The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder : extended results of the SOPHONET-Study

Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken −1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts

Women with a History of Childhood Maltreatment Exhibit more Activation in Association Areas Following Non-Traumatic Olfactory Stimuli: A fMRI Study

Background: The aim of this study was investigating how women with a history of childhood maltreatment (CM) process non-threatening and non-trauma related olfactory stimuli. The focus on olfactory perception is based on the overlap of brain areas often proposed to be affected in CM patients and the projection areas of the olfactory system, including the amygdala, orbitofrontal cortex, insula and hippocampus. Methods: Twelve women with CM and 10 controls participated in the study. All participants were, or have been, patients in a psychosomatic clinic. Participants underwent a fMRI investigation during olfactory stimulation with a neutral (coffee) and a pleasant (peach) odor. Furthermore, odor threshold and odor identification (Sniffin ’ Sticks) were tested. Principal Findings: Both groups showed normal activation in the olfactory projection areas. However, in the CM-group we found additionally enhanced activation in multiple, mainly neocortical, areas that are part of those involved in associative networks. These include the precentral frontal lobe, inferior and middle frontal structures, posterior parietal lobe, occipital lobe, and the posterior cingulate cortex. Conclusions: The results indicate that in this group of patients, CM was associated with an altered processing of olfactory stimuli, but not development of a functional olfactory deficit. This complements other studies on CM insofar as we found th

The sensory channel of presentation alters subjective ratings and autonomic responses toward disgusting stimuli – Blood pressure, heart rate and skin conductance in response to visual, auditory, haptic and olfactory presented disgusting stimuli

Disgust causes specific reaction patterns, observable in mimic responses and body reactions. Most research on disgust deals with visual stimuli. However, pictures may cause another disgust experience than sounds, odors, or tactile stimuli. Therefore, disgust experience evoked by four different sensory channels was compared. A total of 119 participants received 3 different disgusting and one control stimulus, each presented through the visual, auditory, tactile, and olfactory channel. Ratings of evoked disgust as well as responses of the autonomic nervous system (heart rate, skin conductance level, systolic blood pressure) were recorded and the effect of stimulus labeling and of repeated presentation was analyzed. Ratings suggested that disgust could be evoked through all senses; they were highest for visual stimuli. However, autonomic reaction toward disgusting stimuli differed according to the channel of presentation. In contrast to the other, olfactory disgust stimuli provoked a strong decrease of systolic blood pressure. Additionally, labeling enhanced disgust ratings and autonomic reaction for olfactory and tactile, but not for visual and auditory stimuli. Repeated presentation indicated that participant's disgust rating diminishes to all but olfactory disgust stimuli. Taken together we argue that the sensory channel through which a disgust reaction is evoked matters

Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social phobia into clinical practice: study protocol for a cluster-randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia.</p> <p>Methods/Design</p> <p>The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale.</p> <p>Discussion</p> <p>We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study.</p> <p>Trial Registration</p> <p>German Clinical Trials Register (DRKS) DRKS00000570</p

The specificity and the development of social-emotional competence in a multi-ethnic-classroom

<p>Abstract</p> <p>Background</p> <p>Ethnic diversity in schools increases due to globalization. Thus, the children's social-emotional competence development must be considered in the context of a multi-ethnic classroom.</p> <p>Methods</p> <p>In this study, the social-emotional competence of 65 Asian-American and Latin-American children was observed at the beginning and the end of their kindergarten year.</p> <p>Results</p> <p>Initially, significant differences existed among these ethnic groups in respect to moral reasoning. Furthermore, the male children showed more dysregulated aggression but the female children implemented more moral reasoning than their male counterparts. These ethnic specificities did not disappear over the course of the year. In addition, a significant change in avoidance strategies as well as expressed emotions in the narrative took place over the course of one year.</p> <p>Conclusion</p> <p>Ethnic specificity in social-emotional competence does exist independent of gender at the beginning as well as at the end of the kindergarten year in a multi-ethnic kindergarten classroom.</p

Fidgeting Behavior During Psychotherapy: Hand Movement Structure Contains Information About Depressive Symptoms

&lt;jats:title&gt;Abstract&lt;/jats:title&gt; &lt;jats:p&gt;Fidgeting may be a motor sign reflecting self-regulation processes in patients with social anxiety disorder (SAD) and depressive patients. Since SAD co-occurs with comorbid depression, the question arises whether fidgeting is a disorder-unspecific phenomenon or a specific and therefore diagnostically relevant sign of depression. 33 SAD patients with (n = 12) and without (n = 21) depression from the Social Phobia Psychotherapy Research Network project were compared regarding their nonverbal behavior. Four video sequences of a psychotherapy session with each patient were analyzed using a standardized system for the analysis of nonverbal behavior by two independent, certified, blind raters. SAD patients with comorbid depression exhibited significantly more (number/minute) irregular movements, but fewer (number/minute) repetitive movements than SAD patients without depression. Irregular movements, which reflect less structured motor behavior, are associated with comorbid depression in SAD. In contrast, in SAD without depression, more structured repetitive movements were prominent. Thus, irregular movements represent a diagnostically relevant behavior for comorbid depression among SAD patients.&lt;/jats:p&gt

Mentalizing Language Development in a Longitudinal Attachment Sample: Implications for Alexithymia

Background: The construct of alexithymia implies a deficit in symbolization for emotional, somatic, and mental states. However, the etiologic factors for alexithymia have not yet been fully elucidated. The present study investigated the use of mentalizing language, i.e. the utterance of internal states, from a developmental perspective according to attachment organization and disorganization. Methods: A longitudinal design across 4 time points was applied to a volunteer sample of 42 children. At 12 months, children were tested with the strange situation procedure, the standard measure of attachment at the optimal age, and attachment classifications were taken of videotapes. At ages 17, 23, 30 and 36 months, mother and child were observed in simplified separation episodes of 30 min duration. Transcripts of the sessions were subject to coding of internal state words. Results: During the investigated span, securely attached children rapidly acquired emotion, physiology, cognition and emotion-regulatory language, whereas insecurely attached and disorganized children either completely lacked internal state language or displayed a considerable time lag in the use of emotion and cognition vocabulary. Conclusion: The results raise the possibility that alexithymia might be a consequence of deficits in the development of internal state language in the context of insecure or disorganized childhood attachment relationships.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Attachment organization and the early development of internal state language: a longitudinal perspective

There are many postulates of a relation between quality of attachment with theory of mind and language functions (e.g., de Rosnay &amp; Hughes, 2006). The current study examined in longitudinal design how different patterns of attachment are associated with usage of internal state language at ages 17, 23, 30 and 36 months. Transcripts of mother�child play situations were coded for eleven categories of internal state language: positive emotion, negative emotion, valence reversal, physiology, ability, volition, obligation, moral, cognition, emotion-modulatory particles and cognitive-contrast particles. Repeated-measures ANOVAs revealed that securely attached children exhibit more frequent utterances of positive emotion, valence reversal, physiology, ability, cognition, emotion-modulatory, and cognitive-contrast particles at relatively earlier times. Negative emotion terms were more frequently uttered by avoidant-insecure children at 30 months and by disorganized children at 36 months