Transdiagnostic factors in symptoms of depression and post-traumatic stress: a systematic review.

The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and post-traumatic stress disorder (PTSD). The overall research aim was to examine the relationship between these transdiagnostic factors and their relation with depression and PTSD symptoms. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Out of the 768 articles initially identified, 55 met the inclusion criteria for the current review. The results determined that intolerance of uncertainty is indirectly related to depression and PTSD symptoms, mainly through other factors including emotion dysregulation and rumination. Additionally, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. This review provides evidence on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination in the relationship with depression and PTSD symptoms.

Generalisation of threat expectancy increases with time.

Excessive fear generalisation is a feature characteristic of clinical anxiety and has been linked to its aetiology. Previous animal studies have shown that the mere passage of time increases fear generalisation and that brief exposure to training cues prior to long-term testing reverses this effect. The current study examined these phenomena in humans. Healthy participants learned the relationship between the presentation of a picture of a neutral male face and the delivery of a mild shock. One group was immediately tested with a novel picture of a somewhat different male face (generalisation test). Another group was tested one week later. A third group was also tested one week later and was additionally exposed to the training picture prior to testing. During picture presentations, shock-expectancy ratings were obtained as a measure of fear. Fear generalisation increased from the immediate test to the 1-week follow-up test. This result could not be attributed to level of neuroticism or a general increase in fear (incubation). Furthermore, the time-dependent increase in fear generalisation vanished following brief exposure to the training picture. Results indicate that human fear generalisation is a temporally dynamic process and that memory for stimulus details can be re-established following a reminder treatment.

SLEEP AND TREATMENT OUTCOME IN POSTTRAUMATIC STRESS DISORDER: RESULTS FROM AN EFFECTIVENESS STUDY.

BACKGROUND: Most patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Concerns have been raised about possible detrimental effects of sleep problems on the efficacy of psychological treatments for PTSD. In this study, we investigated the relation of session-to-session changes in PTSD symptoms and sleep, and tested whether sleep problems predicted poorer short- and long-term treatment outcome. METHODS: Self-reported sleep quality, sleep duration, and PTSD symptoms were assessed weekly in a consecutive sample of 246 patients who received cognitive therapy for PTSD (CT-PTSD; Ehlers & Clark, 2000), and at follow-up (mean = 247 days posttreatment). Additionally, moderating effects of medication use and comorbid depression were assessed. RESULTS: Sleep and PTSD symptoms improved in parallel. The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression, however, showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Residual sleep problems at the end of treatment did not predict PTSD symptoms at follow-up once residual PTSD symptoms were taken into account. CONCLUSIONS: CT-PTSD leads to simultaneous improvement in sleep and PTSD symptoms. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. For those without comorbid depression, self-reported sleep problems did not interfere with response to trauma-focused psychological treatment.

Anger: cause or consequence of posttraumatic stress? A prospective study of Dutch soldiers.

Many studies have shown that individuals with posttraumatic stress disorder (PTSD) experience more anger over time and across situations (i.e., trait anger) than trauma-exposed individuals without PTSD. There is a lack of prospective research, however, that considers anger levels before trauma exposure. The aim of this study was to prospectively assess the relationship between trait anger and PTSD symptoms, with several known risk factors, including baseline symptoms, neuroticism, and stressor severity in the model. Participants were 249 Dutch soldiers tested approximately 2 months before and approximately 2 months and 9 months after their deployment to Afghanistan. Trait anger and PTSD symptom severity were measured at all assessments. Structural equation modeling including cross-lagged effects showed that higher trait anger before deployment predicted higher PTSD symptoms 2 months after deployment (ß = .36), with stressor severity and baseline symptoms in the model, but not with neuroticism in the model. Trait anger at 2 months postdeployment did not predict PTSD symptom severity at 9 months, and PTSD symptom severity 2 months postdeployment did not predict subsequent trait anger scores. Findings suggest that trait anger may be a pretrauma vulnerability factor for PTSD symptoms, but does not add variance beyond the effect of neuroticism.

Childhood Maltreatment and Revictimization: A Systematic Literature Review.

