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

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

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 role of the individual in the coming era of process-based therapy

For decades the development of evidence-based therapy has been based on experimental tests of protocols designed to impact psychiatric syndromes. As this paradigm weakens, a more process-based therapy approach is rising in its place, focused on how to best target and change core biopsychosocial processes in specific situations for given goals with given clients. This is an inherently more idiographic question than has normally been at issue in evidence-based therapy over the last few decades. In this article we explore methods of assessment and analysis that can integrate idiographic and nomothetic approaches in a process-based era.Accepted manuscrip

Enhanced mental reinstatement of exposure treatment to improve the generalization of learning in claustrophobia

Exposure therapy is the gold standard treatment for anxiety disorders, but reductions in fear following exposure often do not generalize well outside the context in which they took place. This study tested a strategy for increasing generalization that involved revisiting the memory of a prior exposure experience in order to enhance the retrieval of the learning that occurred. Forty-five participants (29 females, 16 males) with claustrophobia received exposure training consisting of repeated 5-minute trials lying inside a narrow cabinet laid on its back. One week later, they were randomly assigned to either enhanced mental reinstatement (EMR) or control procedures. Results of the exposure training showed significant decreases in subjective fear, heart rate and avoidance in the training context, as well as reduced claustrophobia symptoms. As expected, fear levels in the mock MRI scanner one week later increased relative to the exposure training context post-treatment. Compared to the control condition, the EMR intervention led to significantly reduced heart rate reactivity in the mock MRI scanner, but not to reduced self-reported fear or avoidance of the mock scanner, nor to differences in claustrophobia symptoms at one-month follow-up. Expectancy violations about coping self-efficacy, measured via participants’ surprise about their ability to effectively cope during exposure, predicted lower fear in the mock MRI regardless of condition. Fear-related expectancy violations, reflecting greater discrepancy in expected vs. actual fear levels during exposure, predicted greater fear in the mock MRI. Results highlight the potential for mental reinstatement of exposure to improve generalization of learning in claustrophobia, though effects may be limited. The impact of expectancy violations on exposure outcomes may depend on the type of expectancy that is violated

Foundations in Wisconsin: A Directory [31st ed. 2012]

The 2012 release of Foundations in Wisconsin marks the 31st edition of the print directory and the twelfth year of the online version. The directory is designed as a research tool for grantseekers interested in locating information on private, corporate, and community foundations registered in Wisconsin. Each entry in this new edition has been updated or reviewed to provide the most current information available. Most of the data was drawn from IRS 990-PF tax returns filed by the foundations. Additional information was obtained from surveys, foundation Web sites, annual reports, and newsletters. Fortunately, Wisconsin foundations are rebounding from the recent economic downturn. While the total number of active foundations (1301) decreased slightly from 2011’s high number, 57 new foundations were identified and two key measures show positive growth. Total assets increased by 12% from last year to over $7 billion, and grants rose 7$490 million, close to pre-recession totals. The following table illustrates the 10-year financial pattern as documented in Foundations in Wisconsin.https://epublications.marquette.edu/lib_fiw/1010/thumbnail.jp

Effect of d-cycloserine on fear extinction training in adults with social anxiety disorder

