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OBJECTIVE: A substantial number of sexual assault victims report experiencing some form of peritraumatic tonic immobility (TI). A self-report questionnaire that is widely used to assess TI retrospectively is the Tonic Immobility Scale (TIS). This study explored the factor structure of the TIS in a clinical sample of adolescent and young adults.METHOD: The sample comprised 131 female rape victims, aged 13-25, who were referred for specialized trauma-focused treatment. An exploratory factor analysis (EFA) was performed.RESULTS: The EFA showed support for a three-factor model, with factors TI, Fear, and Detachment. Item correlations ranged from .32 to .57 for TI, from .14 to .35 for Fear, and .29 for the two Detachment items.CONCLUSIONS: We found support for a three-factor solution distinguishing TI, fear, and detachment, suggesting the need to further develop the TIS with different subscales in varying age groups and clinical samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. Methods A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. Discussion The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. Trial registration ISRCTN—ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022—retrospectively registered. ISRCTN—ISRCTN29668369.

The role of negative attention biases (AB), central to cognitive models of adult depression, is yet unclear in youth depression. We investigated negative AB in depressed compared to healthy youth and tested whether AB are more pronounced in depressed than at-risk youth. Negative AB was assessed for sad and angry faces with an eye-tracking paradigm [Passive Viewing Task (PVT)] and a behavioural task [Visual Search Task (VST)], comparing three groups of 9–14-year-olds: youth with major depression (MD; n = 32), youth with depressed parents (high-risk; HR; n = 49) and youth with healthy parents (low-risk; LR; n = 42). The PVT revealed MD participants to maintain attention longer on sad faces compared to HR, but not LR participants. This AB correlated positively with depressive symptoms. The VST revealed no group differences. Our results provide preliminary evidence for a negative AB in maintenance of attention on disorder-specific emotional information in depressed compared to at-risk youth.

Background and objectives: Interpretation bias plays a crucial role in anxiety. To test the causal role and potential clinical benefits, training procedures were developed to experimentally change interpretation bias. However, these procedures are monotonous and plain, which could negatively affect motivation and adherence. The aim of this study was to make the interpretation training more engaging and enjoyable, without compromising its effectiveness, through gamification. Methods: The training was gamified by including extrinsically and intrinsically motivating elements such as points, scores, time-pressure, fun and adaptive elements (training at an individually challenging level). A 2 (Type: Gamified vs. Standard) x 2 (Training Valence: Positive vs. Placebo) between-subjects design was used with random allocation of 79 above-average anxious individuals. Post-training, we assessed the liking and recommendation of the training task, interpretation bias (Recognition task and the Scrambled Sentence Task) and anxiety. Results: Participants experienced the gamified training tasks as more engaging and enjoyable than the standard tasks, although it was not recommend more to fellow-students. Both positive training conditions (gamified and standard) were successful in eliciting a positive interpretation bias when assessed with the Recognition task, while only the standard positive training impacted on interpretations when assessed with the Scrambled Sentence Task. No differential effects were observed on anxiety. Limitations: The study involved only a single-session training and participants were selected for high trait (and not social) anxiety. Conclusions: The gamified training was evaluated more positively by the participants, while maintaining the effectiveness of eliciting positive interpretations when assessed with the Recognition task. This suggests that gamification might be a promising new approach.

High self-esteem, an overall positive evaluation of self-worth, is a cornerstone of mental health. Previously we showed that people with low self-esteem differentially construct beliefs about momentary self-worth derived from social feedback. However, it remains unknown whether these anomalies extend to constructing beliefs about self-performance in a non-social context, in the absence of external feedback. Here, we examined this question using a novel behavioral paradigm probing subjects’ self-performance estimates with or without external feedback. We analyzed data from young adults (N = 57) who were selected from a larger community sample (N = 2402) on the basis of occupying the bottom or top 10% of a reported self-esteem distribution. Participants performed a series of short blocks involving two perceptual decision-making tasks with varying degrees of difficulty, with or without feedback. At the end of each block, they had to decide on which task they thought they performed best, and gave subjective task ratings, providing two measures of self-performance estimates. We found no robust evidence of differences in objective performance between high and low self-esteem participants. Nevertheless, low self-esteem participants consistently underestimated their performance as expressed in lower subjective task ratings relative to high self-esteem participants. These results provide an initial window onto how cognitive processes underpinning the construction of self-performance estimates across different contexts map on to global dispositions relevant to mental health such as self-esteem.

Empirical evidence and clinical observations suggest a strong -yet under acknowledged-link between anorexia nervosa (AN) and non-suicidal self-injurious behavior (NSSI). By reviewing the literature on the psychopathology and neurobiology of AN and NSSI, we shed light on their relationship. Both AN and NSSI are characterized by disturbances in affect regulation, dysregulation of the reward circuitry and the opioid system. By formulating a reward-centered hypothesis, we explain the overlap between AN and NSSI. We propose three approaches understanding the relationship between AN and NSSI, which integrate psychopathology and neurobiology from the perspective of self-destructiveness: (1) a nosographical approach, (2) a research domain (RDoC) approach and (3) a network analysis approach. These approaches will enhance our knowledge of the underlying neurobiological substrates and may provide groundwork for the development of new treatment options for disorders of self-destructiveness, like AN and NSSI. In conclusion, we hypothesize that self-destructiveness is a new, DSM-5-transcending concept or psychopathological entity that is reward-driven, and that both AN and NSSI could be conceptualized as disorders of self-destructiveness.

