Assuntos
Medo/psicologia , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/reabilitação , Modalidades de Fisioterapia/tendências , Medicina Física e Reabilitação/tendências , Aprendizagem da Esquiva , Humanos , Movimento , Transtornos Fóbicos/etiologia , Transtornos Fóbicos/reabilitação , Modalidades de Fisioterapia/psicologiaRESUMO
Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives. IMPACT: For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
Assuntos
Dor Crônica/reabilitação , Medo/psicologia , Terapia Implosiva/métodos , Transtornos Fóbicos/reabilitação , Teoria Psicológica , Dor Crônica/psicologia , Humanos , Transtornos Fóbicos/psicologiaRESUMO
Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that-according to the current evidence in sports medicine-the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level-and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.
Assuntos
Traumatismos em Atletas/reabilitação , Terapia Comportamental/métodos , Relesões/prevenção & controle , Volta ao Esporte/psicologia , Medicina Esportiva/métodos , Traumatismos em Atletas/psicologia , Aprendizagem da Esquiva , Medo/psicologia , Humanos , Movimento , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Relesões/psicologiaRESUMO
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
Assuntos
Modelos Psicológicos , Dor Musculoesquelética/reabilitação , Transtornos Fóbicos/reabilitação , Segurança , Aprendizagem da Esquiva , Medo/psicologia , Humanos , Dor Musculoesquelética/psicologia , Transtornos Fóbicos/etiologiaRESUMO
Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider-fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self-reported phobia symptoms. Second, a guided text-mining approach was used to extract the most common words in free-text responses to the question: "What is it about spiders that you find frightening?" Both analysis types suggested that movement-related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement-related fears in in-vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer-based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.
Assuntos
Transtornos Fóbicos/fisiopatologia , Aranhas , Adulto , Animais , Mineração de Dados , Humanos , Transtornos Fóbicos/reabilitação , Autorrelato , Terapia de Exposição à Realidade VirtualRESUMO
BACKGROUND AND OBJECTIVES: Anxious individuals infer danger from information about physiological responses, anxiety responses, and safety behaviors. This study investigated whether anxious individuals also infer safety from approach behavior. METHODS: 325 students rated the danger they perceived in general and spider-relevant scenarios in which information about objective safety versus objective danger, and approach behavior versus no approach behavior, was varied. A high and low spider fearful group was created with a median split on spider fear. RESULTS: Participants with a high fear of spiders, compared to participants with low spider fear, rated spider scenarios with approach behavior as safer than spider scenarios without approach behavior. This effect was similar for objectively dangerous and safe spider scenarios. No behavior as information effects were found for general scenarios. LIMITATIONS: The data were collected in a non-clinical student sample. CONCLUSIONS: Spider fearful individuals infer safety from approach behavior in spider-relevant scenarios. For spider fearful individuals, approach behavior may add to the beneficial effects of exposure therapy. Future research is needed to investigate whether patients with anxiety disorders also show a tendency to infer safety from approach behavior.
Assuntos
Ansiedade/psicologia , Ansiedade/reabilitação , Comportamento de Escolha/fisiologia , Terapia Implosiva/métodos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Adolescente , Adulto , Medo/psicologia , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: The aim of the study was to examine habituation of subjective anxiety and electrophysiological correlates of cortical hyper-vigilance during exposure to spider images among high (n = 12) and low (n = 11) spider fear groups. METHODS: Participants viewed a six-stage hierarchy of spider images. The images used at stage 1 and stage 6 were the same. Subjective anxiety was rated at four intervals during each three-minute exposure stage (0, 60, 120, and 180 s) and event-related potentials (ERPs) were averaged across these epochs (0-60, 60-120, 120-180). RESULTS: High spider fearfuls demonstrated greater habituation of self-reported anxiety within and between exposure stages compared to low fearfuls. Consistent with attentional hyper-vigilance, the high-fear group also demonstrated greater P1 amplitude in response to spider images. In both groups, habituation of P1 amplitude was found at later relative to earlier stages, but increased at stage six when the stage 1 image was re-presented, despite low subjective anxiety. LIMITATIONS: While the passive viewing paradigm mirrored image-based exposure, it was not possible to determine whether participants engaged in avoidance strategies. In addition, further research is needed to assess the relevance of habituation and reinstatement of P1 amplitude to therapeutic outcome. CONCLUSIONS: Habituation of subjective anxiety during image-based exposure is not necessarily accompanied by a reduction in measures of cortical hyper-vigilance. The reinstatement of the P1 response may indicate either re-activation of previous associations, less avoidance, or a more generalised dishabituation mechanism.
