control network) and subgenual cingulate (affective network). The globus pallidus seed showed significant increases in connectivity in the patient group, primarily in the precuneus, which is part of the default mode network. Significant hyper-connectivity in the precuneus, interior temporal, and parahippocampal cortices was also observed with the thalamus seed in the patient population, when compared with controls. With amygdala as seed region, between-group differences were primarily in supplementary motor area, inferior temporal gyrus, secondary visual cortex, angular gyrus, and cingulate gyrus. Seed from periaqueductal gray resulted in hyper-connectivity in the patient group, when compared with controls, in dorsolateral prefrontal cortex, precuneus, middle temporal gyrus, and inferior parietal lobule. In all the subcortical regions examined in this study, the control group did not have any significant enhancements in functional connectivity when compared with the patient group.

Glucocorticoids enhance in vivo exposure-based therapy outcome in spider phobia

Abstract: BACKGROUND: Preclinical and clinical studies indicate that the administration of glucocorticoids may promote fear extinction processes. In particular, it has been shown that glucocorticoids enhance virtual reality based exposure therapy of fear of heights. Here, we investigate whether glucocorticoids enhance the outcome of in vivo exposure-based group therapy of spider phobia. METHODS: In a double blind, block-randomized, placebo-controlled, between-subject study design, 22 patients with specific phobia of spiders were treated with two sessions of in vivo exposure-based group therapy. Cortisol (20 mg) or placebo was orally administered 1 hr before each therapy session. Patients returned for a follow-up assessment one month after therapy. RESULTS: Exposure-based group therapy led to a significant decrease in phobic symptoms as assessed with the Fear of Spiders Questionnaire (FSQ) from pretreatment to immediate posttreatment and to follow-up. The administration of cortisol to exposure therapy resulted in increased salivary cortisol concentrations and a significantly greater reduction in fear of spiders (FSQ) as compared to placebo at follow-up, but not immediately posttreatment. Furthermore, cortisol-treated patients reported significantly less anxiety during standardized exposure to living spiders at follow-up than placebo-treated subjects. Notably, groups did not differ in phobia-unrelated state-anxiety before and after the exposure sessions and at follow-up. CONCLUSIONS: These findings indicate that adding cortisol to in vivo exposure-based group therapy of spider phobia enhances treatment outcome.

Glucocorticoids enhance in vivo exposure-based therapy of spider phobia

Abstract: Background: Preclinical and clinical studies indicate that the administration of glucocorticoids may promote fear extinction processes. In particular, it has been shown that glucocorticoids enhance virtual reality based exposure therapy of fear of heights. Here, we investigate whether glucocorticoids enhance the outcome of in vivo exposure-based group therapy of spider phobia. Methods: In a double blind, block-randomized, placebo-controlled, between-subject study design, 22 patients with specific phobia of spiders were treated with two sessions of in vivo exposure-based group therapy. Cortisol (20 mg) or placebo was orally administered 1 hr before each therapy session. Patients returned for a follow-up assessment one month after therapy. Results: Exposure-based group therapy led to a significant decrease in phobic symptoms as assessed with the Fear of Spiders Questionnaire (FSQ) from pretreatment to immediate posttreatment and to follow-up. The administration of cortisol to exposure therapy resulted in increased salivary cortisol concentrations and a significantly greater reduction in fear of spiders (FSQ) as compared to placebo at follow-up, but not immediately posttreatment. Furthermore, cortisol-treated patients reported significantly less anxiety during standardized exposure to living spiders at follow-up than placebotreated subjects. Notably, groups did not differ in phobia-unrelated state-anxiety before and after the exposure sessions and at follow-up. Conclusions: These findings indicate that adding cortisol to in vivo exposure-based group therapy of spider phobia enhances treatment outcome. Depression and Anxiety 0:1–7, 2013.