A major challenge in understanding the neurobiological basis of psychiatric disorders is rigorously quantifying subjective metrics that lie at the core of mental illness, such as low self-esteem. Self-esteem can be conceptualized as a ‘gauge of social approval’ that increases in response to approval and decreases in response to disapproval. Computational studies have shown that learning signals that represent the difference between received and expected social approval drive changes in self-esteem. However, it is unclear whether self-esteem based on social approval should be understood as a value updated through associative learning, or as a belief about approval, updated by new evidence depending on how strongly it is held. Our results show that belief-based models explain self-esteem dynamics in response to social evaluation better than associative learning models. Importantly, they suggest that in the short term, self-esteem signals the direction and rate of change of one’s beliefs about approval within a group, rather than one’s social position.

Background: Approach bias modification (ApBM) and interpretation bias modification (IBM) are two promising adjunct treatments for alcohol use and social anxiety, respectively. However, the acceptability of combining ApBM and IBM into one program for people who experience both of these disorders is unknown. The present study describes the codevelopment of a new, hybrid ApBM + IBM program and provides insight into the perceptions of acceptability from service providers and emerging adults.Methods: Service providers (n = 14) and emerging adults aged 18 to 25 years with lived experience of hazardous alcohol use and heightened social anxiety (n = 15) were recruited via online advertisements and through existing networks. All participants were shown a beta version of the program and asked to complete qualitative and quantitative questions to ascertain feedback on the program's acceptability and suggestions for improvement.Results: Themes emerged relating to the ApBM + IBM program's quality and usefulness, appropriateness, motivation and engagement, and potential clinical value. The program was well received and deemed acceptable for the target age group. It was rated particularly highly with regard to the overall quality and ease of use. Emerging adults had fewer suggestions for how the intervention might be revised; however, there were suggestions from both groups regarding the need for a compelling rationale at the outset of treatment and a suggestion to include a motivational interviewing and psychoeducational-based module prior to the first training session, to increase user buy-in and engagement.Conclusions: The current findings reflect positively on the acceptability of a hybrid ApBM + IBM for emerging adults with co-occurring hazardous alcohol use and social anxiety. Service providers and emerging adults identified a number of ways to improve the design and implementation of the program, which will likely improve adherence to, and outcomes of, the intervention when added as an adjunct to treatment as usual.

Objective Overviews of treatment goals and influencing factors may support shared decision making and optimize customized treatment to the patient with somatic symptom disorder (SSD). The aim of this study was to identify and structure comprehensive sets of treatment goals and factors influencing goal attainment in patients with SSD from the perspective of clinicians. Methods Using a concept mapping procedure, clinicians participated in interviews (N = 17) and card sorting tasks comprising 55 treatment goals and 55 factors influencing goal attainment (N = 38). Results We identified four overarching categories (A to D) of nine clusters (1 to 9) of treatment goals: A. empowerment (A1. personal values, A2. committed action, A3. self-esteem), B. skill improvement (B4. interpersonal skills, B5. emotion and stress regulation), C. symptom reduction (C6. dysfunctional beliefs, C7. somatic symptoms, C8. psychological symptoms), and D9. active and structured lifestyle. Also, we identified four overarching categories (A to D) of nine clusters (1 to 9) of factors influencing goal attainment: A1. therapeutic alliance, B. social and everyday context (B2. [family] system, B3. meaningful daily schedule, B4. social and economic circumstances), C. ability to change (C5. externalizing tendency, C6. reflective and psychological skills, C7. perspective and motivation), and D. psychological vulnerability (D8. vulnerable personality, D9. [psychiatric] comorbidity). Conclusion The overviews of treatment goals and factors influencing goal attainment reflect different paradigmatic backgrounds of clinicians. The results can be used, in combination with the perspective of the patient, to define treatment goals, and to monitor and evaluate change in outcomes.

Daily life consists of a chain of decisions. Typically, individuals may choose to pursue what they already know (exploitation) or to search for other options (exploration). This exploration-exploitation dilemma is a topic of interest across multiple scientific fields. Here we propose that investigating how individuals solve this dilemma may improve our understanding of how individuals make behavioral decisions (eg, avoidance) when facing pain. To this end, we present the data of 3 experiments in which healthy individuals were given the opportunity to choose between 4 different movements, with each movement being associated with different probabilities of receiving a painful outcome only (experiment 1) or pain and/or a reward (experiment 2). We also investigated whether participants stuck to their decisions when the contingencies between each movement and the painful/rewarding outcome changed during the task (experiment 3). The key findings across all experiments are the following: First, after initial exploration, participants most often exploited the safest option. Second, participants weighted rewards more heavily than receiving pain. Finally, after receiving a painful outcome, participants were more inclined to explore than to exploit a rewarding movement. We argue that by focusing more on how individuals in pain solve the exploration-exploitation dilemma is helpful in understanding behavioral decision making in pain. ispartof: Pain vol:163 issue:2 pages:1-19 ispartof: location:United States status: Published online

ObjectiveFatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.MethodsParticipants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.ResultsAt 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.ConclusionsProtracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.

