Does the Way Exposure Exercises are Presented Matter? Comparing Fear Reduction Versus Fear Toleration Models

Exposure therapy is considered to be a first line treatment for a variety of anxiety disorders as supported by several review studies. However, there is no clear understanding of how it works. The present study examined how framing exposure exercises impacted outcomes in socially anxious individuals. We conducted a brief two-session exposure-based intervention, including experiential exercises from each therapeutic rationale, with homework assigned between sessions. We were specifically interested in the efficacy of four brief skills interventions: (a) fear reduction, (b) psychological flexibility, (c) values rationale, and (d) control for reducing public speaking anxiety from first to second exposure session. By combining participants at Utah State University and the University of Colorado Boulder, 81 individuals were randomized to participate in the study. Consistent with our prediction, individuals receiving an active intervention improved to a greater extent on major outcome measures of social anxiety compared to the control group. No significant differences were found between active interventions. Results showed no significant group differences in SUDs change at session 1 or session 2. Additionally, at session 1 those who received an active intervention displayed more within-session exposure engagement than individuals in the control condition. Importantly, there was no difference in between-session exposure engagement (number of exposures attempted) between groups. Overall, the results from this study suggest that there may not be one right way to implement exposure. Furthermore, there may be an overarching mechanism by which exposure works

Effectiveness of Acceptance and Commitment Therapy as a Treatment for Posttraumatic Stress Disorder and Moral Injury

Posttraumatic stress disorder (PTSD) is a common condition among military personal and veterans. Despite strong empirical support for first line treatments for PTSD, many veterans do not complete or respond to treatment. Research suggests that experiential avoidance is a contributing factor to both treatment dropout and minimal treatment gains. Acceptance and commitment therapy (ACT) is an empirically supported cognitive behavioral intervention that aims to decrease experiential avoidance while increasing psychological flexibility. Research has shown ACT to be a promising intervention for the treatment of PTSD; however, its effectiveness in veterans with PTSD is limited. In conjunction with Utah State University (USU) and the Salt Lake City Veterans Affairs Medical Center, Ellen Bluett, a USU doctoral psychology student and staff psychologist at the VA conducted a study to examine a next-step treatment for veterans with PTSD. The main purpose of this study was to examine the effectiveness of an 8- week closed group design ACT intervention for veterans with PTSD and subclinical PTSD who had previously completed a first line intervention for PTSD. Thirty-three veterans enrolled in the intervention, which focused on vitality (e.g., increasing valued living and decreasing experiential avoidance) rather than symptom reduction. Symptom and process of change measures including PTSD symptoms, valued living, and quality of life were measured at pretreatment, posttreatment, and again at 1-month follow-up. Findings from this study showed that 64.7% of veterans showed a favorable response to treatment as measured by a 5-point change in PTSD symptoms. Additionally, outcomes of interest including PTSD symptoms, valued living, depression, wellbeing, and moral injury by transgressions improved from pretreatment to posttreatment. Of note, a majority of treatment gains were not maintained at follow-up. Overall, results provide preliminary support for ACT as a second-line intervention for veteran PTSD

Milk Production from Cows Grazing Perennial Ryegrass Pastures Infected with Wild or AR1 Endophyte in New Zealand

Most perennial ryegrass (Lolium perenne) cultivars in New Zealand are available with either the natural wild endophyte (Neotyphodium lolii); the AR1 novel endophyte (no lolitrem B or ergovaline production); or endophyte-free. Although wild endophyte protects ryegrass against insect attack, improving pasture persistence, it can also cause ryegrass staggers and reduced animal performance. Endophyte AR1 does not cause ryegrass staggers but still protects against insect pests such as Argentine stem weevil (Listronotus bonariensis). A 3-year farmlet experiment was carried out to evaluate the effects of AR1 and wild endophyte-infected ryegrass on pasture performance, milk production and cow health

A Longitudinal Perspective on User Uptake of an Electronic Personal Health Record for Diabetes, With Respect To Patient Demographics