Emotion regulation predicts anxiety over a five-year interval: a cross-lagged panel analysis

Abstract: Background: Emotion regulation (ER) deficits have been linked to symptoms of anxiety in cross-sectional studies. However, the direction of the relationship between ER and anxiety symptom severity (ASS) is unclear. Methods: In order to clarify the relationship between ER skills and ASS symptoms, we assessed skills andsymptomsin131 individualstwiceovera5-yearinterval.Cross-laggedpanel analyses were conducted to test whether ER skills were a significant predictor of subsequent ASS or vice versa. Additionally, we explored whether specific ER skills differed in regard to the strength of prospective associations with subsequent ASS. Results: ER skills negatively predicted subsequent ASS over and above the effects of baseline ASS (whereas anxiety symptoms did not predict subsequent ER deficits). Acceptance, tolerance, and willingness to confront had the strongest prospective effects on lower subsequent ASS. Conclusions:General ER skills may play an important role in the development and maintenance of anxiety disorders. Depression and Anxiety 31:87–95, 2014. C � 2013 Wiley Periodicals, Inc.

Evidence-Based Psychological Interventions and the Common Factors Approach: The Beginnings of a Rapprochement?

Abstract: Laska, Gurman, and Wampold (2014, pp. 467-481) argue that common factors (CFs) have largely been ignored by clinical researchers developing research-based interventions but that CFs are primarily responsible for therapeutic change. On the contrary, many clinical researchers developing empirically supported treatments have been studying the contribution of these factors for decades. What has been demonstrated is that these factors are contributory, but are not sufficient to produce maximum effects and their impact differs greatly from disorder to disorder. But we also take note of a change of tone and perhaps substance from these authors on the contribution of CFs to evidence-based psychological interventions, and reflect on recent changes in our own views both of which may reduce differences in our respective positions.

Attachment style moderates the effects of oxytocin on social behaviors and cognitions during social rejection: Applying a research domain criteria framework to social anxiety

Abstract: Whereas the DSM categorizes individuals with similar self-reported symptoms, the Research Domain Criteria (RDoC) offers a new approach for classifying mental disorders based on dimensions of observable behaviors and neurobiological measures. The objective of this proof-of-concept study is to adopt this approach by distinguishing individuals based on disorder-related personality traits during an experimental manipulation that targeted a disorder-related biological mechanism. Specifically, we examined whether attachment style moderated the effect of oxytocin administration on social behaviors and cognitions during a social exclusion test in individuals with social anxiety disorder. When receiving oxytocin compared to placebo, only individuals with low attachment avoidance displayed more social affiliation and cooperation, and only those with high attachment avoidance showed faster detection of disgust and neutral faces. Thus, attachment style moderated oxytocin's effects among individuals who shared the same DSM diagnosis. We conclude that neurobiological tests can inform new classification strategies by adopting an RDoC framework.

The need for a behavioural science focus in research on mental health and mental disorders

Abstract: Psychology as a science offers an enormous diversity of theories, principles, and methodological approaches to understand mental health, abnormal functions and behaviours and mental disorders. A selected overview of the scope, current topics as well as strength and gaps in Psychological Science may help to depict the advances needed to inform future research agendas specifically on mental health and mental disorders. From an integrative psychological perspective, most maladaptive health behaviours and mental disorders can be conceptualized as the result of developmental dysfunctions of psychological functions and processes as well as neurobiological and genetic processes that interact with the environment. The paper presents and discusses an integrative translational model, linking basic and experimental research with clinical research as well as population-based prospective-longitudinal studies. This model provides a conceptual framework to identify how individual vulnerabilities interact with environment over time, and promote critical behaviours that might act as proximal risk factors for ill-health and mental disorders. Within the models framework, such improved knowledge is also expected to better delineate targeted preventive and therapeutic interventions that prevent further escalation in early stages before the full disorder and further complications thereof develop. In contrast to conventional "personalized medicine" that typically targets individual (genetic) variation of patients who already have developed a disease to improve medical treatment, the proposed framework model, linked to a concerted funding programme of the "Science of Behaviour Change", carries the promise of improved diagnosis, treatment and prevention of health-risk behaviour constellations as well as mental disorders.

