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1.
BMC Psychiatry ; 21(1): 403, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34429091

RESUMO

BACKGROUND: Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. METHODS: We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles. RESULTS: Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking. DISCUSSION: CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.


Assuntos
Transtornos de Ansiedade , Depressão , Adolescente , Ansiedade/prevenção & controle , Atenção , Depressão/prevenção & controle , Emoções , Humanos
2.
Lancet Psychiatry ; 8(9): 836-852, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34419188

RESUMO

Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.


Assuntos
Ansiedade/terapia , Depressão/terapia , Emoções , Imagens, Psicoterapia/métodos , Imaginação , Ansiedade/psicologia , Depressão/psicologia , Humanos , Resultado do Tratamento
3.
Behav Res Ther ; 144: 103913, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34214822

RESUMO

Maladaptive cognitive styles confer vulnerability for emotional disorders and may emerge in childhood. In three phases, we developed and evaluated a novel parent-led intervention (My Memory Forest) to target overgeneral memory and avoidance of negative memories. In phase 1, the intervention was co-designed using two focus groups (n = 30 children) and consultation with teachers and parents. The acceptability, feasibility, and clinical potential of My Memory Forest was initially evaluated in phase two (n = 12 children aged 6 to 9) and then in a feasibility randomised controlled trial in phase three, against an active control (n = 56 aged 6 to 9). Acceptability and engagement were good, and no harm was reported by parents or participants. Phase 2 identified decreases in self-reported anxiety (d = 1.08), depression (d = 0.51) and vividness of negative events (d = 0.53). There was little change in parent-reported symptoms. In phase 3, recruitment was highly feasible and participant retention excellent (100%) but parent retention poor (55%). Descriptive statistics indicated similar changes in anxiety and depression for both groups. Changes between Phases 2 and 3 (e.g. methods of recruitment) could explain the discrepancy between results. Further development is necessary before proceeding to another trial. TRIAL REGISTRATION: ISRCTN13142918.

4.
Behav Res Ther ; 143: 103876, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34098409

RESUMO

Brief, evidence-based interventions for adolescent depression are urgently required, particularly for school-settings. Cognitive mechanisms research suggests dysfunctional mental imagery and overgeneral memory could be promising targets to improve mood. This feasibility randomised controlled trial with parallel symptomatic groups (n = 56) compared a novel imagery-based cognitive behavioural intervention (ICBI) to non-directive supportive therapy (NDST) in school settings. Blind assessments (of clinical symptoms and cognitive mechanisms) took place pre-intervention, post-intervention and follow-up three months later. The trial aimed to evaluate the feasibility and acceptability of the methodology and interventions, and estimate the likely range of effects of the intervention on self-reported depression. The pre-defined criteria for proceeding to a definitive RCT were met: full recruitment occurred within eleven months; retention was 89%; ICBI acceptability was above satisfactory; and no harm was indicated. Intention-to-treat analysis found large effects in favour of ICBI (relative to NDST) at post-intervention in reducing depressive symptoms (d = -1.34, 95% CI [-1.87, -0.80]) and improving memory specificity (d = 0.79 [0.35, 1.23]), a key cognitive target. The findings suggest that ICBI may not only improve mood but also strengthen abilities associated with imagining and planning the future, critical skills at this life stage. A fully powered evaluation of ICBI is warranted. Trial Registration: https://www.isrctn.com/; ISRCTN85369879.

5.
Clin Child Psychol Psychiatry ; 25(1): 119-132, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31266347

RESUMO

Depression in young people is common and impairing. There have been significant service changes in the United Kingdom in the last decade, aiming to improve access to evidence-based interventions for depression. However, it is unclear whether youth with depression, first, access services and, second, receive appropriate interventions. In the current study, anonymised data from child and adolescent mental health services were extracted from a 1-year period at two time points (time 1: n = 770; time 2: n = 733). First, these were compared with prevalence and population data. Second, a subsample (n = 45 at each time point) was evaluated against National Institute for Clinical Excellence (NICE) guidelines. Approximately, one-quarter of the expected number of cases (according to population and prevalence data) were seen in the 12 to 18-years age group, and only 2% of expected cases were seen in the 0 to 11-years age group. This was consistent across time points. Adherence to NICE guidance was mostly good at both time points, but there were concerns raised by this evaluation, in particular the use of medication in this population. From time 1 to 2, there was an increase in use of questionnaire measures, but a decrease in the correct completion of risk assessments.


