From extinction learning to anxiety treatment: mind the gap

Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.Published versio

Enhancing health care via affective computing

Affective computing is a multidisciplinary field that studies the various ways by which computational processes are able to elicit, sense, and detect manifestations of human emotion. While the methods and technology delivered by affective computing have demonstrated very promising results across several domains, their adoption by healthcare is still at its initial stages. With that aim in mind, this commentary paper introduces affective computing to the readership of the journal and praises for the benefits of affect-enabled systems for prognostic, diagnostic and therapeutic purposes.peer-reviewe

Within- and between-session prefrontal cortex response to virtual reality exposure therapy for acrophobia

Exposure Therapy (ET) has demonstrated its efficacy in the treatment of phobias, anxiety and Post-traumatic Stress Disorder (PTSD), however, it suffers a high drop-out rate because of too low or too high patient engagement in treatment. Virtual Reality Exposure Therapy (VRET) is comparably effective regarding symptom reduction and offers an alternative tool to facilitate engagement for avoidant participants. Neuroimaging studies have demonstrated that both ET and VRET normalize brain activity within a fear circuit. However, previous studies have employed brain imaging technology which restricts people’s movement and hides their body, surroundings and therapist from view. This is at odds with the way engagement is typically controlled. We used a novel combination of neural imaging and VR technology—Functional Near-Infrared Spectroscopy (fNIRS) and Immersive Projection Technology (IPT), to avoid these limitations. Although there are a few studies that have investigated the effect of VRET on a brain function after the treatment, the present study utilized technologies which promote ecological validity to measure brain changes after VRET treatment. Furthermore, there are no studies that have measured brain activity within VRET session. In this study brain activity within the prefrontal cortex (PFC) was measured during three consecutive exposure sessions. N = 13 acrophobic volunteers were asked to walk on a virtual plank with a 6 m drop below. Changes in oxygenated (HbO) hemoglobin concentrations in the PFC were measured in three blocks using fNIRS. Consistent with previous functional magnetic resonance imaging (fMRI) studies, the analysis showed decreased activity in the DLPFC and MPFC during first exposure. The activity increased toward normal across three sessions. The study demonstrates potential efficacy of a method for measuring within-session neural response to virtual stimuli that could be replicated within clinics and research institutes, with equipment better suited to an ET session and at fraction of the cost, when compared to fMRI. This has application in widening access to, and increasing ecological validity of, immersive neuroimaging across understanding, diagnosis, assessment and treatment of, a range of mental disorders such as phobia, anxiety and PTSD or addictions

Tailoring therapeutic strategies for treating posttraumatic stress disorder symptom clusters

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, posttraumatic stress disorder (PTSD) is characterized by three major symptom clusters following an event that elicited fear, helplessness, or horror. This review will examine each symptom cluster of PTSD separately, giving case study examples of patients who exhibit a preponderance of a given symptom domain. We use a translational approach in describing the underlying neurobiology that is relevant to particular symptoms and treatment options, thus showing how clinical practice can benefit from current research. By focusing on symptom clusters, we provide a more specific view of individual patient’s clinical presentations, in order to better address treatment needs. Finally, the review will also address potential genetic approaches to treatment as another form of individualized treatment

Acquisition and extinction across multiple virtual reality contexts: implications for specific phobias and current treatment methods

Victor Wong studied human acquisition learning over multiple contexts using virtual reality. He found that learning an association over multiple contexts can impact subsequent extinction training. This suggests that fears acquired over multiple contexts may be more difficult to treat using exposure-based therapies and will need to be augmented for effectiveness

BEST PRACTICE OCCUPATIONAL THERAPY INTERVENTIONS FOR ADDRESSING TRAUMA AND POSTTRAUMATIC STRESS DISORDER: A PRACTITIONER GUIDE

Posttraumatic stress disorder (PTSD) impacts approximately 3.6% of adults and 5% of adolescents in the United States and has pervasive impacts on occupational performance (National Institute of Mental Health, n.d.). Occupational therapy practitioners (OTPs) likely encounter clients with PTSD frequently due to this widespread prevalence in addition to trauma being comorbid with a variety of mental and physical health conditions. Despite the widespread prevalence of trauma, many OTPs find that trauma-informed care is not adequately implemented in practice (Holman et al., 2022). There is a gap in the literature regarding occupational performance deficits experienced among clients with trauma, knowledge of how to address trauma in practice among OTPs, and application of trauma related knowledge to practice. Best Practice Occupational Therapy Interventions for Addressing Trauma and Posttraumatic Stress Disorder: A Practitioner Guide (see appendix A) was created to bridge this gap. A needs assessment including a literature review, skilled observation, and collaboration with an OTP with expertise in trauma, was conducted to inform the guide. The guide leads the OTP through the occupational therapy process, discusses impacts of trauma, and addresses common comorbidities. With trauma being highly prevalent and having widespread impacts on occupational performance, Best Practice Occupational Therapy Interventions for Addressing Trauma and Posttraumatic Stress Disorder: A Practitioner Guide is needed to provide OTPs with knowledge on how to address it in practice