Assuntos
Ansiedade , Nível de Alerta/fisiologia , Habituação Psicofisiológica/fisiologia , Imagens, Psicoterapia/métodos , Transtornos Fóbicos , Autorrelato , Adolescente , Adulto , Análise de Variância , Animais , Ansiedade/fisiopatologia , Ansiedade/psicologia , Ansiedade/reabilitação , Eletroencefalografia , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino , Transtornos Fóbicos/fisiopatologia , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Escalas de Graduação Psiquiátrica , Aranhas , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias ('ConfID'). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness. METHODS: Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization. RESULTS: Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants' attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range. LIMITATIONS: Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results. CONCLUSIONS: The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants' attitudes towards Internet interventions.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Internet , Transtorno de Pânico/reabilitação , Transtornos Fóbicos/reabilitação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Terapia Assistida por Computador , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVES: The current study examines effects of exposure in multiple contexts on fear reduction and renewal and the moderating effect of baseline threat-specific and nonspecific emotionality. METHODS: Snake-fearful participants received a negative or neutral emotion induction and were randomized to video exposure to a snake in a single context, multiple context, or a no exposure control group. RESULTS: Anxiety in response to video presentations of a snake was significantly reduced in the two exposure groups compared to the control group, especially among those with heightened baseline threat-specific emotionality as indicated by snake anxiety ratings at baseline. Although the two exposure groups did not differ in responding when confronted with a novel snake, both exposure groups reported significantly lower snake anxiety and arousal than the control group. Subsequent analysis did show that compared to controls, the single context group demonstrated greater increase in anxiety and arousal from post-exposure to exposure to the novel snake among those with heightened snake anxiety at baseline. Furthermore, the multiple context group was less avoidant and less fearful than the single context group on a post-exposure behavioral test. LIMITATIONS: The study used an analogue exposure paradigm with an analogue sample and findings may not be generalizable to a clinical population. CONCLUSIONS: These findings suggest that baseline threat-specific emotionality influences fear reduction and renewal. The benefits of exposure in multiple contexts are discussed in relation to a distinct pattern of symptom change that is in line with an inhibitory learning approach.
Assuntos
Emoções/fisiologia , Medo , Terapia Implosiva/métodos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Adolescente , Análise de Variância , Animais , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Serpentes , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported. AIM: Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion. DESIGN: Population-based cohort study. SETTING: Secondary care rehabilitation hospital. POPULATION: In-patients undergoing rehabilitation after lumbar fusion. METHODS: At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values. RESULTS: The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830). CONCLUSIONS: The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion. CLINICAL REHABILITATION IMPACT: The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.
Assuntos
Catastrofização/reabilitação , Terapia Cognitivo-Comportamental , Dor Lombar/cirurgia , Vértebras Lombares , Transtornos Fóbicos/reabilitação , Fusão Vertebral , Adulto , Idoso , Aprendizagem da Esquiva , Catastrofização/diagnóstico , Catastrofização/etiologia , Estudos de Coortes , Medo , Feminino , Humanos , Dor Lombar/psicologia , Dor Lombar/reabilitação , Masculino , Pessoa de Meia-Idade , Atividade Motora , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/etiologia , PsicometriaRESUMO
BACKGROUND AND OBJECTIVES: Individuals with public speaking anxiety (PSA) under-rate their performance compared to objective observers. The present study examined whether exposure reduces the discrepancy between self and observer performance ratings and improved observer-rated performance in individuals with PSA. METHODS: PSA participants gave a speech in front of a small audience and rated their performance using a questionnaire before and after completing repeated exposures to public speaking. Non-anxious control participants gave a speech and completed the questionnaire one time only. Objective observers watched videos of the speeches and rated performance using the same questionnaire. RESULTS: PSA participants underrated their performance to a greater degree than did controls prior to exposure, but also performed significantly more poorly than did controls when rated objectively. Bias significantly decreased and objective-rated performance significantly increased following completion of exposure in PSA participants, and on one performance measure, anxious participants no longer showed a greater discrepancy between self and observer performance ratings compared to controls. LIMITATIONS: The study employed non-clinical student sample, but the results should be replicated in clinical anxiety samples. CONCLUSIONS: These findings indicate that exposure alone significantly reduces negative performance bias among PSA individuals, but additional exposure or additional interventions may be necessary to fully correct bias and performance deficits.