© 2019 Hofmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Preclinical and clinical data have shown that D-cycloserine (DCS), a partial agonist at the N-methyl-d-aspartate receptor complex, augments the retention of fear extinction in animals and the therapeutic learning from exposure therapy in humans. However, studies with nonclinical human samples in de novo fear conditioning paradigms have demonstrated minimal to no benefit of DCS. The aim of this study was to evaluate the effects of DCS on the retention of extinction learning following de novo fear conditioning in a clinical sample. Eighty-one patients with social anxiety disorder were recruited and underwent a previously validated de novo fear conditioning and extinction paradigm over the course of three days. Of those, only 43 (53%) provided analyzable data. During conditioning on Day 1, participants viewed images of differently colored lamps, two of which were followed by with electric shock (CS+) and a third which was not (CS-). On Day 2, participants were randomly assigned to receive either 50 mg DCS or placebo, administered in a double-blind manner 1 hour prior to extinction training with a single CS+ in a distinct context. Day 3 consisted of tests of extinction recall and renewal. The primary outcome was skin conductance response to conditioned stimuli, and shock expectancy ratings were examined as a secondary outcome. Results showed greater skin conductance and expectancy ratings in response to the CS+ compared to CS- at the end of conditioning. As expected, this difference was no longer present at the end of extinction training, but returned at early recall and renewal phases on Day 3, showing evidence of return of fear. In contrast to hypotheses, DCS had no moderating influence on skin conductance response or expectancy of shock during recall or renewal phases. We did not find evidence of an effect of DCS on the retention of extinction learning in humans in this fear conditioning and extinction paradigm

Characterising the dynamics of cerebral metabolic dysfunction following traumatic brain injury: A microdialysis study in 619 patients.

Funder: National Institute for Health Research (NIHR)Traumatic brain injury (TBI) is a major cause of death and disability, particularly amongst young people. Current intensive care management of TBI patients is targeted at maintaining normal brain physiology and preventing secondary injury. Microdialysis is an invasive monitor that permits real-time assessment of derangements in cerebral metabolism and responses to treatment. We examined the prognostic value of microdialysis parameters, and the inter-relationships with other neuromonitoring modalities to identify interventions that improve metabolism. This was an analysis of prospective data in 619 adult TBI patients requiring intensive care treatment and invasive neuromonitoring at a tertiary UK neurosciences unit. Patients had continuous measurement of intracranial pressure (ICP), arterial blood pressure (ABP), brain tissue oxygenation (PbtO2), and cerebral metabolism and were managed according to a standardized therapeutic protocol. Microdialysate was assayed hourly for metabolites including glucose, pyruvate, and lactate. Cerebral perfusion pressure (CPP) and cerebral autoregulation (PRx) were derived from the ICP and ABP. Outcome was assessed with the Glasgow Outcome Score (GOS) at 6 months. Relationships between monitoring variables was examined with generalized additive mixed models (GAMM). Lactate/Pyruvate Ratio (LPR) over the first 3 to 7 days following injury was elevated amongst patients with poor outcome and was an independent predictor of ordinal GOS (p70mmHg, PRx 18mmHg, and brain glucose >1mM. Deranged cerebral metabolism is an important determinant of patient outcome following TBI. Variations in cerebral perfusion, oxygenation and glucose supply are associated with changes in cerebral LPR and suggest therapeutic interventions to improve cerebral metabolism. Future prospective studies are required to determine the efficacy of these strategies

Increased blood glucose is related to disturbed cerebrovascular pressure reactivity after traumatic brain injury.

BACKGROUND: Increased blood glucose and impaired pressure reactivity (PRx) after traumatic brain injury (TBI) are both known to correlate with unfavorable patient outcome. However, the relationship between these two variables is unknown. METHODS: To test the hypothesis that increased blood glucose leads to increased PRx, we retrospectively analyzed data from 86 traumatic brain injured patients admitted to the Neurocritical Care Unit. Data analyzed included arterial glucose concentration, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and end-tidal CO2. PRx was calculated as the moving correlation coefficient between averaged (10 seconds) arterial blood pressure and ICP. One arterial glucose concentration and one time-aligned PRx value were obtained for each patient, during each day until the fifth day after ictus. RESULTS: Mean arterial glucose concentrations during the first 5 days since ictus were positively correlated with mean PRx (Pearson correlation coefficient = 0.25, p = 0.02). The correlation was strongest on the first day after injury (Pearson correlation coefficient = 0.47, p = 0.008). CONCLUSION: Our preliminary findings indicate that increased blood glucose may impair cerebrovascular reactivity, potentially contributing to a mechanistic link between increased blood glucose and poorer outcome after TBI.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s12028-014-0042-