A complex network perspective on clinical science

Contemporary classification systems for mental disorders assume that abnormal behaviors are expressions of latent disease entities. An alternative to the latent disease model is the complex network approach. Instead of assuming that symptoms arise from an underlying disease entity, the complex network approach holds that disorders exist as systems of interrelated elements of a network. This approach also provides a framework for the understanding of therapeutic change. Depending on the structure of the network, change can occur abruptly once the network reaches a critical threshold (the tipping point). Homogeneous and highly connected networks often recover more slowly from local perturbations when the network approaches the tipping point, potentially making it possible to predict treatment change, relapse, and recovery. In this article, we discuss the complex network approach as an alternative to the latent disease model and its implications for classification, therapy, relapse, and recovery.R34 MH086668 - NIMH NIH HHS; R01 AT007257 - NCCIH NIH HHS; R21 MH101567 - NIMH NIH HHS; R34 MH099311 - NIMH NIH HHS; R21 MH102646 - NIMH NIH HHS; K23 MH100259 - NIMH NIH HHS; R01 MH099021 - NIMH NIH HH

Interpersonal Emotion Regulation Questionnaire (IERQ): scale development and psychometric characteristics

Despite the popularity of emotion regulation in the contemporary literature, research has almost exclusively focused on only intrapersonal processes, whereas much less attention has been placed in interpersonal emotion regulation processes. In order to encourage research on interpersonal emotion regulation, we present a series of 4 studies to develop the Interpersonal Emotion Regulation Questionnaire (IERQ). The final scale consists of 20 items with 4 factors containing 5 items each. The 4 factors are: Enhancing Positive Affect; Perspective Taking; Soothing; and Social Modeling. The scale shows excellent psychometric characteristics. Implications for future research are discussed.R01 MH078308 - NIMH NIH HHS; R34 MH086668 - NIMH NIH HHS; R01 AT007257 - NCCIH NIH HHS; R21 MH101567 - NIMH NIH HHS; R34 MH099311 - NIMH NIH HHS; R21 MH102646 - NIMH NIH HHS; K23 MH100259 - NIMH NIH HHS; R01 MH099021 - NIMH NIH HH

Neuroenhancement of exposure therapy in anxiety disorders

Although exposure-based treatments and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Interestingly, combining these two modalities is usually not more effective than the monotherapies. Recent translational research has identified a number of novel approaches for treating anxiety disorders using agents that serve as neuroenhancers (also known as cognitive enhancers). Several of these agents have been studied to determine their efficacy at improving treatment outcome for patients with anxiety and other psychiatric disorders. In this review, we examine d-cycloserine, yohimbine, cortisol, catecholamines, oxytocin, modafinil, and nutrients such as caffeine and amino fatty acids as potential neuroenhancers. Of these agents, d-cycloserine shows the most promise as an effective neuroenhancer for extinction learning and exposure therapy. Yet, the optimal dosing and dose timing for drug administration remains uncertain. There is partial support for cortisol, catecholamines, yohimbine and oxytocin for improving extinction learning and exposure therapy. There is less evidence to indicate that modafinil and nutrients such as caffeine and amino fatty acids are effective neuroenhancers. More research is needed to determine their long term efficacy and clinical utility of these agents.R34 MH086668 - NIMH NIH HHS; R01 AT007257 - NCCIH NIH HHS; R21 MH101567 - NIMH NIH HHS; R34 MH099311 - NIMH NIH HHS; R21 MH102646 - NIMH NIH HHS; K23 MH100259 - NIMH NIH HHS; R01 MH099021 - NIMH NIH HH

The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis

BACKGROUND: Some evidence suggests that heart rate variability (HRV) biofeedback might be an effective way to treat anxiety and stress symptoms. To examine the effect of HRV biofeedback on symptoms of anxiety and stress, we conducted a meta-analysis of studies extracted from PubMed, PsycINFO and the Cochrane Library. METHODS: The search identified 24 studies totaling 484 participants who received HRV biofeedback training for stress and anxiety. We conducted a random-effects meta-analysis. RESULTS: The pre-post within-group effect size (Hedges' g) was 0.81. The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Moderator analyses revealed that treatment efficacy was not moderated by study year, risk of study bias, percentage of females, number of sessions, or presence of an anxiety disorder. CONCLUSIONS: HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety. Although more well-controlled studies are needed, this intervention offers a promising approach for treating stress and anxiety with wearable devices

