Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial.

BACKGROUND: Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. METHODS: A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). RESULTS: Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d = .16 or smaller at post-test). Anxiety reduction was similar across conditions (d = .059 at post-test) and neither therapy was superior on long term. CONCLUSION: This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders.

Prevalence and Psychosocial Correlates of Party-Drug Use and Associated Problems among University Students in the Netherlands.

BACKGROUND: Recent developments in drug use patterns call for an investigation of current party-drug use and associated problems among college students, who appear to be an important target population for harm reduction interventions. OBJECTIVES: In addition to reporting on party-drug use prevalence, we investigated whether initial use and continuation of party-drug use among students was associated with demographic, personality and psychosocial factors. METHODS: An online questionnaire was administered to 446 students from a Dutch university, inquiring about party-drug use, demographic characteristics, social norms and personality (big five, impulsiveness, aggression). Univariate and multivariate bootstrapped linear regression analyses were used. RESULTS: Of all students, 22.9% indicated having used party-drugs at least once, with a notable sex difference (39.2% of men vs. 16.2% of women). In contrast to the reported trends in Dutch nightlife, GHB was used rarely (lifetime 1.6%) and new psychoactive substances (NPS; 6.7%) appeared almost equally popular as amphetamines (7.6%) and cocaine (7%). Mild health/psychosocial problems (e.g., doing embarrassing things, feeling unwell) were common (65%), whereas serious problems (e.g., being hospitalized) were rare. Neuroticism, extraversion, conscientiousness and impulsiveness were associated with lifetime but not regular party-drug use. Of all predictors, lifetime and regular party-drug use were most strongly related to lenient injunctive and descriptive norms in friends, and a low motivation to comply with parents. CONCLUSIONS: Our findings indicate that harm reduction/preventive interventions might profit from focusing on social norms, and targeting students who are highly involved in a pro-party-drug environment while experiencing less parental influence.

The role of sex and gender in anxiety disorders: Being scared "like a girl"?

Anxiety disorders are among the most prevalent mental disorders, and women are at much higher risk to develop an(y) anxiety disorder. Women seem to experience more severe and long-lasting symptoms than men. Sex differences regarding etiology can be best understood from a vulnerability-stress perspective. A different exposure to psychosocial stressors and an increased biologic and/or psychologic vulnerability toward anxiety in women may contribute to the sex differences in anxiety disorders. Evidently, these findings have implications for both the diagnosis and treatment of patients with anxiety disorders. Therapists should be aware of gender bias during the diagnostic process and be sensitive for self-reporting bias (i.e., the reluctance to report "female-like" symptoms by men). Research on sex differences with respect to treatment is lacking and gender-related knowledge has rarely been integrated into clinical interventions. Interventions aimed at transdiagnostic factors that have been shown to relate to sex differences in anxiety seem rather promising and have the potential to enhance the care for both men and women with anxiety disorders.

Oxytocin reduces interpersonal distance: Examining moderating effects of childrearing experiences and interpersonal context in virtual reality.

Oxytocin has been shown to stimulate social approach behaviors, although effects may depend on contextual and individual difference factors. Here, we examined intranasal oxytocin effects on interpersonal distance using an immersive Virtual Reality paradigm, taking into account early caregiving experiences and interpersonal context as potential moderators. Participants were 180 women who received 24 IU oxytocin or a placebo and had reported how often their mother used love withdrawal as a disciplinary strategy, involving withholding love and affection after a failure or misbehavior. We used a virtual stop-distance paradigm, instructing participants to approach a virtual person or to stop an approaching virtual person at a preferred distance (passive approach). In order to examine the role of interpersonal context in shaping oxytocin effects, facial expressions and bodily gestures of the virtual person were manipulated. The person showed a dynamical expression of sadness, happiness, anger, fear, disgust, or no emotional expression in six different emotion conditions. We found that oxytocin reduced interpersonal distance across the different emotion conditions, but only in individuals with lower levels of love withdrawal. In addition, oxytocin reduced anxiety levels during passive approach, in particular in the disgust condition, but only in individuals with lower levels of maternal disciplinary love withdrawal. Individuals with more love withdrawal experienced more anxiety while being approached by a virtual person displaying disgust or fear, but benefitted less from anxiety-reducing oxytocin effects. These results are consistent with previous research showing a dysregulated oxytocinergic system after childhood adversity and indicate that oxytocin may be less effective for individuals who are most in need of an intervention because of a problematic family background.