Contains fulltext : 241320.pdf (Publisher’s version ) (Closed access) Objective: One of the prevailing theories of eating disorders (ED) is the transdiagnostic cognitive behavioural theory of eating disorders, which suggests that certain ED symptoms, such as over-valuation of eating, shape, and weight, may be more central than others. In the present study, network analyses were used to evaluate these assumptions in a patient sample. Methods: Participants were 336 individuals receiving treatment at an expert center for ED in the Netherlands. Eating disorder symptoms were used to create transdiagnostic and diagnosis-specific networks and assess symptom centrality and density of the networks. Results: Networks for patients with bulimia nervosa and binge eating disorder confirmed that over-valuation of shape, weight, and eating is the most central symptom in the network. A transdiagnostic network of ED symptoms and separate networks for patients with anorexia nervosa and bulimia nervosa showed that strict dieting was an additional central ED symptom. An exploratory analysis revealed that, although eating disorder symptoms decreased, there were no differences in density of the eating disorder networks before and after treatment with cognitive behavioural therapy. Discussion: In conclusion, the current study confirmed that over-valuation of shape, weight, and eating is a central symptom across eating disorders, in agreement with the transdiagnostic cognitive behavioural model of eating disorders. Specifically targeting this symptom in treatment could lead to other symptoms improving as a result. 8 p.

Objective: Approach bias modification (ApBM) is a promising new add-on training intervention for patients with alcohol use disorder (AUD). Given that comorbid anxiety and major depressive disorders are very common in AUD, and that such comorbidity affects psychological treatments negatively, the primary aim of the present study was investigating whether ApBM training is moderated by anxiety/major depressive disorder comorbidity. The secondary aim was to examine whether ApBM's relapse-preventive effect can be replicated. Method: We conducted a large-scale randomized controlled trial (RCT) in a clinical sample of AUD inpatients (n = 729) with a follow-up assessment after 1 year. All patients received 12 weeks of inpatient treatment as usual (TAU). On top of that, patients were randomized to a 12-session ApBM (TAU + ApBM), and a no-training control condition (TAU-only). Treatment success was defined as either no relapse or a single lapse shorter than 3 days in duration, ended by the patient and followed by at least 4 weeks of abstinence. Failure was defined as relapse, passed away, no contact, or refusal to provide information. Results: We found that TAU + ApBM had significantly higher success rates than TAU-only at 1-year follow-up. Importantly, anxiety/depressive comorbidity moderated ApBM's effects: Adding ApBM to TAU increased success rates more for patients with a comorbid anxiety and/or depressive disorder than for patients without such comorbidity. Conclusions: Our data suggest that adding ApBM to TAU works better in patients with a comorbid anxiety and/or depressive disorder; a promising finding gave the high rates of comorbidity in clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Abbreviated Math Anxiety Scale (AMAS) is commonly used to compare groups on math anxiety. Group comparisons should however be preceded by a demonstration of metric and scalar measurement invariance, which is currently only available for undergraduate students in the USA. This study tested for metric and scalar measurement invariance of AMAS scores across sexes and age groups and investigated reliability and validity evidence. Dutch secondary school students (N = 1504) and university students (N = 629) completed the AMAS and reported their math grades. Subsamples also completed questionnaires on related (e.g., trait anxiety) and unrelated constructs (e.g., anxiety for learning a foreign language). Results of multi-group Confirmatory Factor Analyses showed the 2-factor structure that was detected in earlier studies and supported partial metric and scalar invariance, although cross-loadings for one item were included for the female university students group to improve model fit. Reliability ranged from acceptable to good and validity was supported.

Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.

One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.

Generalization of conditioned fear is adaptive in some situations but maladaptive when fear excessively generalizes to innocuous stimuli with incidental resemblance to a genuine threat cue. Recently, empirical interest in fear generalization as a transdiagnostic explanatory mechanism underlying anxiety-related disorders has accelerated. As there are now several studies of fear generalization across multiple types of anxiety-related disorders, the authors conducted a meta-analysis of studies reporting behavioral measures (subjective ratings and psychophysiological indices) of fear generalization in anxiety-related disorder vs. comparison groups. We conducted systematic searches of electronic databases (conducted from January-October 2020) for fear generalization studies involving anxiety-related disorder groups or subclinical analog groups. A total of 300 records were full-text screened and two unpublished datasets were obtained, yielding 16 studies reporting behavioral fear generalization measures. Random-effects meta-analytic models and meta-regressions were applied to the identified data. Fear generalization was significantly heightened in anxiety-related disorder participants (N = 439) relative to comparison participants (N = 428). We did not identify any significant clinical, sample, or methodological moderators. Heightened fear generalization is quantitatively supported as distinguishing anxiety-related disorder groups from comparison groups. Evidence suggests this effect is transdiagnostic, relatively robust to experimental or sample parameters, and that generalization paradigms are a well-supported framework for neurobehavioral investigations of learning and emotion in anxiety-related disorders. We discuss these findings in the context of prior fear conditioning meta-analyses, past neuroimaging investigations of fear generalization in anxiety-related disorders, and future directions and challenges for the field. ispartof: NEUROPSYCHOPHARMACOLOGY vol:47 issue:9 pages:1652-1661 ispartof: location:England status: published