Assuntos
Viés , Autoavaliação Diagnóstica , Terapia Implosiva/métodos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Fala , Adolescente , Adulto , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
BACKGROUND: Fear reactions in phobic patients can be activated by specific perceptual cues (C) or by conceptual fear-related information (I). An earlier study with spider phobic participants documented that perceptual stimuli are particularly potent to trigger fear responses. Because fear of spiders is activated by very circumscribed stimuli, we set out to investigate whether another phobia with more contextual fear-elicitation (i.e., a situational phobia) would yield similar patterns. Thus, we investigate the two paths of fear activation (cues vs. information) and fear reduction during exposure in claustrophobic patients. METHOD: Forty-eight claustrophobic patients and 48 healthy control participants were randomly assigned to one of three virtual reality exposure conditions: C, I, or a combination of both (CI). Exposure lasted 5 min and was repeated 4 times. Self-report and physiological reactions were assessed. RESULTS: Claustrophobic patients experienced more initial self-reported fear when confronted with fear-relevant perceptual cues than conceptual information, when the perceptual cues were combined with conceptual information there was no significant enhancement. Furthermore, fear habituated more in the perceptual condition. For the physiological parameters, groups differed and in claustrophobic patients heart rate decreased differently in the conditions. LIMITATIONS: Longer exposure duration and long-term effects of the manipulation were not investigated. CONCLUSION: We found similar patterns in a situational phobia as compared to a specific-cue related phobia (animal type). Thus, once more this highlights the central role of visual cues in phobic fear and the potential of virtual reality for conducting exposure therapy.
Assuntos
Formação de Conceito/fisiologia , Sinais (Psicologia) , Percepção/fisiologia , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Dióxido de Carbono/metabolismo , Estudos de Casos e Controles , Medo/psicologia , Feminino , Resposta Galvânica da Pele , Frequência Cardíaca , Humanos , Hidrocortisona/metabolismo , Masculino , Pessoa de Meia-Idade , Estimulação Física , Escalas de Graduação Psiquiátrica , Respiração , Saliva/química , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Attention Bias Modification (ABM) targets attention bias (AB) towards threat and is a potential therapeutic intervention for anxiety. The current study investigated whether initial AB (towards or away from spider images) influenced the effectiveness of ABM in spider fear. METHODS: AB was assessed with an attentional probe task consisting of spider and neutral images presented simultaneously followed by a probe in spider congruent or spider incongruent locations. Response time (RT) differences between spider and neutral trials > 25 ms was considered 'Bias Toward' threat. RT difference < - 25 ms was considered 'Bias Away' from threat, and a difference between -25 ms and +25 ms was considered 'No Bias'. Participants were categorized into Initial Bias groups using pre-ABM AB scores calculated at the end of the study. 66 participants' (Bias Toward n = 27, Bias Away n = 18, No Bias n = 21) were randomly assigned to ABM-active training designed to reduce or eliminate a bias toward threat and 61 (Bias Toward n = 17, Bias Away n = 18, No Bias n = 26) to ABM-control. RESULTS: ABM-active had the largest impact on those demonstrating an initial Bias Towards spider images in terms of changing AB and reducing Spider Fear Vulnerability, with the Bias Away group experiencing least benefit from ABM. However, all Initial Bias groups benefited equally from active ABM in a Stress Task. LIMITATIONS: Participants were high spider fearful but not formally diagnosed with a specific phobia. Therefore, results should be confirmed within a clinical population. CONCLUSIONS: Individual differences in Initial Bias may be an important determinant of ABM efficacy.
