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27 results

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  • Resting state connectivity predictors of symptom change during gaze-contingent music reward therapy of social anxiety disorder

  • Xi Zhu, Amit Lazarov, Sarah Dolan, Yair Bar-Haim, Daniel G Dillon, Diego A Pizzagalli, Franklin Schneier
  • Journal: Psychological Medicine / Volume 53 / Issue 7 / May 2023
  • Published online by Cambridge University Press: 22 March 2022, pp. 3115-3123
  • Print publication: May 2023
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  • Background

    Social anxiety disorder (SAD) is common, first-line treatments are often only partially effective, and reliable predictors of treatment response are lacking. Here, we assessed resting state functional connectivity (rsFC) at pre-treatment and during early treatment as a potential predictor of response to a novel attention bias modification procedure, gaze-contingent music reward therapy (GC-MRT).

    Methods

    Thirty-two adults with SAD were treated with GC-MRT. rsFC was assessed with multi-voxel pattern analysis of fMRI at pre-treatment and after 2–3 weeks. For comparison, 20 healthy control (HC) participants without treatment were assessed twice for rsFC over the same time period. All SAD participants underwent clinical evaluation at pre-treatment, early-treatment (week 2–3), and post-treatment.

    Results

    SAD and depressive symptoms improved significantly from pre-treatment to post-treatment. After 2–3 weeks of treatment, decreased connectivity between the executive control network (ECN) and salience network (SN), and increased connectivity within the ECN predicted improvement in SAD and depressive symptoms at week 8. Increased connectivity between the ECN and default mode network (DMN) predicted greater improvement in SAD but not depressive symptoms at week 8. Connectivity within the DMN decreased significantly after 2–3 weeks of treatment in the SAD group, while no changes were found in HC over the same time interval.

    Conclusion

    We identified early changes in rsFC during a course of GC-MRT for SAD that predicted symptom change. Connectivity changes within the ECN, ECN-DMN, and ECN-SN may be related to mechanisms underlying the clinical effects of GC-MRT and warrant further study in controlled trials.

  • Anterior hippocampal volume predicts affect-focused psychotherapy outcome

  • Benjamin Suarez-Jimenez, Xi Zhu, Amit Lazarov, J. John Mann, Franklin Schneier, Andrew Gerber, Jacques P. Barber, Dianne L. Chambless, Yuval Neria, Barbara Milrod, John C. Markowitz
  • Journal: Psychological Medicine / Volume 50 / Issue 3 / February 2020
  • Published online by Cambridge University Press: 18 February 2019, pp. 396-402
  • Print publication: February 2020
  • Background

    The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)].

    Methods

    Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes.

    Results

    Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome.

    Conclusions

    This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the ‘limbic’ AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.

  • Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial

  • Amit Lazarov, Benjamin Suarez-Jimenez, Rany Abend, Reut Naim, Erel Shvil, Liat Helpman, Xi Zhu, Santiago Papini, Ariel Duroski, Rony Rom, Franklin R. Schneier, Daniel S. Pine, Yair Bar-Haim, Yuval Neria
  • Journal: Psychological Medicine / Volume 49 / Issue 14 / October 2019
  • Published online by Cambridge University Press: 12 November 2018, pp. 2432-2440
  • Print publication: October 2019
  • Background

    Randomized control trials (RCTs) comparing attention control training (ACT) and attention bias modification (ABM) in posttraumatic stress disorder (PTSD) have shown mixed results. The current RCT extends the extant literature by comparing the efficacy of ACT and a novel bias-contingent-ABM (BC-ABM), in which direction of training is contingent upon the direction of pre-treatment attention bias (AB), in a sample of civilian patients with PTSD.

    Methods

    Fifty treatment-seeking civilian patients with PTSD were randomly assigned to either ACT or BC-ABM. Clinician and self-report measures of PTSD and depression, as well as AB and attention bias variability (ABV), were acquired pre- and post-treatment.

    Results

    ACT yielded greater reductions in PTSD and depressive symptoms on both clinician-rated and self-reported measures compared with BC-ABM. The BC-ABM condition successfully shifted ABs in the intended training direction. In the ACT group, there was no significant change in ABV or AB from pre- to post-treatment.

    Conclusions

    The current RCT extends previous results in being the first to apply ABM that is contingent upon AB at pre-treatment. This personalized BC-ABM approach is associated with significant reductions in symptoms. However, ACT produces even greater reductions, thereby emerging as a promising treatment for PTSD.