There is established evidence that childhood/adolescent victimization is associated with victimization in adulthood although the underlying mechanisms are not still clear. The current study aimed to systematically review empirical studies examining potential psychological factors linking childhood maltreatment to victimization in adulthood and the gaps in the literature. Following PRISMA protocol, 71 original studies consisting of a total sample of n = 31,633 subjects were analyzed. Symptom severity for various trauma-related disorders, dissociation, emotion dysregulation, and risky sexual behaviors emerged as potential predictors of revictimization. While these potential risk factors mediate the relationship between childhood maltreatment and adulthood victimization, evidence for additional factors such as social support, attachment styles, maladaptive schemas, and risk detection is very limited. Addressing these intrapersonal risk factors, found by prior studies, in interventions and preventive programs might decrease the probability of revictimization. The interactions between the identified risk factors have not been studied well yet. Hence, more research on mediating risk factors of revictimization is needed.

Self-regulatory Sex Motives Scale in Online Dating: Exploratory Factor Analysis and Internal Consistency.

Risky sex behavior is common among online dating users. Understanding the motives behind risky sex behavior might help identify suitable targets for prevention. We developed the Self-regulatory Sex Motives Scale in Online Dating (SSOD) to assess sex motives for casual sex in online dating users. This study evaluated the psychometric properties of the SSOD and examined the relationship between sex motives indexed by the SSOD and risky sex behavior. The new scale showed high internal consistency. Exploratory factor analysis suggested a one-factor solution. Sex motives were related to a higher frequency of having sex on the first date.

Fear generalization predicts post-traumatic stress symptoms: A two-year follow-up study in Dutch fire fighters.

INTRODUCTION: Excessive fear generalization has been associated with pathological anxiety, including posttraumatic stress disorder (PTSD). However, studies investigating the longitudinal relationship between generalization and the development of anxiety symptomatology are scarce. This study aims to test the predictive value of fear generalization for PTSD symptoms in a high-risk profession sample and to explore the relationship between generalization and neuroticism, which are both linked to PTSD. METHOD: Longitudinal data from a multi-wave study in 529 Dutch fire-fighters were used. Fear generalization, PTSD symptoms and neuroticism were assessed at baseline. PTSD symptoms were reevaluated at six, 12, 18, and 24 months. Generalization was assessed in a differential conditioning paradigm by measuring expectancies of an aversive outcome when presented with stimuli similar to previously conditioned stimuli. RESULTS: Higher expectancy ratings towards stimuli most similar to safety signals predicted PTSD symptoms at follow-up after controlling for baseline PTSD symptoms, whereas higher expectancy ratings towards stimuli most similar to danger signals was associated with neuroticism. Neuroticism weakened the predictive power of fear generalization when considered simultaneously. DISCUSSION: These findings suggest that heightened fear generalization is associated with the development of anxiety and trauma-related symptoms. Targeting problematic fear generalization may be a promising intervention approach.

Effectiveness of exposure-based treatment for childhood anxiety disorders: An open clinical trial to test its relation with indices of emotional processing and inhibitory learning.

BACKGROUND AND OBJECTIVES: The current study examined how effectiveness of exposure-based CBT was related to indices of emotional processing and inhibitory learning during exposure exercises. METHODS: Adolescents with anxiety disorder(s) (N = 72; age 11-19; 85% girls) received a group-based, intensive two-week treatment of which effectiveness was indexed by the SCARED and by ratings of anxiety and approach towards individualized goal situations. To index emotional processing, subjective units of distress (SUDs) were used to indicate both initial and final fear level, and absolute, relative, and total dose of fear reduction. To index inhibitory learning, subjective threat expectancies (STEs) were used to indicate initial and final threat expectancy, and absolute, relative, and total dose of expectancy change. RESULTS: From pre-treatment to follow-up, there was a large-sized reduction of anxiety symptoms, small-sized decrease of subjective anxiety and a large-sized increase in subjective approach towards individual treatment goals. Higher fear levels prior to exposure were related to a larger decrease of symptoms. Higher threat expectancies after exposure exercises were independently associated with less decrease of anxiety and increase of approach towards treatment goals. Total dose of experienced fear reduction and total dose of experienced expectancy change were (partly) independently related to more increase in approach towards individualized goal situations. LIMITATIONS: As patients also received other treatment elements, the results cannot be interpreted unequivocally. CONCLUSIONS: The pattern of findings seems to indicate that emotional processing (as indexed by fear reduction) and inhibitory learning (as indexed by expectancy change) are both relevant in exposure-based CBT.