Assuntos
Transtorno Depressivo/diagnóstico , Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Adolescente , Criança , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Prevalência , Inquéritos e Questionários , Reino Unido/epidemiologia
6.
Behav Res Ther ; 124: 103508, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31855697

RESUMO

Distressing intrusive images commonly occur in anxiety. Worry may function to reduce the emotional power of intrusive imagery, but this also prevents emotional processing. As worry is a future-orientated process, suppression of intrusive future imagery could be particularly pertinent to generalized anxiety. Here, we investigate whether youth high in symptoms of generalized anxiety (compared to depression and social anxiety) experience greater impact of future imagery (more intrusions, hyperarousal and avoidance), and whether this relationship varies as a function of the tendency to suppress or reappraise emotional experience. These relationships are important in adolescence, when generalized anxiety commonly begins and emotional regulation strategies develop. Participants (n = 352, age 11-16) completed measures of symptomatology, the impact of prospective personally-relevant imagery (IFES) and emotional regulation strategies. IFES scores correlated with an established measure of prospective imagery. Higher IFES scores were uniquely associated with more symptoms of generalized anxiety and depression, but not with social anxiety. A tendency to supress emotion was related to higher IFES scores and moderated the relationship between generalized anxiety and IFES (but not between depression and IFES). This provides initial impetus to develop novel approaches to investigate and intervene cognitively with negative prospective imagery in adolescent generalized anxiety.


Assuntos
Ansiedade/psicologia , Regulação Emocional/fisiologia , Emoções/fisiologia , Imaginação/fisiologia , Repressão Psicológica , Adolescente , Criança , Medo/psicologia , Feminino , Humanos , Masculino
7.
Child Neuropsychol ; 25(3): 394-409, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29877753

RESUMO

Many individuals with Tourette syndrome and chronic tic disorders (TS/CTDs) report poor social functioning and comorbid social anxiety. Yet limited research has investigated the role of cognitive factors that highlight social threats in youth with TS/CTD, and whether these biases underlie tic severity and co-occurring social anxiety. This study examined whether selective attention to social threat is enhanced young people with TS/CTDs compared to healthy controls, and whether attention biases are associated with tic severity and social anxiety. Twenty seven young people with TS/CTDs and 25 matched control participants completed an experimental measure of attention bias toward/away from threat stimuli. A clinician-rated interview measuring tic severity/impairment (YGTSS Total Score) and questionnaire measures of social anxiety were completed by participants and their parents. Young people with TS/CTD showed an attention bias to social threat words (relative to benign words) compared to controls but no such bias for social threat faces. Attention bias for social threat words was associated with increasing YGTSS Total Score and parent-reported social anxiety in the TS/CTDs group. Mediation analysis revealed a significant indirect path between YGTSS Total Score and social anxiety, via attention to social threat. Tentatively, these associations appeared to be driven by impairment rather than tic severity scores. Preliminary data suggests that youth with TS/CTD have enhanced attention to threat, compared to controls, and this is associated with impairment and social anxiety. Attention to threat could offer a cognitive mechanism connecting impairment and social anxiety, and so be a valuable trans-diagnostic treatment target.


Assuntos
Ansiedade/psicologia , Psicopatologia/métodos , Transtornos de Tique/psicologia , Síndrome de Tourette/psicologia , Adolescente , Atenção , Viés , Criança , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
8.
Cognit Ther Res ; 42(5): 581-597, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30237649

RESUMO

Research studies applying cognitive bias modification of attention (CBM-A) and interpretations (CBM-I) training to reduce adolescent anxiety by targeting associated cognitive biases have found mixed results. This study presents a new multi-session, combined bias CBM package, which uses a mix of training techniques and stimuli to enhance user-engagement. We present preliminary data on its viability, acceptability and effectiveness on reducing symptoms and biases using an A-B case series design. 19 adolescents with elevated social anxiety reported on their social anxiety, real-life social behaviours, general anxiety, depression, and cognitive biases at pre/post time-points during a 2-week baseline phase and a 2-week intervention phase. Retention rate was high. Adolescents also reported finding the CBM training helpful, particularly CBM-I. Greater reductions in social anxiety, negative social behaviour, and general anxiety and depression, characterised the intervention but not baseline phase. There was a significant correlation between interpretation bias change and social anxiety symptom change. Our enhanced multi-session CBM programme delivered in a school-setting appeared viable and acceptable. Training-associated improvements in social anxiety will require further verification in a study with an active control condition/group.