  • Integrating Neurobiology and Psychopathology into Evidence-Based Treatment of Social Anxiety Disorder

  • Michael R. Liebowitz, Philip T. Ninan, Franklin R. Schneier, Carlos Blanco, David L. Ginsberg, Eric Hollander
  • Journal: CNS Spectrums / Volume 10 / Issue S13 / September 2005
  • Published online by Cambridge University Press: 07 November 2014, pp. 1-2

  • Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy.

    This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.

  • Psychosocial Treatments for Social Phobia

  • Carrie L. Masia, Franklin R. Schneier
  • Journal: CNS Spectrums / Volume 4 / Issue 11 / November 1999
  • Published online by Cambridge University Press: 07 November 2014, pp. 53-60

  • Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.

  • Integrating Neurobiology and Psychopathology into Evidence-Based Treatment of Social Anxiety Disorder

  • Michael R. Liebowitz, David L. Ginsberg, Philip T. Ninan, Franklin R. Schneier, Carlos Blanco
  • Journal: CNS Spectrums / Volume 10 / Issue 10 / October 2005
  • Published online by Cambridge University Press: 07 November 2014, pp. 805a-805b

  • Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy.

    This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.

  • 6 - Evidence-based pharmacotherapy of social anxiety disorder

  • Edited by Dan Stein, University of Cape Town, Bernard Lerer, Stephen M. Stahl, University of California, San Diego
  • Book: Essential Evidence-Based Psychopharmacology
  • Published online: 05 August 2012
  • Print publication: 05 July 2012, pp 90-109

  • Summary

    This chapter summarizes the available evidence for the pharmacological management of social anxiety disorder (SAD). Monoamine oxidase inhibitors (MAOIs) were the first medications to be widely studied as a treatment for SAD. Six double-blind, placebo-controlled trials have consistently demonstrated the efficacy of phenelzine in the treatment of SAD, resulting in symptomatic and functional improvement. Compared with non-reversible MAOIs, reversible inhibitors of monoamine oxidase-A (RIMAs) have a significantly lower risk of potentiating the dangerous pressor effect of tyramine, which allows for relaxation or total elimination of dietary restrictions. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have been studied widely because of their efficacy, safety, and tolerability compared with earlier medications. The evidence from the reviewed clinical trials and meta-analyses suggests that a number of medications are efficacious in the treat.

  • 8 - Is there a spectrum of social anxiety disorder?

  • from Section 2 - Challenges in diagnosing pathological anxiety
  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 80-89

  • Summary

    This chapter assesses the relationship of social anxiety disorder (SAD) to trait phenomena of shyness, behavioral inhibition, and avoidant personality. It explores the concept that these constructs lie on a spectrum of socially anxious temperaments, and that these temperaments are essential and adaptive for group-living species. Finally, it considers evidence that the same temperamental features influence, to a variable extent, a much broader spectrum of psychopathology. Several key features of SAD are also considered defining features of personality traits and disorders, including early age of onset, chronic course, pervasive quality, and tendency to be experienced as ego-syntonic. The spectrum of social anxiety temperament also appears to be related to a much broader spectrum of associated psychopathology. SAD has been reported to be a pre-morbid risk factor for schizophrenia and a comorbid disorder in as many as 36% of outpatients with schizophrenia.

  • Section 1 - Evolving concepts of anxiety

  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 6-68

  • Summary

    Epidemiologic surveys consistently document that anxiety disorders are the most prevalent class of mental disorders. This chapter reviews the prevalence and distribution of DSM-IV anxiety disorders across the life span, drawing predominantly on large-scale epidemiologic surveys conducted in developed regions of the world, where the most rigorous work has been conducted. Sex differences in the prevalence of anxiety disorders are consistent across cultures and survey methods. Across cultures, epidemiologic work typically finds women to be at greater risk for social anxiety disorder (SAD) than men. Across several DSM iterations, generalized anxiety disorder (GAD) has evolved from a non-specific residual anxiety category to its current status as a primary anxiety disorder. Across cultures, lifetime panic disorder (PD) rates range roughly from 2% to 4%, and 1-3% reports the presence of PD within the past year. Increased efforts are needed to document population- based prevalence estimates of childhood anxiety disorders.