Background: Anorexia nervosa (AN) is a severe psychiatric disease that often takes a chronic course due to insufficient treatment options. Emerging evidence on the gut-brain axis offers the opportunity to find innovative treatments for patients with psychiatric disorders. The gut microbiome of patients with AN shows profound alterations that do not completely disappear after weight rehabilitation. In previous studies, the administration of polyunsaturated fatty acids (PUFA) resulted in effects that might be beneficial in the treatment of AN, affecting the microbiome, body weight and executive functions. Therefore, the MiGBAN study aims to examine the effects of a nutritional supplementation with PUFA on the gut microbiome and body mass index (BMI) in patients with AN. Methods: This is a longitudinal, double-blind, randomized, placebo-controlled trial. Within 2 years, 60 adolescent patients aged 12 to 19 years with AN will receive either PUFA or placebo for 6 months additional to treatment as usual. After 1 year, the long-term effect of PUFA on the gut microbiome and consecutively on BMI will be determined. Secondary outcomes include improvement of gastrointestinal symptoms, eating disorder psychopathology, and comorbidities. Additionally, the interaction of the gut microbiome with the brain (microbiome-gut-brain axis) will be studied by conducting MRI measurements to assess functional and morphological changes and neuropsychological assessments to describe cognitive functioning. Anti-inflammatory effects of PUFA in AN will be examined via serum inflammation and gut permeability markers. Our hypothesis is that PUFA administration will have positive effects on the gut microbiota and thus the treatment of AN by leading to a faster weight gain and a reduction of gastrointestinal problems and eating disorder psychopathology. Discussion: Due to previously heterogeneous results, a systematic and longitudinal investigation of the microbiome-gut-brain axis in AN is essential. The current trial aims to further analyse this promising research field to identify new, effective therapeutic tools that could help improve the treatment and quality of life of patients. If this trial is successful and PUFA supplementation contributes to beneficial microbiome changes and a better treatment outcome, their administration would be a readily applicable additional component of multimodal AN treatment. Trial registration: German Clinical Trials Register DRKS00017130. Registered on 12 November 2019.

Background and objectivesFor many psychotherapies, like Eye Movement and Desensitization Reprocessing (EMDR) therapy, there is an ongoing discussion about the role of specific versus non-specific mechanisms in their effectiveness However, experimental research directly examining the potential role of non-specific mechanisms is scarce. Here, we address the role of a non-specific factor that is often put forward for EMDR, namely treatment effectiveness expectations, within a laboratory model of EMDR therapy.MethodsIn a lab-based (N = 96) and an online experiment (N = 173), we gave participants verbal instructions to manipulate their treatment expectations. Instructions emphasized EMDR's effectiveness or ineffectiveness. Then, participants were asked to recollect an unpleasant autobiographical memory with or without making eye-movements.ResultsIn line with previous studies, we found significant reductions of reported vividness and emotionality of negative autobiographical memories in the eye-movements condition. These reductions did not differ between the verbal suggestions conditions in both experiments, suggesting a limited effect of treatment effectiveness suggestions.LimitationsTreatment effectiveness expectations were not successfully manipulated by the suggestions manipulation. This suggests that treatment expectations may be more difficult to influence than anticipated, thus limiting the interpretation of our findings.ConclusionsThese findings tentatively corroborate the results of two earlier reports, suggesting that the effects of verbal suggestions about treatment effectiveness in a laboratory model of EMDR therapy may be limited.

Introduction Fatigue and pain are the main symptoms of rheumatic and musculoskeletal diseases (RMDs). Healthcare professionals have a primary role in helping patients to manage both these symptoms, which are part of a complex network of co-occurring factors including sleep problems, psychological distress, social support, body weight, diet, inactive lifestyle and disease activity. The patterns of relationships (networks) between these factors and these symptoms, fatigue and pain, are largely unknown. The current proposal aims to reveal them using network estimation techniques. We will also consider differences in networks for subgroups of people with (1) different RMDs and (2) different clusters (profiles) of biopsychosocial factors. Methods and analysis Adults with at least one RMD will be recruited to this online cross-sectional observational project. To provide a complete overview, a large sample size from different countries will be included. A brief online survey, using 0–10 numeric rating scales will measure, for the past month, levels of fatigue and pain as well as scores on seven biopsychosocial factors. These factors were derived from literature and identified by interviews with patients, health professionals and rheumatologists. Using this input, the steering committee of the project decided the factors to be measured giving priority to those that can be modified in self-management support in community health centres worldwide. Network estimation techniques are used to detect the complex patterns of relationships between these biopsychosocial factors, fatigue and pain; and how these differ for subgroups of people with different RMDs and profiles. Ethics and dissemination Ethical approval of national Institutional Review Boards was obtained. The online survey includes an information letter and informed consent form. The findings will be disseminated via conferences and publications in peer-reviewed scientific journals, while public media channels will be used to inform people with RMDs and other interested parties., European League Against Rheumatism (EULAR) Health Professionals Research Grant HPR045, Ministry of Science and Innovation, Spain (MICINN), Spanish Government RYC2021-034311-I, Spanish Ministry of Universities and Next Generation 'Margarita Salas' Grant Program

Background: The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce. Methods: We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals. Results: Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology. Conclusions: The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

Background The efficacy of virtual reality exposure therapy (VRET) for fear of flying has been well established. Yet, little is known about the extent to which anxiety sensitivity and self-efficacy predict the efficacy of VRET. We aimed at investigating these cognitive predictors as well as the contribution of the therapeutic alliance to treatment outcome. Methods In a within-subjects design with 67 patients with fear of flying, four sessions of an exposure-based treatment using VRET were given. Sessions were held every week, each consisting of two virtual flights of 25 min. Results Results showed that pre-treatment levels of anxiety sensitivity, initial improvement in self-efficacy (and not pre-treatment levels of self-efficacy), and the quality of the therapeutic alliance significantly predicted treatment outcome. Conclusions The findings provide evidence that initial changes in self-efficacy, pre-treatment anxiety sensitivity, and therapeutic alliance are significant predictors of response to VRET for specific phobia.