9.
Artigo em Inglês | MEDLINE | ID: mdl-29997904

RESUMO

Background: Adolescent depression is common and impairing. There is an urgent need to develop early interventions to prevent depression becoming entrenched. However, current psychological interventions are difficult to access and show limited evidence of effectiveness. Schools offer a promising setting to enhance access to interventions, including reducing common barriers such as time away from education. Distressing negative mental images and a deficit in positive future images, alongside overgeneral autobiographical memories, have been implicated in depression across the lifespan, and interventions targeting them in adults have shown promise. Here, we combine techniques targeting these cognitive processes into a novel, brief psychological intervention for adolescent depression. This feasibility randomised controlled trial will test the feasibility and acceptability of delivering this imagery-based cognitive behavioural intervention in schools. Methods/design: Fifty-six adolescents (aged 16-18) with high symptoms of depression will be recruited from schools. Participants will be randomly allocated to the imagery-based cognitive behavioural intervention (ICBI) or the control intervention, non-directive supportive therapy (NDST). Data on feasibility and acceptability will be recorded throughout, including data on recruitment, retention and adherence rates as well as adverse events. In addition, symptom assessment will take place pre-intervention, post-intervention and at 3-month follow-up. Primarily, the trial aims to establish whether it is feasible and acceptable to carry out this project in a school setting. Secondary objectives include collecting data on clinical measures, including depression and anxiety, and measures of the mechanisms proposed to be targeted by the intervention. The acceptability of using technology in assessment and treatment will also be evaluated. Discussion: Feasibility, acceptability and symptom data for this brief intervention will inform whether an efficacy randomised controlled trial is warranted and aid planning of this trial. If this intervention is shown in a subsequent definitive trial to be safe, clinically effective and cost-effective, it has potential to be rolled out as an intervention and so would significantly extend the range of therapies available for adolescent depression. This psychological intervention draws on cognitive mechanism research suggesting a powerful relationship between emotion and memory and uses imagery as a cognitive target in an attempt to improve interventions for adolescent depression. Trial registration: ISRCTN85369879.

10.
J Affect Disord ; 238: 269-276, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29894932

RESUMO

BACKGROUND: Enhancing positive future imagery offers promise for treatment innovation in adult depression but has been neglected in adolescence. While negative life events are linked with depression-onset in adolescence, mechanisms underlying this association are poorly understood. We investigate whether difficulties in generating vivid positive future imagery characterise depression, compared to anxiety, and examine potential moderation of the relationship between negative life events and depressive symptoms in adolescence. METHOD: Three hundred and seventy-five young people (11-16 years) completed the Prospective Imagery Task, and self-reported on symptoms of anxiety and depression. They were also asked to describe a past negative life event they had been thinking about or imagining over the last seven days, which was subsequently coded by a clinician over whether it was no, low, moderate or high impact. RESULTS: Symptoms of depression were associated with less vivid positive imagery and more vivid negative imagery whether past or future, whilst symptoms of anxiety were associated with increased vividness for past negative events only. The relationship between life event severity and depression was increased for those with poorer vividness for positive future events. LIMITATIONS: These data were collected at a single time-point only, limiting conclusions on temporal relationships. All measures were also self-reported, increasing shared method variance. CONCLUSIONS: These findings suggest that the relationship between negative life events and prospective positive imagery are specific to depressive symptoms in adolescence and provide foundations for novel approaches to strengthen psychological interventions.