  • 1 - Introduction: the need for interdisciplinary approaches

  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 1-5

  • Summary

    This introductory chapter presents an overview of concepts covered in the following chapters of the book. It represents a selective review of the work undertaken over the last three decades to advance our understanding of anxiety and anxiety disorders. Research has transformed how we treat anxiety disorders: evidence-based practices have been developed and are being disseminated not only to mental health settings but also to primary care practices. Cognitive-behavioral approaches reign among psychotherapies, and the FDA has approved several classes of medication for the treatment of anxiety disorders. The focus has shifted away from identifying a treatment that can beat a placebo or usual care to developing better and novel treatments for those who do not fully respond to first-line treatments. Increasingly, these novel treatments are based on sophisticated theories of the mechanisms underlying the symptoms.

  • Section 4 - Treatment of anxiety: current status and controversial issues

  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 249-361

  • Summary

    This chapter describes the clinical relevance of idioms of distress for the generation and treatment of anxiety disorders, focusing mainly on those related to panic disorder and post-traumatic stress disorder (PTSD) in Southeast Asian and Latino populations. It reviews idioms of distress that are cultural illness syndromes. Certain idioms of distress may indicate impairment in psychosocial functioning, including work and social functioning, as well as general well-being, as assessed by quality-of-life and disability measures. The chapter also presents a model of how anxiety disorders and idioms of distress mutually reinforce each other, forming interacting escalating loops that link expectation, attention, catastrophic cognitions, and activation of the autonomic nervous system. Awareness of the relationship between cultural syndromes and anxiety disorders can enhance clinicians' ability to engage patients about a variety of therapeutic approaches and to tailor evidence-based treatments to patients' cultural understandings and experiences.

Anxiety Disorders
  • Theory, Research and Clinical Perspectives
  • Edited by Helen Blair Simpson, Yuval Neria, Roberto Lewis-Fernández, Franklin Schneier
  • Published online: 10 November 2010
  • Print publication: 26 August 2010
  • Anxiety disorders are amongst the most common of all mental health problems. Research in this field has exploded over recent years, yielding a wealth of new information in domains ranging from neurobiology to cultural anthropology to evidence-based treatment of specific disorders. This book offers a variety of perspectives on new developments and important controversies relevant to the theory, research, and clinical treatment of this class of disorders. Clinicians will find reviews of state-of-the-art treatments for panic disorder, social anxiety disorder, phobias, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder, as well as controversies over diagnostic and treatment issues. Researchers will find in-depth consideration of important selected topics, including genetics, neuroimaging, animal models, contemporary psychoanalytic theory, and the impact of stressors. This book illustrates the enormous advances that have occurred in anxiety research and describes the evolving multi-disciplinary efforts that will shape the future of the field.

  • Section 3 - Understanding the causes of anxiety

  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 139-248

  • Summary

    Social phobia turned out to be a severe clinical problem for patients whose fear of evaluation and scrutiny by others interfered with social functioning as well as performance. The study comparing phenelzine, atenolol, and placebo in social anxiety disorder became a model to be followed by subsequent trials. Social anxiety disorder appears to be a highly prevalent condition. While the most recent epidemiologic survey, the NESARC, has found a lifetime prevalence of 5% as opposed to the 13% found in the original National Comorbidity Survey (NCS) study, it would still appear that social anxiety disorder is one of the more common psychiatric conditions. Future studies should go a long way toward clarifying the pathophysiology of social anxiety disorder, which in turn should facilitate diagnosis as well as treatment. Positron emission tomography (PET) scans of patients giving speeches are beginning to delineate the brain circuits relevant to social phobic symptomatology.

  • 23 - Treatment of social anxiety disorder

  • from Section 4 - Treatment of anxiety: current status and controversial issues
  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book: Anxiety Disorders
  • Published online: 10 November 2010
  • Print publication: 26 August 2010, pp 260-270

  • Summary

    This chapter discusses the evidence for the role of genetic factors in the etiology of anxiety disorders, and summarizes the genetic study designs used in research on anxiety disorders. Molecular genetic study designs used to investigate the genetics of anxiety disorders include linkage analysis and candidate gene association studies. Twin studies support a heritability estimate between 30% and 40%. More recently, regulators of G-protein signaling have been investigated regarding anxiety-related phenotypes including panic disorder. Family studies suggest that risk of social anxiety disorder (SAD) to first-degree relatives of SAD probands ranges from 16% to 26%. Investigations of panic disorder, specific phobias, SAD, and obsessive-compulsive disorder (OCD) have produced some evidence of linkage to specific regions. Two exciting yet mostly unexplored areas in anxiety disorder research are gene-environment interaction and epigenetic studies. Epigenetic research examines the dynamic heritable changes in the function of a gene.

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