There is heterogeneity in and a lack of consensus on the preferred statistical analyses foranalyzing fear conditioning effects in light of a multitude of potentially equally justifiablestatistical approaches. Here, we introduce the concept of multiverse analysis for fearconditioning research. We also present a model multiverse approach specifically tailored tofear conditioning research and introduce the novel and easy to use R package ‘multifear’ thatallows to run all the models though a single line of code. Model specifications and datareduction approaches employed in the ‘multifear’ package were identified through arepresentative systematic literature search. The heterogeneity of statistical models identifiedincluded Bayesian ANOVA and t-tests as well as frequentist ANOVA, t-test as well as mixedmodels with a variety of data reduction approaches (i.e., number of trials, trial blocks,averages) as input. We illustrate the power of a multiverse analysis for fear conditioning databased on two pre-existing data sets with partial (data set 1) and 100% reinforcement rate(data set 2) by using CS discrimination in skin conductance responses (SCRs) during fearacquisition and extinction training as case examples. Both the effect size and the direction ofeffect was impacted by choice of the model and data reduction techniques. We anticipatethat an increase in multiverse-type of studies in the field of fear conditioning research andtheir extension to other outcome measures as well as data and design multiverse analyseswill aid the development of formal theories through the accumulation of empirical evidence.This may contribute to facilitated and more successful clinical translation.

BackgroundThe use of oral contraceptives (OCs) has been associated with increased incidences of anxiety and depression, for which adolescents seem to be particularly vulnerable. Rather than looking at singular outcomes, we examined whether OC use is associated with depressive and anxiety symptom trajectories from early adolescence into early adulthood.Materials and MethodsData from 178 girls were drawn from the Research on Adolescent Development and Relationships (RADAR-Y) younger cohort study. We used assessments on 9 waves from age 13 until 24. Developmental trajectories of ratings on the Reynolds Adolescent Depression Scale (RADS-2) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were compared between never and ever users of OCs.ResultsNever users showed increases in depressive and anxiety symptoms in late adolescence, whereas OC users showed a stable level of symptoms throughout adolescence. This effect remained after adjusting for baseline differences between groups in romantic relationships, sexual debut, educational level, smoking, drinking, and drug use. Age of OC use onset did not significantly predict symptom development.ConclusionsOC use in adolescence was related to an altered developmental trajectory of internalizing symptoms, in which OC users did not show an increase in depressive and anxiety symptoms in late adolescence, whereas never users did. The question remains whether this altered symptom trajectory can be considered a protective effect of OC use on psychopathology. Additional research is needed to improve our understanding of the long-term consequences of OC use on mental health.

Highlights • Meta-analyses showed that the effects of online CBT for PTSD are promising. • Worldwide only one trial examined the effects of online EMDR for PTSD. • Wider usage and implementation of online EMDR seems premature in times of COVID-19., COVID-19 affects many societies by measures as “social distancing”, forcing mental health care professionals to deliver treatments online or via telephone. In this context, online Eye Movement Desensitization and Reprocessing (EMDR) is an emerging treatment for patients with Posttraumatic Stress Disorder (PTSD). We performed a systematic review of studies investigating online EMDR for PTSD. Only one trial was identified. That uncontrolled open trial showed promising results. There is an urgent need to further examine the effects of online EMDR for PTSD, before its wider dissemination is warranted. Remotely delivered cognitive behavioural therapy seems the preferred PTSD-treatment in times of COVID-19.

Psychological problems like procrastination, perfectionism, low self-esteem, test anxiety and stress are common among college students. There are evidence-based interventions available for these problems that not only have direct effects on these problems, but also indirect effects on mental disorders such as depression and anxiety disorders. Targeting these psychological problems may offer new opportunities to prevent and treat mental disorders in a way that is less stigmatizing to students. In this study we examined the association of five psychological problems with five common mental disorders (panic, generalized anxiety, bipolar, major depressive, and substance use disorder) in a sample of 2,449 students from two Dutch universities. Psychological problems were measured with one item for each problem and mental disorders were measured with the Composite International Diagnostic Interview Screening Scales. Associations were examined with Poisson regression models as relative risks (RR) of the disorders as a function of the psychological problems. The population attributable fraction (PAF) indicates by what percentage the prevalence of the mental disorder would be reduced if the psychological problem was addressed successfully by an intervention. Especially generalized anxiety disorder was strongly associated with psychological problems (strong associations with stress and low self-esteem and moderately with test anxiety). The group with three or more psychological problems had a strongly increased risk for generalized anxiety (RR = 11.25; 95% CI: 7.51-16.85), and a moderately increase risk for major depression (RR = 3.22; 95% CI: 2.63-3.95), panic disorder (RR = 3.19; 95% CI: 1.96-5.20) and bipolar disorder (RR = 3.66; 95% CI: 2.40-5.58). The PAFs for having any of the psychological problems (one or more) were considerable, especially for generalized anxiety (60.8%), but also for panic disorder (35.1%), bipolar disorder (30.6%) and major depression (34.0%). We conclude that common psychological problems are associated with mental disorders and with each other. After adjustment, psychological problems are associated with different patterns of mental disorders. If the impact of the psychological problems could be taken away, the prevalence of several mental disorders would be reduced considerably. The psychological problems may provide a promising target to indirectly prevent and intervene in psychopathology in hard to reach college students with mental disorders. ispartof: FRONTIERS IN PSYCHIATRY vol:12 ispartof: location:Switzerland status: published