Assuntos
Atenção/fisiologia , Viés , Terapia Cognitivo-Comportamental/métodos , Individualidade , Transtornos Fóbicos/reabilitação , Adolescente , Adulto , Animais , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Fóbicos/psicologia , Estimulação Luminosa/efeitos adversos , Escalas de Graduação Psiquiátrica , Análise de Regressão , Aranhas , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Attention Bias Modification (ABM) is used to manipulate attention biases in anxiety disorders. It has been successful in reducing attention biases and anxious symptoms in social anxiety and generalized anxiety, but not yet in specific fears and phobias. METHODS: We designed a new version of the dot-probe training task, aiming to train fearful participants' attention away from or towards pictures of threatening stimuli. Moreover, we studied whether the training also affected participants' avoidance behavior and their physical arousal upon being confronted with a real threat object. RESULTS: In Experiment 1, students with fear of spiders were trained. We found that the attention manipulation was successful, but the training failed to affect behavior or arousal. In Experiment 2, the same procedure was used on snake-fearful students. Again, attention was trained in the expected directions. Moreover, participants whose attention had been trained away from snakes showed lower physiological arousal upon being confronted with a real snake. LIMITATIONS: The study involved healthy students with normal distribution of the fear of spider/snake. Future research with clinical sample could help with determining the generalizability of the current findings. CONCLUSIONS: The effect of ABM on specific phobia is still in question. The finding in the present study suggested the possibility to alter attentional bias with a dot-probe task with general positive stimuli and this training could even affect the behavior while encountering a real threat.
Assuntos
Atenção/fisiologia , Viés , Terapia Cognitivo-Comportamental/métodos , Transtornos Fóbicos/reabilitação , Serpentes , Aranhas , Adolescente , Adulto , Animais , Feminino , Frequência Cardíaca , Humanos , Masculino , Transtornos Fóbicos/classificação , Transtornos Fóbicos/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: The biased interpretation of ambiguous social situations is considered a maintaining factor of Social Anxiety Disorder (SAD). Studies on the modification of interpretation bias have shown promising results in laboratory settings. The present study aims at pilot-testing an Internet-based training that targets interpretation and judgmental bias. METHOD: Thirty-nine individuals meeting diagnostic criteria for SAD participated in an 8-week, unguided program. Participants were presented with ambiguous social situations, were asked to choose between neutral, positive, and negative interpretations, and were required to evaluate costs of potential negative outcomes. Participants received elaborate automated feedback on their interpretations and judgments. RESULTS: There was a pre-to-post-reduction of the targeted cognitive processing biases (d = 0.57-0.77) and of social anxiety symptoms (d = 0.87). Furthermore, results showed changes in depression and general psychopathology (d = 0.47-0.75). Decreases in cognitive biases and symptom changes did not correlate. The results held stable accounting for drop-outs (26%) and over a 6-week follow-up period. Forty-five percent of the completer sample showed clinical significant change and almost half of the participants (48%) no longer met diagnostic criteria for SAD. LIMITATIONS: As the study lacks a control group, results lend only preliminary support to the efficacy of the intervention. Furthermore, the mechanism of change remained unclear. CONCLUSION: First results promise a beneficial effect of the program for SAD patients. The treatment proved to be feasible and acceptable. Future research should evaluate the intervention in a randomized-controlled setting.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Feedback Formativo , Internet , Transtornos Fóbicos/reabilitação , Adulto , Análise de Variância , Viés , Feminino , Seguimentos , Humanos , Julgamento , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente/psicologia , Transtornos Fóbicos/psicologia , Projetos Piloto , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: The current study is the first to examine whether reactivation of fear memory prior to exposure therapy reduces relapse in a randomized clinical sample. METHODS: In a standardized treatment protocol combining virtual reality and in-vivo exposure, patients underwent a fear reactivation procedure using a virtual spider 10 min prior to a virtual reality (VR) exposure (reactivation group: RG, n = 15). A control group (CG, n = 17) was exposed to a virtual plant 10 min prior to the VR exposure. Outcome measures were a VR spontaneous recovery test (SRT) and in-vivo a behavioral avoidance test assessed 24 h after VR exposure. One week later an in-vivo exposure session followed. Additionally, a follow-up using psychometric assessment was conducted six months after the first session. RESULTS: Both groups benefitted significantly and equally from the combined treatment, and importantly, the SRT revealed no return of fear in both groups. Furthermore, follow-up tests showed long-term treatment effects with no group differences. LIMITATIONS: Due to different study components (VR treatment and in-vivo), we were not able to determine which treatment module was mainly responsible for the long-term treatment effect. Furthermore, no direct measure of memory destabilization was possible in this study. CONCLUSIONS: Our treatment package was highly effective in reducing phobic fear up to 6 months following treatment. Explicit fear reactivation prior to exposure was not beneficial in VR exposure treatment, possibly due to a failure to induce a memory destabilization or due to an implicit fear reactivation prior to treatment in both groups.
