Retraining of automatic action tendencies in individuals with obesity: A randomized controlled trial.

Obesity is a major health concern, characterized by an automatically activated tendency to (over)-eat. Recent research suggests that an effective way to counteract automatic approach tendencies in unhealthy consumption behavior might be approach bias modification. Therefore, we investigated an approach-avoidance training for unhealthy food cues in 189 patients with obesity of a psychosomatic inpatient clinic who were participating in a nutrition advice program. Patients in the active training group were trained to make avoidance movements (pushing a joystick) in response to unhealthy food pictures and approach movements (pulling the joystick) in response to positive pictures, while the control group received sham training (approaching and avoiding both picture types). Approach-avoidance bias, body mass index, eating pathology and food-specific implicit associations were assessed before and after the training. In line with our hypothesis, approach-avoidance bias improved in the active training group after the training, in comparison to the sham training group. Moreover, this effect generalized to new, untrained stimuli. However, no effects of the training were found in a food-specific Single-Target Implicit Association Test, or on eating pathology questionnaires or body mass index. While the training results are promising, the effect of approach-avoidance bias modification on relevant behavior in obesity has yet to be established before it may be implemented as an add-on treatment.

Do health-related factors predict major depression? A longitudinal epidemiologic study.

Major depressive disorder (MDD) is a leading cause of global disease burden. Hence, examining the role of risk and protective factors for MDD is an important target in psychological research. Various studies showed that obesity, smoking, and alcohol consumption are related to depressive symptoms. In contrast, physical activity has been found to be a protective factor. The present population-based study tested whether these health-related factors are prospectively associated with incidence of MDD. Data were taken from the Dresden Predictor Study, which was designed to investigate risk and protective factors of mental health in young women. It included two assessments approximately 17 months apart. Results of single logistic regression analyses showed that being overweight, being a smoker, and being in a high-risk drinking group at baseline were predictive of developing MDD at follow-up. Engaging in regular physical activity and having good physical health were found to be protective factors of MDD. However, being in a medium-risk drinking group was not predictive of incidence of MDD, and irregular physical activity was not a protective factor. This is the first prospective, longitudinal study to show that obesity, smoking, and high-risk drinking are predictive of new onsets of MDD and that physical health is a protective factor. These data provide promising avenues for future research.

Intensive prolonged exposure treatment for adolescent complex posttraumatic stress disorder: a single-trial design.

BACKGROUND: The current study evaluated the effectiveness and safety of intensive prolonged exposure (PE) targeting adolescent patients with complex posttraumatic stress disorder (PTSD) and comorbid disorders following multiple interpersonal trauma. METHODS: Ten adolescents meeting full diagnostic criteria for PTSD were recruited from a specialized outpatient mental health clinic and offered a standardized intensive PE. The intensive PE consisted of three daily 90-min exposure sessions delivered on five consecutive weekdays, followed by 3 weekly 90-min booster sessions. In a single-trial design, the participants were randomly allocated to one of five baseline lengths (4-8 weeks) before starting the intensive PE. Before, during, and after intensive PE completion, self-reported PTSD symptom severity was assessed weekly as a primary outcome (a total of 21 measurements). Furthermore, clinician-administered PTSD diagnostic status and symptom severity (primary outcome), as well as self-reported comorbid symptoms (secondary outcomes), were assessed at four single time points (baseline-to-6-month follow-up). RESULTS: Time-series analyses showed that self-reported PTSD symptom severity significantly declined following treatment (p = .002). Pre-postgroup analyses demonstrated significant reductions of clinician-administered PTSD symptom severity and self-reported comorbidity that persisted during the 3- and 6-month follow-ups (all ps < .05), where 80% of adolescents had reached diagnostic remission of PTSD. There was neither treatment dropout nor any adverse events. CONCLUSIONS: The results of this first proof of concept trial suggest that intensive PE can be effective and safe in an adolescent population with complex PTSD, although the gains achieved need to be confirmed in a randomized controlled trial.

Are addiction-related memories malleable by working memory competition? Transient effects on memory vividness and nicotine craving in a randomized lab experiment.

