A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators

INTRODUCTION: Social anxiety disorder (SAD) is among the most prevalent mental disorders, associated with impaired functioning and poor quality of life. Pharmacotherapy is the most widely utilized treatment option. The current study provides an updated meta-analytic review of the efficacy of pharmacotherapy and examines moderators and mediators of treatment efficacy. Areas Covered: A comprehensive search of the current literature yielded 52 randomized, pill placebo-controlled trials of pharmacotherapy for adults diagnosed with SAD. Data on potential mediators of treatment outcome were collected, as well as data necessary to calculate pooled correlation matrices to compute indirect effects. Expert Opinion: The overall effect size of pharmacotherapy for SAD is small to medium (Hedges' g = 0.41). Effect sizes were not moderated by age, sex, length of treatment, initial severity, risk of study bias, or publication year. Furthermore, reductions in symptoms mediated pharmacotherapy's effect on quality of life. Support was found for reverse mediation. Future directions may include sustained efforts to examine treatment mechanisms of pharmacotherapy using rigorous longitudinal methodology to better establish temporal precedence

D-Cycloserine as an augmentation strategy for cognitive behavioral therapy of anxiety disorders

The goal of this review is to examine the clinical studies on d-cycloserine, a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure procedures during cognitive behavioral therapy for anxiety disorders. Although cognitive behavioral therapy and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Traditional combination strategies typically yield disappointing results. However, recent studies based on translational research have shown promise to augment the neural circuitry underlying fear extinction with pharmacological means. We discuss the current state of the literature, including inconsistencies of findings and issues concerning the drug mechanism, dosing, and dose timing. D-cycloserine is a promising combination strategy for cognitive behavioral therapy of anxiety disorders by augmenting extinction learning. However, there is also evidence to suggest that d-cycloserine can facilitate reconsolidation of fear memory when exposure procedures are unsuccessful

The efficacy of a compassion, acceptance and mindfulness-based pilot intervention for adolescents’ test anxiety: a case study using the academic program

Test anxiety (TA) is one of the most common difficulties for secondary school students, with a negative impact in performance, mental health and well-being, and involving high levels of shame, self-criticism, and experiential avoidance. TA may also be conceptualized through an evolutionary and contextual approach to human suffering. To the best of our knowledge, no study has covered this conceptualization, nor has any previous TA treatment been simultaneously manualized, psychotherapeutic, and co-integrated compassion, acceptance and mindfulness-based practices. Moreover, studies on the efficacy of individual treatments directed to TA in adolescents are scarce, and case studies provide a comprehensive, detailed, and useful input about new models and treatments to both researchers and practitioners. The AcAdeMiC Program (Acting with Acceptance, Mindfulness and Compassion to overcome Test/Exam Anxiety) is a manualized 12-session online individual psychotherapeutic intervention, aiming to decrease test anxiety and boost well-being, compassion, acceptance and mindfulness. This is the first study presenting the treatment of an adolescent with high levels of test anxiety using this program. The Reliable Change Index (RCI) showed improvement, and maintenance or increase of gains over time, across all targeted symptoms and processes. The AcAdeMiC was also qualitatively and quantitatively perceived as useful and effective at posttreatment. This clinical case study provides a first glance at the conceptualization and treatment of TA with the new AcAdeMiC program

Mindfulness-based interventions in epilepsy: a systematic review

Mindfulness based interventions (MBIs) are increasingly used to help patients cope with physical and mental long-term conditions (LTCs). Epilepsy is associated with a range of mental and physical comorbidities that have a detrimental effect on quality of life (QOL), but it is not clear whether MBIs can help. We systematically reviewed the literature to determine the effectiveness of MBIs in people with epilepsy. Medline, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Allied and Complimentary Medicine Database, and PsychInfo were searched in March 2016. These databases were searched using a combination of subject headings where available and keywords in the title and abstracts. We also searched the reference lists of related reviews. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Three randomised controlled trials (RCTs) with a total of 231 participants were included. The interventions were tested in the USA (n = 171) and China (Hong Kong) (n = 60). Significant improvements were reported in depression symptoms, quality of life, anxiety, and depression knowledge and skills. Two of the included studies were assessed as being at unclear/high risk of bias - with randomisation and allocation procedures, as well as adverse events and reasons for drop-outs poorly reported. There was no reporting on intervention costs/benefits or how they affected health service utilisation. This systematic review found limited evidence for the effectiveness of MBIs in epilepsy, however preliminary evidence suggests it may lead to some improvement in anxiety, depression and quality of life. Further trials with larger sample sizes, active control groups and longer follow-ups are needed before the evidence for MBIs in epilepsy can be conclusively determined