Background and objectives In dual-tasking, individuals recall a threat-related memory while performing a demanding dual-task. This is a fruitful approach to reduce the unpleasantness and vividness of aversive memories and to reduce conditioned fear responses. Crucially, it remains unclear whether dual-tasking can also reduce conditioned fear responses and intrusive memories over time. In this pre-registered two-day fear conditioning paradigm, we examined whether a dual-task intervention reduces return of fear and the frequency of intrusive memories of an aversive film over time. Methods On Day 1, 76 healthy participants underwent fear acquisition with aversive film clips. They were then randomly allocated to one of three conditions: dual-tasking, memory recall without a dual-task (‘recall only’), or no task. Afterwards, they underwent an extinction phase and were asked to record intrusive film memories over 48 h. On Day 3, return of fear was assessed. Results On Day 1, fear acquisition and extinction were successful. On Day 3, spontaneous recovery and renewal were evident, but, overall, participants reported few intrusions. The dual-task and recall only groups reported reduced unpleasantness of threat memory compared to the no task group, but they did not show reduced (return of) fear responses or fewer intrusions. Limitations Intrusion frequency was low in all three groups, which limits the detection of intervention effects. Conclusions Even though dual-tasking and recall only devalued threat memory temporarily compared to no task, these interventions did not reduce (return of) fear responses and intrusions. Future studies could focus on improving the potency of imagery-based interventions.

We tested whether surprise elicits similar physiological changes as those associated with orienting and freezing after threat, as surprise also involves a state of interruption and attention for effective action. Moreover, because surprise is primarily driven by the unexpectedness of an event, initial physiological responses were predicted to be similar for positive, neutral, and negative surprises. Results of repetition-change studies (4 + 1 in Supplemental Materials) showed that surprise lowers heart rate (Experiments 1-4) and increases blood pressure (Experiment 4). No effects on body movement (Experiment 2) or finger temperature (Experiment 4) were found. When unexpected stimuli were presented more often (making them less surprising) heart rate returned to baseline, while blood pressure remained high (Experiment 4). These effects were not influenced by stimulus valence. However, second-to-second analyses within the first (surprising) block showed a tendency for a stronger increase in systolic blood pressure after negative vs. positive surprise.

Children of parents with a history of depression have an increased risk of developing depression themselves. The present study investigated the role of interpretation biases (that have been found in adults and adolescents with depression but have rarely been examined in at-risk youth) in the transgenerational transmission of depression risk. Interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in 9-14-year-old children of parents with a history of depression (high risk; n = 43) in comparison to children of parents with no history of mental disorders (low risk; n = 35). Interpretation biases were also compared between the two groups of parents and relationships between children's and parents' bias scores were examined. As expected, we found more negative interpretation biases in high-risk children compared to low-risk children as well as in parents with a history of depression compared to never-depressed parents (assessed via the SST but not the AST). However, transgenerational correlations were only found for the AST. Our results indicate that negative interpretation biases are present in youth at risk for depression, possibly representing a cognitive vulnerability for the development of depression. Moreover, different measures of interpretation bias seemed to capture different aspects of biased processing with the more implicit measure (SST) being a more valid indicator of depressive processing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Both auditory and visual emotional memories can be made less emotional by loading working memory (WM) during memory recall. Taxing WM during recall can be modality specific (giving an auditory [visuospatial] load during recall of an auditory [visual] memory) or cross modal (an auditory load during visual recall or vice versa). We tested whether modality specific loading taxes WM to a larger extent than cross modal loading. Ninety-six participants undertook a visual and auditory baseline Random Interval Repetition task (i.e. responding as fast as possible to a visual or auditory stimulus by pressing a button). Then, participants recalled a distressing visual and auditory memory, while performing the same visual and auditory Random Interval Repetition task. Increased reaction times (compared to baseline) were indicative of WM loading. Using Bayesian statistics, we compared five models in terms of general and modality specific taxation. There was support for the model describing the effect on WM of dual tasking in general, irrespective of modality specificity, and for the model describing the effect of modality specific loading. Both models combined gained the most support. The results suggest a general effect of dual tasking on taxing WM and a superimposed effect of taxing in matched modality.

Background and objectives Several treatments are effective in reducing symptoms of post-traumatic stress disorder. We tested the effectiveness of an experimental intervention that consists of elements from two of these: virtual reality (VR) exposure therapy and eye movement desensitization and reprocessing. The latter is characterized by a dual-task approach: the patient holds a traumatic memory in mind while simultaneously making voluntary eye movements, resulting in reduced vividness and emotionality of the traumatic memory. If the experimental intervention is effective, it could provide a useful approach for highly avoidant individuals. Methods Participants recalled negative memories induced by a VR paradigm. The experimental group viewed VR screenshots that represented these negative memories while carrying out a dual-task. One control group recalled negative memories while carrying out the same dual-task (a standard dual-task condition) and another merely viewed the VR screenshots. Pre-to-post changes in self-rated memory vividness/emotionality were measured. Results The results indicate that viewing a screenshot only was outperformed by both dual-task interventions in terms of reductions in vividness/emotionality. Furthermore, the dual-task interventions had a comparable impact on vividness, but the screenshot variant led to greater decreases in emotionality. Limitations Changes in memory vividness/emotionality were only assessed shortly after the interventions and no measures of avoidance behavior were included in the study. Conclusions Looking at an image in VR that represents a memory while carrying out a dual-task may be at least as effective as recalling the memory during the dual-task. Interestingly, visually supporting a negative memory does not seem to prevent memory degrading by dual-tasking.