Assuntos
Afeto , Depressão/psicologia , Imaginação , Acontecimentos que Mudam a Vida , Adolescente , Ansiedade/psicologia , Criança , Feminino , Previsões , Humanos , Imagens, Psicoterapia , Masculino , Autorrelato , Pensamento
11.
J Autism Dev Disord ; 48(10): 3474-3482, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29777473

RESUMO

Aberrant interoceptive accuracy could contribute to the co-occurrence of anxiety and premonitory urge in chronic tic disorders (CTD). If it can be manipulated through intervention, it would offer a transdiagnostic treatment target for tics and anxiety. Interoceptive accuracy was first assessed consistent with previous protocols and then re-assessed following an instruction attempting to experimentally enhance awareness. The CTD group demonstrated lower interoceptive accuracy than controls but, importantly, this group difference was no longer significant following instruction. In the CTD group, better interoceptive accuracy was associated with higher anxiety and lower quality of life, but not with premonitory urge. Aberrant interoceptive accuracy may represent an underlying trait in CTD that can be manipulated, and relates to anxiety and quality of life.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Propriocepção , Transtornos de Tique/fisiopatologia , Adolescente , Transtornos de Ansiedade/complicações , Conscientização , Feminino , Humanos , Masculino , Fenótipo , Qualidade de Vida , Transtornos de Tique/complicações
12.
Compr Psychiatry ; 83: 31-37, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29549877

RESUMO

OBJECTIVE: Depression is common in Tourette syndrome and Chronic Tic Disorders (TS/CTD) and contributes to significant impairment. The specificity of autobiographical memories is implicated in an individual's sense of self and their daily functioning but also in the onset and development of depression in the general population. Here, we examined whether memory specificity is reduced in young people with TS/CTD, relative to control participants, and whether memory specificity is associated with depression. METHOD: Thirty young people with TS/CTD (14 females; age: x̅ = 11.31; SD = 1.66; 87% White British) and twenty-six (12 females; age: x̅ = 11.23; SD = 2.43; 77% White British) control participants completed the study. Participants completed the Autobiographical Memory Task, which asks participants to respond with a specific memory to cue words, and a questionnaire measure of depressive symptoms. RESULTS: There was no significant difference between the two groups in terms of age, gender, ethnicity, IQ and depressive symptomatology. Young people with TS/CTD had less specific autobiographical memories than their peers (p < 0.001, r = 0.49). Across both groups, increased memory specificity for positive cue words was associated with reduced depressive symptomatology (p < 0.001, R2 = 0.51). CONCLUSIONS: Our findings indicate that autobiographical memory in young people with TS is characterised by a lack of specificity and, as with neurotypical peers, reduced memory specificity for positive words is associated with depressive symptoms. Autobiographical memory specificity could be an important factor in understanding mood symptoms that characterise young people with TS/CTD and may be an important cognitive target to reduce the development of depression in young people with TS/CTD.


Assuntos
Memória Episódica , Transtornos de Tique/diagnóstico , Transtornos de Tique/psicologia , Adolescente , Afeto/fisiologia , Criança , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Inquéritos e Questionários , Síndrome de Tourette/diagnóstico , Síndrome de Tourette/psicologia , Adulto Jovem
13.
J Child Psychol Psychiatry ; 59(8): 831-844, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29052837

RESUMO

BACKGROUND: Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS: Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS: We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS: In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Pensamento , Adolescente , Transtornos de Ansiedade/fisiopatologia , Criança , Humanos
14.
J Behav Ther Exp Psychiatry ; 55: 41-48, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27888749

RESUMO

BACKGROUND AND OBJECTIVES: Young people with social anxiety display poor social functioning but it is unclear whether this is underscored by difficulties in key social cognitive abilities, such as perspective taking. Here, we examined whether increased social anxiety is associated with reduced accuracy on a perspective taking task and whether this relationship is stronger at particular periods within adolescence. METHODS: Fifty-nine adolescents aged 11-19 years completed the computerised Director Task (DT) and the Social Anxiety Scale for Adolescence. In the DT, participants virtually move objects by following either instructions given by the 'Director' (who can see only some objects), or a simple rule to ignore certain objects. RESULTS: Participants who scored above the clinical cut-off for social anxiety (n = 17) were less accurate when they had to take the perspective of the Director into account than those scoring below cut-off, yet performed similarly on control trials. Preliminary analysis indicated that poorer performance was most strongly associated with social anxiety in mid-adolescence (14-16.5 years). LIMITATIONS: The DT has been used previously to measure online perspective taking but the underlying cognitive mechanisms have not been fully elucidated. Extending these findings using additional measures of perspective taking would be valuable. CONCLUSIONS: Adolescents with higher social anxiety were less accurate at taking the perspective of a computerised character, with some suggestion that this relationship is strongest during mid-adolescence. If replicated, these findings highlight the importance of addressing specific social cognitive abilities in the assessment and treatment of adolescent social anxiety.