Prescribing where there is a comorbid presentation of anxiety and depression: a case study

This case study considers a complex presentation of anxiety with associated depression, and describes a stepped approach to care and treatment, as advocated by the National Institute for Health and Clinical Excellence. The classification of mental disorders is referred to in the case study. Mixed anxiety and depression is a common presentation in primary care, characterised by a mix of anxiety and depressive symptoms without clear prominence of any one type and the presence of one or more physical symptoms that are present for more than six months. Anxiolytic medication is often used as a first aid measure in anxiety, and is very useful and appropriate for this. However, it is quite difficult to assess the longer-term effectiveness of these drugs, as anxiety tends to vary for reasons other than drug treatment, such as external pressures. There is good evidence to support the efficacy of psychological interventions in anxiety spectrum disorders. Consequently, self help and cognitive behaviour therapy may be the first line of treatment for less severe cases and can be used in conjunction with medication

Assessing psychological flexibility in test situations: The test anxiety acceptance and action questionnaire for adolescents

Acceptance-based interventions such as acceptance and commitment therapy motivated the development of measures of psychological flexibility. As an anxiety-based condition, test anxiety can be conceptualized as an experiential avoidance condition. Given the need to evaluate acceptance and action processes in test anxiety and the lack of such an instrument, the present study aimed to explore the factor structure and psychometric properties of the Test Anxiety-Acceptance and Action Questionnaire for Adolescents (TA-AAQ-A), adapted from the Social Anxiety-Acceptance and Action Questionnaire. The sample comprised 827 adolescents (12-18 years old) from 10 Portuguese schools. Confirmatory factor analysis indicated a well-adjusted 12-item single-factor measure, invariant across genders. Results also showed high internal consistency and temporal stability, and good convergent validity. Findings suggest the TA-AAQ-A is a reliable and valid measure for the assessment of adolescents' psychological flexibility in test situations

Coexistence of the topological state and a two-dimensional electron gas on the surface of Bi2Se3

Topological insulators are a recently discovered class of materials with fascinating properties: While the inside of the solid is insulating, fundamental symmetry considerations require the surfaces to be metallic. The metallic surface states show an unconventional spin texture, electron dynamics and stability. Recently, surfaces with only a single Dirac cone dispersion have received particular attention. These are predicted to play host to a number of novel physical phenomena such as Majorana fermions, magnetic monopoles and unconventional superconductivity. Such effects will mostly occur when the topological surface state lies in close proximity to a magnetic or electric field, a (superconducting) metal, or if the material is in a confined geometry. Here we show that a band bending near to the surface of the topological insulator Bi$_2$Se$_3$ gives rise to the formation of a two-dimensional electron gas (2DEG). The 2DEG, renowned from semiconductor surfaces and interfaces where it forms the basis of the integer and fractional quantum Hall effects, two-dimensional superconductivity, and a plethora of practical applications, coexists with the topological surface state in Bi$_2$Se$_3$. This leads to the unique situation where a topological and a non-topological, easily tunable and potentially superconducting, metallic state are confined to the same region of space.Comment: 12 pages, 3 figure

Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials

Objective Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Method Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Results Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = −0.59, 95% CI = −0.12 to −1.06). Effects were demonstrated for depressive symptom severity (Hedges g = −0.73, 95% CI = −0.09 to −1.36), but not for anxiety symptom severity (Hedges g = −0.55, 95% CI = 0.09 to −1.18), for RCTs with an inactive control (Hedges g = −1.03, 95% CI = −0.40 to −1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to −0.48) and effects were found for MBCT (Hedges g = −0.39, 95% CI = −0.15 to −0.63) but not for MBSR (Hedges g = −0.75, 95% CI = 0.31 to −1.81). Conclusions This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population