Reducing emotional reasoning: an experimental manipulation in individuals with fear of spiders.

Emotional reasoning involves the tendency to use subjective responses to make erroneous inferences about situations (e.g., "If I feel anxious, there must be danger") and has been implicated in various anxiety disorders. The aim of this study of individuals with fear of spiders was to test whether computerised experimental training, compared to control training, would decrease emotional reasoning, reduce fear-related danger beliefs, and increase approach behaviour towards a fear-relevant stimulus. Effects were assessed shortly after the experimental manipulation and one day later. Results showed that the manipulation significantly decreased emotional reasoning in the experimental condition, not in the control condition, and resulted in lower danger estimates of a spider, which was maintained up to one day later. No differences in approach behaviour towards the spider were found. Reducing emotional reasoning may ultimately help patients with anxiety disorders attend more to objective situational information to correct erroneous danger beliefs.

Treating specific phobia in youth: A randomized controlled microtrial comparing gradual exposure in large steps to exposure in small steps.

INTRODUCTION: Exposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE). METHODS: Children and young people with a specific phobia (SP) (N = 50, age 8-17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS: Within exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one's individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises. DISCUSSION: SmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.

Childhood maltreatment and adulthood victimization: An evidence-based model.

There is ample evidence showing that childhood maltreatment increases two to three fold the risk of victimization in adulthood. Various risk factors, including posttraumatic stress disorder (PTSD) symptoms, dissociation, self-blame, and alcohol abuse are related to revictimization. Although previous research examined associations between risk factors for revictimization, the evidence is limited and the proposed models mostly include a handful of risk factors. Therefore, it is critical to investigate a more comprehensive model explaining the link between childhood maltreatment and adulthood (re)victimization. Accordingly, this study tested a data-driven theoretical path model consisting of 33 variables (and their associations) that could potentially enhance understanding of factors explaining revictimization. Cross-sectional data derived from a multi-wave study were used for this investigation. Participants (N = 2156, age mean = 19.94, SD = 2.89) were first-year female psychology students in the Netherlands and New Zealand, who responded to a battery of questionnaires and performed two computer tasks. The path model created by structural equation modelling using modification indices showed that peritraumatic dissociation, PTSD symptoms, trauma load, loneliness, and drug use were important mediators. Attachment styles, maladaptive schemas, meaning in life, and sex motives connected childhood maltreatment to adulthood victimization via other factors (i.e., PTSD symptoms, risky sex behavior, loneliness, emotion dysregulation, and sex motives). The model indicated that childhood maltreatment was associated with cognitive patterns (e.g., anxious attachment style), which in turn were associated with emotional factors (e.g., emotion dysregulation), and then with behavioral factors (e.g., risky sex behavior) resulting in revictimization. The findings of the study should be interpreted in the light of the limitations. In particular, the cross-sectional design of the study hinders us from ascertaining that the mediators preceded the outcome variable.

Better together? A randomized controlled microtrial comparing different levels of therapist and parental involvement in exposure-based treatment of childhood specific phobia.

INTRODUCTION: Exposure is often limited to homework assignments in routine clinical care. The current study compares minimally-guided (MGE) and parent-guided (PGE) out-session homework formats to the 'golden standard' of therapist-guided in-session exposure with minimally-guided exposure at home (TGE). METHODS: Children with specific phobia (N = 55, age 8-12, 56% girls) participated in a single-blind, randomized controlled microtrial with a four-week baseline-treatment period design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS: TGE resulted in a larger decline of specific phobia severity from baseline to post-treatment compared to MGE but not compared to PGE. Parental anxiety was found to be a moderator of less treatment efficacy of PGE from baseline to post-treatment. Overall, there was no meaningful difference in efficacy of TGE versus MGE or PGE from baseline to follow-up. CONCLUSIONS: These findings suggest that for improving short-term treatment gains, exposure exercises can best be conducted with the help of a therapist within the therapy session before they are conducted as homework assignments outside the therapy session. However, for long-term treatment gains exposure exercises can be handled by the child itself or with help of its parents.

Peer-provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus.