Importance: Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited. Objective: This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy, or waiting list) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). Data Sources: English-language publications were identified from PubMed, PsycINFO, Embase, Cochrane, OpenGrey (1980 to January 2019), and recent reviews. The search strategy included a combination of terms associated with anxiety disorders (eg, panic or phobi) and study design (eg, clinical trial or randomized controlled trial). Study Selection: Randomized clinical trials on posttreatment and at least 1-month follow-up effects of cognitive behavioral therapy compared with control conditions among adults with generalized anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobia, PTSD, or OCD. Data Extraction and Synthesis: Researchers independently screened records, extracted statistics, and assessed study quality. Data were pooled using a random-effects model. Main Outcomes and Measures: Hedges g was calculated for anxiety symptoms immediately after treatment and at 1 to 6 months, 6 to 12 months, and more than 12 months after treatment completion. Results: Of 69 randomized clinical trials (4118 outpatients) that were mainly of low quality, cognitive behavioral therapy compared with control conditions was associated with improved outcomes after treatment completion and at 1 to 6 months and at 6 to 12 months of follow-up for a generalized anxiety disorder (Hedges g, 0.07-0.40), panic disorder with or without agoraphobia (Hedges g, 0.22-0.35), social anxiety disorder (Hedges g, 0.34-0.60), specific phobia (Hedges g, 0.49-0.72), PTSD (Hedges g, 0.59-0.72), and OCD (Hedges g, 0.70-0.85). After 12-month follow-up, these associations were still significant for generalized anxiety disorder (Hedges g, 0.22; number of studies [k] = 10), social anxiety disorder (Hedges g, 0.42; k = 3), and PTSD (Hedges g, 0.84; k = 5), but not for panic disorder with or without agoraphobia (k = 5) and could not be calculated for specific phobia (k = 1) and OCD (k = 0). Relapse rates after 3 to 12 months were 0% to 14% but were reported in only 6 randomized clinical trials (predominantly for panic disorder with or without agoraphobia). Conclusions and Relevance: The findings of this meta-analysis suggest that cognitive behavioral therapy for anxiety-related disorders is associated with improved outcomes compared with control conditions until 12 months after treatment completion. After 12 months, effects were small to medium for generalized anxiety disorder and social anxiety disorder, large for PTSD, and not significant or not available for other disorders. High-quality randomized clinical trials with more than 12 months of follow-up and reported relapse rates are needed.

Background: various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury.Methods: data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3).Results: based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.Limitations: the posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria.Conclusions: this study suggests that mothers’ acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents’ early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

Background: Tonic immobility (TI; a state of motor arrest during threat) and has been found to be associated with the development of psychopathology. It also hindered recovery from posttraumatic stress disorder (PTSD) after pharmacological treatment. The present study investigated the role of TI in recovery from PTSD in a large representative community sample with mixed traumas outside an exclusive treatment context.Methods: Participants with PTSD from the panel for Longitudinal Internet Studies for the Social Sciences (LISS) completed measures for trauma, PTSD symptoms, and peritraumatic responses (fear, dissociation, and TI) in two subsequent years. Traumatized participants with PTSD were selected for the analyses (N = 262).Results: TI was a relevant predictor for increased PTSD symptoms in year 2 after controlling for peritraumatic fear, peritraumatic dissociation, and PTSD symptoms in year 1, especially in abuse victims. Peritraumatic fear and dissociation no longer predicted PTSD in year 2 after entering TI in the model.Conclusions: Our results indicate that TI may indeed hinder recovery from PTSD. TI may thus be a relevant factor to take into account after trauma and in treatment. The effects of TI may be especially negative for abuse victims.

BACKGROUND: Late-life depression (LLD) is related to an increased risk of developing dementia; however, the biological mechanisms explaining this relationship remain unclear.OBJECTIVE: To determine whether the relationship between LLD and dementia can be best explained by the glucocorticoid cascade or vascular hypothesis.METHODS: Data are from 4,354 persons (mean age 76±5 years) without dementia at baseline from the AGES-Reykjavik Study. LLD was assessed with the MINI diagnostic interview (current and remitted major depressive disorder [MDD]) and the Geriatric Depression Scale-15. Morning and evening salivary cortisol were collected (glucocorticoid cascade hypothesis). White matter hyperintensities (WMH; vascular hypothesis) volume was assessed using 1.5T brain MRI. Using Cox proportional hazard models, we estimated the associations of LLD, cortisol levels, and WMH volume with incident all-cause dementia, AD, and non-AD dementia.RESULTS: During 8.8±3.2 years of follow-up, 843 persons developed dementia, including 397 with AD. Current MDD was associated with an increased risk of developing all-cause dementia (HR = 2.17; 95% CI 1.66-2.67), with risks similar for AD and non-AD, while remitted MDD was not (HR = 1.02; 95% CI 0.55-1.49). Depressive symptoms were also associated with increased risk of dementia, in particular non-AD dementias. Higher levels of evening cortisol increased risk of dementia, but this was independent of MDD. WMH partially explained the relation between current MDD and dementia risk but remained increased (HR = 1.71; 95% CI 1.34-2.08).CONCLUSION: The current study highlights the importance of LLD in developing dementia. However, neither the glucocorticoid cascade nor the vascular hypotheses fully explained the relation between depression and dementia.