INTRODUCTION: The growing prevalence of diabetes has increased the need for scalable technologies to improve outcomes. My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) available to all people with diabetes in Scotland since 2010, associated with improved clinical outcomes among users. MDMW pulls data from a national clinician-facing informatics platform and provides self-management and educational information. This study aims to describe MDMW user demographics through time with respect to the national diabetes population, with a view to addressing potential health inequalities. METHODS: Aggregate data were obtained retrospectively from the MDMW database and annual Scottish Diabetes Survey (SDS) from 2010 to 2020. Variables included diabetes type, sex, age, socioeconomic status, ethnicity, and glycemic control. Prevalence of MDMW uptake was calculated using corresponding SDS data as denominators. Comparisons between years and demographic sub-groups were made using Chi- Squared tests. RESULTS: Overall uptake of MDMW has steadily increased since implementation. By 2020, of all people with T1D or T2D in Scotland, 13% were fully enrolled to MDMW (39,881/312,326). There was proportionately greater numbers of users in younger, more affluent demographic groups (with a clear social gradient) with better glycemic control. As uptake has increased through time, so too has the observed gaps between different demographic sub-groups. CONCLUSIONS: The large number of MDMW users is encouraging, but remains a minority of people with diabetes in Scotland. There is a risk that innovations like MDMW can widen health inequalities and it is incumbent upon healthcare providers to identify strategies to prevent this

Longitudinal Effects of a 2-Year Meditation and Buddhism Program on Well-being, Quality of Life, and Valued Living

Objectives: Most research on mindfulness and meditation has focused on structured therapeutic interventions, such as mindfulness-based stress reduction, or meditation retreats. Such programs have received moderate empirical support for improving psychological outcomes in clinical and nonclinical populations, but there remains a paucity of research on intensive or long-term mindfulness or meditation programs for experienced practitioners, especially those that incorporate Buddhist teachings. The purpose of the current study was to investigate the effects of a long-term integrated mindfulness/meditation and Buddhism program, Dharma in Daily Life (DIDL). Methods: Well-being, quality of life, valued living, and theorized processes of change were measured using a naturalistic, quasi-experimental design over the course of the 2-year program and 6-month follow-up. Participants included 17 individuals enrolled in the program and 14 individuals recruited from community meditation groups. Results: Participation in the program predicted increases in subjective well-being and mindfulness over time compared to the control group. Regardless of condition, frequency of meditation predicted lower psychological inflexibility and higher mindfulness, well-being, and progress toward values. Length of meditation session predicted a greater ability to observe experience, and prior meditation experience predicted greater non-reactivity to experience. Conclusions: Although preliminary, results suggest that participation in a long-term integrated mindfulness/meditation and Buddhism program may positively impact mindfulness and general well-being. Frequency of meditation sessions appears to be a particularly important variable. These findings warrant further investigation of such programs and practice parameters, as well as how each may affect key outcomes

Moderators and Processes of Change in Traditional Exposure and Response Prevention (ERP) Versus Acceptance and Commitment Therapy-Informed ERP for Obsessive-Compulsive Disorder

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT+ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, posttreatment, and follow-up data from the study. We examined (a) moderation effects of anxiety, depression, psychological inflexibility, and interpretation of intrusions and (b) the role of psychological inflexibility and interpretation of intrusions respectively as processes of change. Participants with less dysfunctional appraisals at pretreatment performed consistently better in ERP relative to ACT+ERP. In process analyses, psychological inflexibility and interpretation of intrusions positively influenced OCD severity over time in both conditions but OCD symptom severity also positively influenced psychological inflexibility and interpretation of intrusions in both conditions. Furthermore, whereas OCD symptom severity strongly and positively predicted dysfunctional appraisals over the course of treatment in ERP, symptom severity had a weaker positive effect on dysfunctional appraisals in ACT+ERP. Clinical and theoretical implications as well as study limitations are discussed

A proteomics study of rheumatoid arthritis patients on etanercept identifies putative biomarkers associated with clinical outcome measures

\ua9 The Author(s) 2023. Objectives: Biologic DMARDs (bDMARDs) are widely used in patients with RA, but response to bDMARDs is heterogeneous. The objective of this work was to identify pretreatment proteomic biomarkers associated with RA clinical outcome measures in patients starting bDMARDs. Methods: Sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) was used to generate spectral maps of sera from patients with RA before and after 3 months of treatment with the bDMARD etanercept. Protein levels were regressed against RA clinical outcome measures, i.e. 28-joint DAS (DAS28) and its subcomponents and DAS28 <2.6 (i.e. remission). The proteins with the strongest evidence for association were analysed in an independent, replication dataset. Finally, subnetwork analysis was carried out using the Disease Module Detection algorithm and biological plausibility of identified proteins was assessed by enrichment analysis. Results: A total of 180 patients with RA were included in the discovery dataset and 58 in the validation dataset from a UK-based prospective multicentre study. Ten individual proteins were found to be significantly associated with RA clinical outcome measures. The association of T-complex protein 1 subunit g with DAS28 remission was replicated in an independent cohort. Subnetwork analysis of the 10 proteins from the regression analysis identified the ontological theme, with the strongest associations being with acute phase and acute inflammatory responses. Conclusion: This longitudinal study of 180 patients with RA commencing etanercept has identified several putative protein biomarkers of treatment response to this drug, one of which was replicated in an independent cohort

Dropout Rates in Exposure with Response Prevention for Obsessive-Compulsive Disorder: What Do the Data Really Say?