BACKGROUND: The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. OBJECTIVE: To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Netherlands. METHODS: We conducted a single-blind, randomised controlled trial among adult Syrian refugees recruited in March 2019-December 2021 (No. NTR7552). Individuals with psychological distress (Kessler Psychological Distress Scale (K10) >15) and functional impairment (WHO Disability Assessment Schedule (WHODAS 2.0) >16) were allocated to PM+ in addition to care as usual (PM+/CAU) or CAU only. Participants were reassessed at 1-week and 3-month follow-up. Primary outcome was depression/anxiety combined (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes included depression (HSCL-25), anxiety (HSCL-25), post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PCL-5), impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS; Psychological Outcomes Profiles). Primary analysis was intention-to-treat. FINDINGS: Participants (n=206; mean age=37 years, 62% men) were randomised into PM+/CAU (n=103) or CAU (n=103). At 3-month follow-up, PM+/CAU had greater reductions on depression/anxiety relative to CAU (mean difference -0.25; 95% CI -0.385 to -0.122; p=0.0001, Cohen's d=0.41). PM+/CAU also showed greater reductions on depression (p=0.0002, Cohen's d=0.42), anxiety (p=0.001, Cohen's d=0.27), PTSD symptoms (p=0.0005, Cohen's d=0.39) and self-identified problems (p=0.03, Cohen's d=0.26), but not on impairment (p=0.084, Cohen's d=0.21). CONCLUSIONS: PM+ effectively reduces symptoms of CMDs among Syrian refugees. A strength was high retention at follow-up. Generalisability is limited by predominantly including refugees with a resident permit. CLINICAL IMPLICATIONS: Peer-provided psychological interventions should be considered for scale-up in HICs.

Extinction learning as pretrauma vulnerability factor of posttraumatic stress: a replication study.

Background: Learning tasks have been used to predict why some, and not others, develop posttraumatic stress disorder (PTSD) after exposure to a traumatic event. There is some evidence from prospective studies in high risk profession samples that reduced extinction learning might represent a marker or even a vulnerability factor for PTSD development. Objective: Since the evidence is scarce, the aim of this study was to perform a conceptual replication of an earlier prospective study, testing whether pretrauma extinction learning predicts later PTSD symptom severity. Method: A sample of 529 fire fighters performed a conditioning task at baseline and filled out questionnaires to assess PTSD symptom severity and neuroticism. At six and 12 months follow-up, exposure to stressful events and PTSD symptom severity were measured. Results: Results indicate that previous findings were not replicated: although reduced extinction learning was associated with higher PTSD symptom severity at baseline, extinction learning did not predict PTSD symptom severity at follow-up. Only PTSD symptom severity at baseline and stressor severity predicted PTSD symptom severity at follow-up. Conclusions: Since earlier findings on the predictive value of pre-trauma extinction learning on PTSD symptom severity were not replicated, extinction learning might not be a general risk factor PTSD for all individuals. More prospective studies including multiple factors seem needed to unravel the complex relationships of these factors influencing PTSD development. HIGHLIGHTS: Reduced extinction learning correlated with higher PTSD symptom severity at baseline.Reduced extinction learning did not predict PTSD symptom severity at follow-up.The predictive effect of pre-trauma extinction learning on PTSD was not replicated.

Antecedentes: Las tareas del aprendizaje se han utilizado para predecir por qué algunos, y no otros, desarrollan trastorno de estrés postraumático (TEPT) después de la exposición a un evento traumático. Existe cierta evidencia de estudios prospectivos en muestras de profesiones de alto riesgo de que el aprendizaje de extinción diminuido podría representar un marcador o incluso un factor de vulnerabilidad para el desarrollo del TEPT. Objetivo: Dado que la evidencia es escasa, el objetivo de este estudio fue realizar una replicación conceptual de un estudio prospectivo anterior, probando si el aprendizaje de extinción pretraumático predice la gravedad posterior de los síntomas de TEPT. Método: Una muestra de 529 bomberos realizó una tarea de condicionamiento al inicio del estudio y llenó cuestionarios para evaluar la gravedad de los síntomas del TEPT y neuroticismo. A los 6 y 12 meses de seguimiento, se midió la exposición a eventos estresantes y la gravedad de los síntomas de TEPT. Resultados: Los resultados indican que los hallazgos anteriores no se replicaron. Aunque el aprendizaje de extinción disminuido se asoció con una mayor gravedad de los síntomas de TEPT al inicio del estudio, el aprendizaje de extinción no predijo la gravedad de los síntomas de TEPT en el seguimiento. Solo la gravedad de los síntomas de TEPT al inicio y la gravedad del factor estresante predijeron la gravedad de los síntomas de TEPT en el seguimiento. Conclusiones: Dado que los hallazgos anteriores sobre el valor predictivo del aprendizaje de extinción pretraumático sobre la gravedad de los síntomas de TEPT no se replicaron, el aprendizaje de extinción podría no ser un factor de riesgo general de TEPT para todos los individuos. Parece que se necesitan más estudios prospectivos que incluyan múltiples factores para desentrañar las complejas relaciones de estos factores que influyen en el desarrollo del TEPT.