On nonrelativistic diffeomorphism invariance

Abstract: We study certain aspects of the recently proposed notion of nonrelativistic diffeomorphism invariance. In particular, we consider specific examples of invariant actions, extended gauge symmetry as well as an application to the theory of quantum Hall effect. We also discuss an alternative approach based on Ho\ifmmode \check{r}\else \v{r}\fi{}ava-Lifshitz gravity.

The Effects of Approach-Avoidance Modification on Social Anxiety Disorder: A Pilot Study.

Abstract: Cognitive bias modification has recently been discussed as a possible intervention for mental disorders. A specific form of this novel treatment approach is approach–avoidance modification. In order to examine the efficacy of approach–avoidance modification for positive stimuli associated with social anxiety, we recruited 43 individuals with social anxiety disorder and randomly assigned them to a training (implicit training to approach smiling faces) or a control (equal approach and avoidance of smiling faces) condition in three sessions over the course of a 1-week period. Dependent measures included clinician ratings, self-report measures of social anxiety, and overt behavior during behavioral approach tasks. No group differences in any of the outcome measures were observed after training. In addition, while individuals in the training group showed increased approach tendency in one of the sessions, this effect was inconsistent across the three sessions and did not result in long-term changes in implicit approach tendencies between the groups over the course of the entire study. These results suggest that approach–avoidance modification might result in short-lasting effects on implicit approach tendencies towards feared positive stimuli, but this modification may not result in meaningful behavioral change or symptom reduction in individuals with social anxiety disorder.

Cognitive enhancers for the treatment of anxiety disorders.

Abstract: Traditional treatments for anxiety disorders include cognitive-behavioral therapy and anxiolytic medications. Although these treatments are more effective than placebo, there is still considerable room for further improvement. Unfortunately, combining these different modalities is generally not substantially better than monotherapies. Recently, researchers have turned their attention toward translating preclinical research on the neural circuitry underlying fear extinction to clinical applications for the treatment of anxiety disorders with the goal to augment the learning process during exposure-based procedures with cognitive enhancers. This review examines d-cycloserine, cortisol, catecholamines, yohimbine, oxytocin, modafinil, as well as nutrients and botanicals as agents to augment treatment for anxiety disorders. D-cycloserine shows the most empirical support. Other promising agents include cortisol, catecholamines, yohimbine, and possibly oxytocin. Less support comes from studies that examined nutrients and botanicals, such as caffeine, nicotine, and omega-3 fatty acid. Limitations of the exiting literature and future research directions are discussed.

Culture and affect: the factor structure of the affective style questionnaire and its relation with depression and anxiety among Japanese

Abstract: Affective styles are assumed to be one of the underlying processes of depression and anxiety maintenance. However, little is known about the effect of depression and anxiety and the cultural influence of the factor structure. Here, we examined the cross-cultural validity of the Affective Style Questionnaire and its incremental validity for the influence on depression and anxiety. Affective Style Questionnaire was translated into Japanese using standard back-translation procedure. Japanese university students (N = 1,041) served as participants. Emotion Regulation Questionnaire, Acceptance and Action Questionnaire-II, Toronto Alexithymia Scale, Rumination and Reflection Questionnaire, Brief COPE, Self-Construal Scale, and Hospital Anxiety and Depression Scale were administered. Exploratory and confirmatory factor analyses showed that the Affective Style Questionnaire comprised four factors: Concealing, Adjusting, Holding and Tolerating (CFI = .92, TLI = .90, RMSEA = .07). The measure’s convergent and discriminant validity was substantiated by its association with various emotion regulation measures. Regression analyses showed that negative influence of Adjusting, Holding, Reappraisal (β = -.17, -.19, -.30) and positive influence of Suppression (β = .23) were observed on depression. For anxiety, Adjusting and Reappraisal was negatively influenced (β = -.29, and -.18). Reliability and validity of the Affective Style Questionnaire was partly confirmed. Further study is needed to clarify the culturally dependent aspects of affective styles.