BACKGROUND AND OBJECTIVES: Experimental research suggests that working memory (WM) taxation reduces craving momentarily. Using a modified Eye Movement Desensitization and Reprocessing (EMDR) procedure, prolonged reductions in craving and relapse rates in alcohol dependence have been demonstrated. Modified EMDR-procedures may also hold promise in smoking cessation attempts. A proof-of-concept study was conducted to narrow the gap between WM-taxation experiments and clinical EMDR studies. To this end the clinical EMDR-procedure was modified for use in a laboratory experiment. METHODS: Daily smokers (n = 47), abstaining overnight, were allocated (by minimization randomization) to one of two groups using a parallel design. In both cases a modified EMDR-procedure was used. In the experimental group (n = 24) eye movements (EM) were induced while control group participants (n = 23) fixed their gaze (not taxing WM). During 6 min trials, craving-inducing memories were recalled. Craving, vividness of target memories, and smoking behavior were assessed at several variable-specific time-points between baseline (one week pre-intervention) and one week follow-up. RESULTS: The experimental group showed significant immediate reductions of craving and vividness of targeted memories. However, these effects were lost during a one-week follow-up period. CONCLUSIONS: A limited dose of WM-taxation, in the form of EM in a modified EMDR-procedure, resulted in transient effects on memory vividness and nicotine craving. EM provide a valuable way of coping with the acute effects of craving during smoking cessation attempts. Other aspects of the EMDR-procedure may provide additional effects. Component and dose-response studies are needed to establish the potential of EMDR-therapy in smoking cessation.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers.

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

Cognitive-behavior therapy resolves implicit fear associations in generalized anxiety disorder.

BACKGROUND: Cognitive schema theories postulate that anxiety disorders are associated with excessive fear associations in memory. For generalized anxiety disorder (GAD), it has been shown that patients not only exhibit negative implicit evaluations of clearly negative worry words (e.g., cancer), but also a generalization of this effect to neutral words (e.g., diagnosis). This study assessed the sensitivity of this bias, which has been interpreted as an indicator of a pathologically broadened fear structure, to cognitive-behavioral therapy (CBT). METHODS: An Extrinsic Affective Simon task was used to measure implicit associations with idiosyncratic neutral and negative worry words in 23 GAD patients and 25 healthy controls (HC). Patients were tested before and after CBT, and half of them were additionally tested while waiting for treatment. Clinical symptoms were measured before and after treatment, and at 6-months follow-up. RESULTS: CBT normalized bias for neutral words, and the extent of bias reduction during treatment predicted the extent of additional symptom improvement during the 6 months following intervention. Furthermore, the amplitude of pre-treatment bias predicted the onset of CBT response, with lower bias predicting immediate symptom improvement at the end of treatment, and higher bias predicting delayed treatment effects during the 6 months follow-up. CONCLUSIONS: Biased implicit evaluation of neutral worry targets does not represent an enduring vulnerability factor for the development of GAD but is related to heightened levels of state worry. Furthermore, the normalization of this bias might be a crucial factor in the therapeutic action of CBT.

Generalized implicit fear associations in generalized anxiety disorder.

BACKGROUND: Cognitive schema theories of anxiety postulate that higher-level cognitive processes such as attention and memory are guided by underlying distorted fear associations. While numerous studies investigated these disorder-specific, biased processes, hardly any research addressed the underlying schemata themselves. In particular, no study has ever addressed implicit fear associations in Generalized Anxiety Disorder (GAD). In addition, no study has ever experimentally investigated the clinical observation that in GAD, patients' worry processes seem to be triggered by a broad range of materials, even by neutral or positive stimuli. METHODS: We used a Single Target Implicit Association Task (STIAT) to investigate implicit associations and stimulus generalization with clearly negative worry-related words (e.g., cancer, bankruptcy) and neutral words that are only indirectly related to worry topics (e.g., doctor, bank). Participants were 39 GAD patients and 23 healthy controls. RESULTS: In line with our expectations, both groups showed negative implicit associations with negative target words, and only GAD patients also associated neutral words with negative attributes. CONCLUSIONS: These results support the hypothesis that GAD patients' fear associations generalize to stimuli that are only peripherally related to the core of their worries.

Screening for anxiety in an epidemiological sample: predictive accuracy of questionnaires.

The study examined the predictive accuracy of selected questionnaires when screening for anxiety in a representative epidemiological sample of young female adults (N = 1877). All participants were diagnosed using a structured diagnostic interview. Anxiety questionnaires included global as well as specific measures (Beck Anxiety Inventory (BAI), Symptom Checklist, Anxiety Sensitivity Index (ASI), Fear Questionnaire (FQ), Mobility Inventory (MI)). Sensitivity, specificity, positive and negative predictive power were computed for two screening decisions: (1) identifying any anxiety disorder or (2) identifying a specific anxiety disorder (agoraphobia) within the total sample and the clinical subsample. Due to naturalistic (low) base rates in epidemiological samples, diagnostic indices were lower than those previously reported. However, questionnaire data proved useful when a specific disorder was targeted (agoraphobia) and specific symptoms were operationalized.