Deleting "fear" from "fear extinction": Estimating the individual extinction rate via non-aversive conditioning.

Individual differences in extinction learning have attracted ample attention of researchers and are under investigation as a marker for the onset of anxiety disorders and treatment response. Unfortunately, the common paradigm for obtaining the extinction rate, which entails aversive stimulus pairings, is subject to practical limitations. Therefore, the present study assessed whether the use of an aversive stimulus is actually needed to get a good estimate of the extinction rate. A total of 161 undergraduate students completed a conditioning task with both an aversive and a non-aversive stimulus. Using latent class growth analysis (LCGA), distinct trajectories, representing normal and stunted extinction learning, were identified for both these stimulus types. Participants' membership in these classes largely overlapped for aversive and non-aversive stimulus pairings and respective extinction indices were significantly correlated. Thereby, findings suggest that the use of a non-aversive stimulus could suffice for successfully capturing individual differences in extinction learning. However, future studies are needed to confirm that conditioning with a non-aversive stimulus may serve to predict clinically relevant outcomes.

Avoidance learning as predictor of posttraumatic stress in firefighters.

BACKGROUND: Avoidance is a well-established maintenance factor in anxiety-related psychopathology. Individuals prone to anxiety show more maladaptive avoidance responses in conditioning paradigms aimed at avoidance learning, which indicates impairments in safety learning. To what extent avoidance learning is associated with posttraumatic stress disorder (PTSD) is still unclear, despite the logical relevance to the symptomatology. In this prospective study, we investigate avoidance learning responses in first responders, a population at high risk for traumatic exposure and thus PTSD development, and studied whether avoidance learning was associated with concurrent and future PTSD symptoms. METHOD: Firefighters (N = 502) performed an avoidance learning task at baseline assessment in which they first learned that two conditioned stimuli (CS+) were followed by an aversive stimulus (US) and one conditioned stimulus (CS-) was not. After that, they could learn to which CS avoidance of the US was effective, ineffective or unnecessary. Self-reported PTSD symptoms were assessed at baseline, and at 6, 12, 18 and 24 months. RESULTS: Participants exhibited comparable avoidance patterns to low anxiety individuals from previous studies. Avoidance learning responses were not associated with PTSD symptoms at baseline nor at follow-up. DISCUSSION: Our study found no evidence that avoidance learning was related to PTSD symptom severity in a high-risk, yet low symptomatic population, nor did it predict the development of PTSD symptoms at a later point in time. Future research should focus on studying avoidance learning in a clinical or high symptomatic sample to further clarify the role of avoidance learning in PTSD development.

Stress management versus cognitive restructuring in trauma-affected refugees - A follow-up study on a pragmatic randomised trial.

BACKGROUND: There is a lack of research and consensus with respect to long-term effective treatments for trauma-affected refugees. The purpose of this follow-up study of a randomised clinical trial was to investigate the effectiveness of Stress Management (SM) versus Cognitive Restructuring (CR) in treating trauma-affected refugees, six and 18 months post-treatment, respectively. METHODS: From a total of 126 refugees with PTSD, the intention-to-treat sample in the original trial, 74 patients were present at the six-month follow-up (SM; n = 37, CR; n = 37) and 34 patients at the 18-month follow-up (SM; n = 14, CR; n = 20). During the trial, the patients had been offered a total of 16 psychotherapy sessions and 10 sessions with a medical doctor. RESULTS: Mixed regression analyses at six and 18-month follow-up showed a non-significant small reduction in PTSD symptoms at both follow-up points with no significant between-group differences between the two psychotherapeutic interventions. Statistically significant between-group treatment effects were, however, observed with the patients receiving SM having significantly reduced symptoms of somatisation measured by the Symptom Checklist (ß = 0.40), depression (ß = 0.29) and anxiety (ß = 0.37) (measured by the Hamilton Depression and Anxiety ratings) at 18 months post-treatment compared to the CR group. LIMITATIONS: Limitations to the present study include the dropout rate at follow-up(s). CONCLUSIONS: The findings suggest that the consolidation of coping strategies including relaxation, attention-diversion and behavioural activation in SM appears to be more beneficial than CR in reducing long-term somatisation, depression and anxiety symptoms for this population.