Assuntos
Fobia Social/psicologia , Ajustamento Social , Percepção Social , Adolescente , Fatores Etários , Análise de Variância , Criança , Feminino , Humanos , Relações Interpessoais , Masculino , Tempo de Reação/fisiologia , Adulto Jovem
15.
Behav Cogn Psychother ; 44(3): 288-305, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26004421

RESUMO

BACKGROUND: Cognitive remediation (CR) is a psychological therapy, effective in improving cognitive performance and functioning in people with schizophrenia. As the therapy becomes more widely implemented within mental health services its longevity and uptake is likely to depend on its feasibility and acceptability to service users and clinicians. AIMS: To assess the feasibility and acceptability of a new strategy-based computerized CR programme (CIRCuiTS) for people with psychosis. METHOD: Four studies were conducted using mixed methods. Perceptions of attractiveness, comprehensibility, acceptability and usability were assessed using self-report questionnaires in 34 non-clinical participants (study 1), and five people with a schizophrenia diagnosis and three experienced CR therapists (studies 2 and 3). The ease with which pre-specified therapy programmes could be assembled was also assessed by three therapists (Study 2). Finally, the satisfaction of 20 service users with a diagnosis of schizophrenia regarding their experience of using CIRCuiTS in the context of a course of the CR therapy was assessed in a qualitative interview study (study 4). RESULTS: Ratings of perceived attractiveness, comprehensibility, acceptability and usability consistently exceeded pre-set high targets by non-clinical, clinical and therapist participants. Qualitative analysis of satisfaction with CIRCuiTS showed that receiving the therapy was generally seen to be a positive experience, leading to perceptions that cognitive functioning had improved and attempts to incorporate new strategy use into daily activities. CONCLUSIONS: CIRCuiTS demonstrates high acceptability and ease of use for both service users with a schizophrenia diagnosis and clinicians.


Assuntos
Remediação Cognitiva/métodos , Esquizofrenia/terapia , Terapia Assistida por Computador/métodos , Adulto , Terapia Cognitivo-Comportamental/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários
16.
PLoS One ; 10(4): e0122971, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25902141

RESUMO

Targeting the consolidation of fear memories following trauma may offer a promising method for preventing the development of flashbacks and other unwanted re-experiencing symptoms that characterise Posttraumatic Stress Disorder (PTSD). Research has demonstrated that performing visuo-spatial tasks after analogue trauma can block the consolidation of fear memory and reduce the frequency of flashbacks. However, no research has yet used verbal techniques to alter memories during the consolidation window. This is surprising given that the most effective treatments for PTSD are verbally-based with exposure therapy and trauma-focused cognitive behavioural therapy gaining the most evidence of efficacy. Psychological therapies aim to reduce the conditioned fear response, which is in keeping with the preliminary finding that an increased propensity for fear conditioning may be a vulnerability factor for PTSD. Our research had two aims. We investigated the degree to which individual differences in fear conditioning predict the development of PTSD symptoms. We also compared the preventative effects of two clinically informed psychological techniques administered during the consolidation window: exposure to the trauma memory and updating the meaning of the trauma. 115 healthy participants underwent a fear conditioning paradigm in which traumatic film stimuli (unconditioned stimuli) were paired with neutral stimuli (conditioned stimuli). Participants were randomly allocated to an updating, exposure or control group to compare the effects on the conditioned fear response and on PTSD symptomatology. The results showed that stronger conditioned responses at acquisition significantly predicted the development of PTSD symptoms. The updating group, who verbally devalued the unconditioned stimulus within the consolidation window, experienced significantly lower levels of PTSD symptoms during follow-up than the exposure and control groups. These findings are consistent with clinical interventions for chronic PTSD and have important implications for identifying those at risk as well as for designing novel early interventions to prevent the development of PTSD.


Assuntos
Condicionamento Psicológico/fisiologia , Medo/psicologia , Terapia Implosiva , Consolidação da Memória , Adolescente , Adulto , Extinção Psicológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Inquéritos e Questionários , Adulto Jovem
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