The purposes of this review were to: 1) determine the attrition rates for exposure with response prevention (ERP) for obsessive-compulsive disorder (OCD), 2) compare them to those in other treatments for OCD, and 3) identify predictors of ERP attrition. A systematic literature search of randomized controlled trials for ERP for OCD yielded 21 studies, representing 1400 participants. Attrition data were extracted for individual treatment conditions. The weighted mean dropout rate for ERP was 14.7% (95% CI [11.4%, 18.4%]). This figure was not statistically different from that of comparison conditions (e.g., cognitive therapy; OR = 0.67-2.22, all ps \u3e 0.15). Only two studies reported refusal rates for ERP (weighted mean = 4.0%; 95% CI [0.7%, 9.2%]), which precluded calculation of a reliable refusal rate for ERP. Based on these figures, we estimated an overall attrition rate of 18.7% for ERP. Treatment experience, therapist qualification, and number of treatment sessions did not significantly predict dropout rate. Our review indicates that ERP may have treatment dropout rates similar to other treatments for OCD. © 2016 Elsevier Ltd

Glucagon-like peptide 1 receptor activation regulates cocaine actions and dopamine homeostasis in the lateral septum by decreasing arachidonic acid levels

Agonism of the glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) has been effective at treating aspects of addictive behavior for a number of abused substances, including cocaine. However, the molecular mechanisms and brain circuits underlying the therapeutic effects of GLP-1R signaling on cocaine actions remain elusive. Recent evidence has revealed that endogenous signaling at the GLP-1R within the forebrain lateral septum (LS) acts to reduce cocaine-induced locomotion and cocaine conditioned place preference, both considered dopamine (DA)-associated behaviors. DA terminals project from the ventral tegmental area to the LS and express the DA transporter (DAT). Cocaine acts by altering DA bioavailability by targeting the DAT. Therefore, GLP-1R signaling might exert effects on DAT to account for its regulation of cocaine-induced behaviors. We show that the GLP-1R is highly expressed within the LS. GLP-1, in LS slices, significantly enhances DAT surface expression and DAT function. Exenatide (Ex-4), a long-lasting synthetic analog of GLP-1 abolished cocaine-induced elevation of DA. Interestingly, acute administration of Ex-4 reduces septal expression of the retrograde messenger 2-arachidonylglycerol (2-AG), as well as a product of its presynaptic degradation, arachidonic acid (AA). Notably, AA reduces septal DAT function pointing to AA as a novel regulator of central DA homeostasis. We further show that AA oxidation product γ-ketoaldehyde (γ-KA) forms adducts with the DAT and reduces DAT plasma membrane expression and function. These results support a mechanism in which postsynaptic septal GLP-1R activation regulates 2-AG levels to alter presynaptic DA homeostasis and cocaine actions through AA

Impact of inadequate adherence on response to subcutaneously administered anti-tumour necrosis factor drugs: results from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort

Objective. Non-adherence to DMARDs is common, but little is known about adherence to biologic therapies and its relationship to treatment response. The purpose of this study was to investigate the association between self-reported non-adherence to s.c. anti-TNF therapy and response in individuals with RA. Methods. Participants about to start s.c. anti-TNF therapy were recruited to a large UK multicentre prospective observational cohort study. Demographic information and disease characteristics were assessed at baseline. Self-reported non-adherence, defined as whether the previous due dose of biologic therapy was reported as not taken on the day agreed with the health care professional, was recorded at 3 and 6 months following the start of therapy. The 28-joint DAS (DAS28) was recorded at baseline and following 3 and 6 months of therapy. Multivariate linear regression was used to examine these relationships. Results. Three hundred and ninety-two patients with a median disease duration of 7 years [interquartile range (IQR) 3–15] were recruited. Adherence data were available in 286 patients. Of these, 27% reported non-adherence to biologic therapy according to the defined criteria at least once within the first 6-month period. In multivariate linear regression analysis, older age, lower baseline DAS28 and ever non-adherence at either 3 or 6 months from baseline were significantly associated with a poorer DAS28 response at 6 months to anti-TNF therapy. Conclusion. Patients with RA who reported not taking their biologic on the day agreed with their health care professional showed poorer clinical outcomes than their counterparts, emphasizing the need to investigate causes of non-adherence to biologics