Reward prospect improves inhibitory control in female university students with a history of childhood sexual and physical abuse.

BACKGROUND AND OBJECTIVES: Childhood abuse and neglect increase the risk for psychiatric disorders (e.g., depression and anxiety) during adulthood and have been associated with deficits in cognitive control. The specific mechanisms underlying these cognitive control deficits are still unknown. METHODS: This study examined the expectation for reward to improve inhibitory control in young women (ages 18-35 years) with a history of childhood sexual and/or physical abuse (AG, N = 28), childhood emotional and/or physical neglect (NG, N = 30), or unaffected comparison women (HC, N = 40). They completed a previously validated rewarded (color-word) Stroop task and filled out questionnaires on depression, anxiety, and resilience. RESULTS: Surprisingly, a significant group by reward interaction revealed larger performance benefits under reward prospect (relative to no-reward) for the AG group relative to both the NG and HC groups. LIMITATIONS: A small sample size limiting generalizability. CONCLUSIONS: These results demonstrate sensitivity of abused subjects to reward in modulating cognitive control and might aid in discussing whether using reward schedules during therapeutic interventions could be effective.

Responding to uncertain threat: A potential mediator for the effect of mindfulness on anxiety.

Mindfulness-based interventions have gained extensive support for their application in the treatment of anxiety. However, their mechanisms remain largely unexplored. Excessive reactivity to uncertainty plays a central role in anxiety, and may represent a mechanism for the effect of mindfulness on anxiety, as mindfulness training fosters an open and accepting stance towards all aspects of experience. The present study sought to investigate both (i) self-reported intolerance of uncertainty (IU) as well as (ii) physiological and subjective responding to uncertain threat in a threat-of-shock paradigm, the NPU-threat test, as mediators for the relationship between mindfulness and anxiety in a cross-sectional study of healthy participants (N = 53). The results indicated that IU mediated the effect of mindfulness on some anxiety symptoms. In contrast, scores of physiological as well as subjective responses to uncertain threat from the NPU-threat test were largely unrelated to mindfulness, anxiety, or the IU self-report measure. The results provide initial evidence that reactions to uncertainty may play a role in the mindfulness-anxiety relationship and suggest that studies are needed to address how methodological variations of the NPU-threat test affect perceived levels of uncertainty and uncertainty-related anxiety.

Treating Speech Anxiety in Youth: A Randomized Controlled Microtrial Testing the Efficacy of Exposure Only Versus Exposure Combined With Anxiety Management Strategies.

CBT for anxious youth usually combines anxiety management strategies (AMS) with exposure, with exposure assumed to be critical for treatment success. To limit therapy time while retaining effectiveness, one might optimize CBT by restricting treatment to necessary components. This study tested whether devoting all sessions to exposure is more effective in reducing speech anxiety in youth than devoting half to AMS including cognitive or relaxation strategies and half to exposure. After a 6-week waitlist period, adolescents with speech anxiety (N = 65; age 12-15; 42 girls) were randomized to a 5-session in-school group-based CBT training consisting of either (1) exposure-only (EXP+EXP) or (2) cognitive strategies followed by exposure (COG+EXP) or (3) relaxation strategies followed by exposure (REL+EXP). Clinical interviews, speech tests, and self-report measures were assessed at pretest, posttest, and follow-up. For all conditions (a) the intervention period resulted in a stronger decline of speech anxiety than waitlist period; (b) there was a large sized reduction of speech anxiety that was maintained at six-week follow-up; (c) there was no meaningful difference in the efficacy of EXP+EXP versus COG+EXP or REL+EXP. These findings suggest that devoting all sessions to exposure is not more effective than combining exposure with AMS. AMS appeared neither necessary for CBT to be effective, nor necessary for youth to tolerate exposure. This indicates that CBT can be optimized by restricting treatment to exposure.