Effect of Hatha yoga on anxiety: a meta-analysis

OBJECTIVE: Some evidence suggests that Hatha yoga might be an effective practice to reduce anxiety. To examine the effect of Hatha yoga on anxiety, we conducted a meta-analysis of relevant studies extracted from PubMed, PsycINFO, the Cochrane Library, and manual searches. METHODS: The search identified 17 studies (11 waitlist controlled trials) totaling 501 participants who received Hatha yoga and who reported their levels of anxiety before and after the practice. We estimated the controlled and within-group random effects of the practice on anxiety. RESULTS: The pre-post within-group and controlled effect sizes were, Hedges' g = 0.44 and Hedges' g = 0.61, respectively. Treatment efficacy was positively associated with the total number of hours practiced. People with elevated levels of anxiety benefitted the most. Effect sizes were not moderated by study year, gender, presence of a medical disorder, or age. Although the quality of the studies was relatively low, the risk of study bias did not moderate the effect. CONCLUSIONS: Hatha yoga is a promising method for treating anxiety. However, more well-controlled studies are needed to compare the efficacy of Hatha yoga with other more established treatments and to understand its mechanism. This article is protected by copyright. All rights reserved.R01 AT007257 - NCCIH NIH HH

Effect of treatments for depression on quality of life: a meta-analysis

Published in final edited form as: Cogn Behav Ther. 2017 June; 46(4): 265–286. doi:10.1080/16506073.2017.1304445.Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges' g = .63) and SSRI (Hedges' g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.This work was supported in part from NIH/NCCIH [grant number R01AT007257], NIH/NIMH [grant numbers R01MH099021; R34MH099311; R34MH086668; R21MH102646; R21MH101567; K23MH100259]. (R01AT007257 - NIH/NCCIH; R01MH099021 - NIH/NIMH; R34MH099311 - NIH/NIMH; R34MH086668 - NIH/NIMH; R21MH102646 - NIH/NIMH; R21MH101567 - NIH/NIMH; K23MH100259 - NIH/NIMH

The conditional process model of mindfulness and emotion regulation: An empirical test

BACKGROUND: The conditional process model (CPM) of mindfulness and emotion regulation posits that specific mediators and moderators link these constructs to mental health outcomes. The current study empirically examined the central tenets of the CPM, which posit that nonreactivity moderates the indirect effect of observation on symptoms of emotional disorders through cognitive emotion regulation strategies. METHODS: A clinical sample (n=1667) of individuals from Japan completed a battery of self-report instruments. Several path analyses were conducted to determine whether cognitive emotion regulation strategies mediate the relationship between observation and symptoms of individual emotional disorders, and to determine whether nonreactivity moderated these indirect effects. RESULTS: Results provided support the CPM. Specifically, nonreactivity moderated the indirect effect of observation on symptoms through reappraisal, but it did not moderate the indirect effect of observation on symptoms through suppression. LIMITATIONS: Causal interpretations are limited, and cultural considerations must be acknowledged given the Japanese sample CONCLUSIONS: These results underscore the potential importance of nonreactivity and emotion regulation as targets for interventions.R01 AT007257 - NCCIH NIH HHS; R34 MH099311 - NIMH NIH HH

Network dynamics of affect and physical activity in a heterogeneous clinical sample with high negative affect: an ecological momentary assessment study

In clinical psychology, contemporary classification systems for mental disorders assume that abnormal behaviors are expressions of latent disease entities. Although the latent disease model has been influential in both medicine and clinical psychology, there are substantive and empirical reasons for disputing its validity in psychiatric disorders. An alternative to the latent disease model is the network approach. Rather than assuming that symptoms arise from an underlying disease entity, the network approach posits that disorders exist as systems of interrelated elements of a network. Although several studies have examined the network structure of depression and related emotional disorders using a cross-sectional design, there has been an increasing emphasis on the network dynamics that underlie emotional psychopathology. Several intensive longitudinal studies have been conducted on affect in clinical psychology; however, none have attempted to characterize the network dynamics of positive and negative affect as they relate to objective measurements of physical activity using smartphone-based sensing data. The current study examined the network dynamics of positive affect, negative affect, perceived stress, and physical activity in a heterogeneous clinical sample of 34 individuals with high levels of negative affect. Participants underwent a two-week ecological momentary assessment phase. Results of the study revealed that in both the temporal and contemporaneous dynamic networks same-valence nodes exhibited positive associations and opposite-valence nodes evidenced negative associations. Physical activity exhibited significant auto-correlation, yet it was unrelated to other affect nodes in the network. Furthermore, critical slowing down, as indicated by temporal autocorrelation, in the affect and physical activity nodes were not predictive of symptom changes. However, momentary stressors were predictive of temporal autocorrelation in physical activity and affect. Baseline symptoms and maladaptive emotion regulation strategies were predictive of dynamics in negative affect. Finally, impulse response function analyses revealed that variance in negative affect nodes is accounted for largely by increases in negative affect, whereas variance in positive affect nodes is accounted for by increases in both positive and negative affect. These results provide insight into factors that influence the dynamics of positive and negative affect in patients with emotional disorders

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

Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial.

Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications.R01 AT007257 - NCCIH NIH HHS; R01 AT007258 - NCCIH NIH HH