Assuntos
Medo/psicologia , Terapia Implosiva/métodos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Terapia de Exposição à Realidade Virtual/métodos , Adolescente , Adulto , Análise de Variância , Animais , Feminino , Seguimentos , Resposta Galvânica da Pele , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Aranhas , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Cognitive behavioral therapy (CBT) combines cognitive restructuring with exposure to feared stimuli in the treatment of anxiety disorders. Due to the complexities of cognitionemotion interactions during ongoing CBT, the underlying mechanisms remain unclear, which hinders treatment optimization. METHODS: We created a laboratory analogue by combining reappraisal, a key ingredient of cognitive restructuring, with Pavlovian conditioning, a key ingredient in behavioral treatments. The novel differential Pavlovian acquisition and extinction task featured social stimuli as conditioned and unconditioned stimuli under unregulated and reappraisal instructions. RESULTS: Findings indicated that reappraising the conditioned stimuli attenuated acquisition (Study 1) and facilitated extinction (Study 2) of conditioned negative valence. In Study 3, highly socially anxious individuals showed deficient extinction learning relative to low socially anxious individuals but compensated for this by using reappraisal. LIMITATIONS: Diagnostic status of participants was not assessed in structured clinical interviews. CONCLUSIONS: Reappraisal of feared stimuli could be useful in prevention and treatment of social anxiety.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Extinção Psicológica/fisiologia , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/reabilitação , Adulto , Análise de Variância , Condicionamento Clássico , Feminino , Humanos , Masculino , Estimulação Luminosa , Adulto JovemRESUMO
Specific phobia is an anxiety disorder characterized by irrational fear and avoidance of specific things or situations, interfering significantly with the patients' daily life. Treatment for the disorder consists of both pharmacological and psychological approaches, mainly cognitive behavioral therapy (CBT). Neuroimaging techniques have been used in an attempt to improve our understanding of the neurobiology of SP and of the effects of treatment options available. This review describes the design and results of eight articles investigating the neuroimaging correlates of pharmacological and psychological treatments for SP. The studies show that CBT is effective in SP, leading to a reduction of anxiety symptoms that is accompanied by functional alterations in the brain. The results of pharmacological interventions for SP are less uniform, but suggest that the partial agonist of the NMDA (N-methyl D-aspartate) receptor DCS (D-cycloserine) can be used in combination with psychotherapy techniques for the achievement of quicker treatment response and that DCS modulates the function of structures implicated in the neurobiology of SP. Further research should explore the augmentation of CBT treatment with DCS in controlled trials.
Assuntos
Ciclosserina/uso terapêutico , Agonistas de Aminoácidos Excitatórios/uso terapêutico , Neuroimagem , Transtornos Fóbicos , Psicoterapia/métodos , Estatística como Assunto , Terapia Combinada , Bases de Dados Bibliográficas/estatística & dados numéricos , Humanos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/tratamento farmacológico , Transtornos Fóbicos/reabilitação , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVES: This study examines the effects of a single session of Cognitive Bias Modification to induce positive Interpretative bias (CBM-I) using standard or explicit instructions and an analogue of computer-administered CBT (c-CBT) program on modifying cognitive biases and social anxiety. METHODS: A sample of 76 volunteers with social anxiety attended a research site. At both pre- and post-test, participants completed two computer-administered tests of interpretative and attentional biases and a self-report measure of social anxiety. Participants in the training conditions completed a single session of either standard or explicit CBM-I positive training and a c-CBT program. Participants in the Control (no training) condition completed a CBM-I neutral task matched the active CBM-I intervention in format and duration but did not encourage positive disambiguation of socially ambiguous or threatening scenarios. RESULTS: Participants in both CBM-I programs (either standard or explicit instructions) and the c-CBT condition exhibited more positive interpretations of ambiguous social scenarios at post-test and one-week follow-up as compared to the Control condition. Moreover, the results showed that CBM-I and c-CBT, to some extent, changed negative attention biases in a positive direction. Furthermore, the results showed that both CBM-I training conditions and c-CBT reduced social anxiety symptoms at one-week follow-up. LIMITATIONS: This study used a single session of CBM-I training, however multi-sessions intervention might result in more endurable positive CBM-I changes. CONCLUSIONS: A computerised single session of CBM-I and an analogue of c-CBT program reduced negative interpretative biases and social anxiety.