The authors regret to inform that an error was made in the data analysis syntax for the analyses reported in the referenced article. Particularly, we included the “Behavioral Inhibition Scale” (BIS) in this study and correlated the scores on this questionnaire to generalization gradients in a fear generalization paradigm. Accidentally, we used items from the Intolerance of Uncertainty Scale (IUS), rather than the BIS, to calculate the BIS total scores. As a result of this error, the average BIS total score and the correlations that we report in Table 1 of the original article with this scale are incorrect. We report the correct BIS total score, standard deviation, and correlations with this scale in the updated table below (Table 1). Please note that, using the correct BIS scores, the correlation between the Generalization Index (GI) for fear potentiated startle (FPS) and BIS (r = −0.19; p = .037) now reached the conventional alpha cut-off level for statistical significance (0.05). However, this correlation was not significant according to our adjusted alpha level (0.017) that we had pre-specified for our study. As such, all the main conclusions of the original article remain unchanged. The authors would like to apologise for any inconvenience caused.

OBJECTIVE: Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation. DESIGN & MAIN OUTCOME MEASURES: Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships. RESULTS: Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly. CONCLUSIONS: Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive–compulsive disorders. Besides an overview into the efficacy of VR, a summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as, for example, dissemination into clinical practice and what VR has to offer therapists in future. This not only in adult population but as well in younger patients, as young adolescents VR has a great potential as it connects easily with its playful elements to this population and might be a low threshold step to offer treatment or preventive interventions.

Background: Visual Schema Displacement Therapy (VSDT) is a novel therapy for the treatment of fears and trauma-related mental health problems including PTSD. VSDT proved to be effective in reducing emotionality of aversive memories in healthy individuals in two previous randomized controlled trials and outperformed both a non-active control condition (CC) and an abbreviated version of EMDR therapy, a well-established first-line treatment for posttraumatic stress disorder. Objectives: In an effort to enhance the understanding concerning the efficacy of VSDT, and to determine its active components, a dismantling study was conducted in individuals with disturbing memories in which the effects of VSDT were tested against EMDR therapy, a non-active CC and three different VSDT-protocols, each excluding or altering a hypothesized active component. Method: Participants (N = 144) were asked to recall an emotional aversive event and were randomly assigned to one of these six interventions, each lasting 8 minutes. Emotional disturbance and vividness of participants’ memories were rated before and after the intervention and at one and four-week follow-up. Results: Replicatory Bayesian analyses supported hypotheses in which VSDT was superior to the CC and the EMDR condition in reducing emotionality, both directly after the intervention and at one week follow-up. However, at four-week follow-up, VSDT proved equal to EMDR while both treatments were superior to the CC. Concerning vividness the data also showed support for hypotheses predicting VSDT being equal to EMDR and both being superior to the CC in vividness reduction. Further analyses specifying differences between the abbreviated VSDT protocols detected no differences between these conditions. Conclusion: It remains unclear how VSDT yields its positive effects. Because VSDT appears to be unique and effective in decreasing emotionality of aversive memories, replication of the results in clinical samples is needed., Highlights • Visual Schema Displacement Therapy reduces emotionality of disturbing memories. • Working mechanisms of VSDT are explored. • VSDT outperforms EMDR in reducing emotionality of disturbing memories.

Recent research findings indicate that human fear conditioning is affected by instructions, particularly those concerning the contingency between the conditioned stimulus (CS) and the unconditioned stimulus (US). However, whether or not such instructions were provided to participants often remains unsaid in fear conditioning studies. In the current study (N=102), we investigated whether conditioned fear acquisition depends on CS-US contingency instructions. Participants were randomly assigned to one of three groups. The first group was instructed about the precise CS-US contingency before conditioning. The second group was instructed to discover the CS-US contingency. The third group did not receive any contingency instructions. We found facilitated fear acquisition (using skin conductance and startle) and increased contingency awareness in the first and second group compared to the third group. Furthermore, contingency reversal instructions immediately reversed conditioned responses. Based on these results, we advise to systematically report the used contingency instructions in fear conditioning research. ispartof: Biological Psychology vol:158 pages:1-40 ispartof: location:Netherlands status: Published online

Research has demonstrated that disgust can be installed through classical conditioning by pairing neutral conditioned stimuli (CSs) with disgusting unconditioned stimuli (USs). Disgust has been argued to play an important role in maintaining fear-related disorders. This maintaining role may be explained by conditioned disgust being less sensitive to extinction (i.e., experiencing the CS in the absence of the US). Promising alternatives to extinction training are procedures that focus on the devaluation of US memory representations. In the current study, we investigated whether such devaluation procedures can be successful to counter conditioned disgust. We conducted two laboratory studies (N = 120 and N = 51) in which disgust was conditioned using audio-visual USs. Memory representations of the USs were devalued by having participants recall these USs while they performed a taxing eye-movement task or executed one of several control tasks. The results showed successful conditioned disgust acquisition. However, no strong evidence was obtained that an US memory devaluation procedure modulates disgust memory and diminishes conditioned disgust as indicated by subjective, behavioral, or psychophysiological measures. We discuss the relevance of our results for methodological improvements regarding US memory devaluation procedures and disgust conditioning. ispartof: JOURNAL OF ANXIETY DISORDERS vol:82 ispartof: location:Netherlands status: published

Individual differences in fear learning are a crucial prerequisite for the translational value of the fear-conditioning model. In a representative sample (N = 936), we used latent class growth models to detect individual differences in associative fear learning. For a series of subsequent test phases varying in ambiguity (i.e., acquisition, extinction, generalization, reinstatement, and re-extinction), conditioned responding was assessed on three response domains (i.e., subjective distress, startle responding, and skin conductance). We also associated fear learning across the different test phases and response domains with selected personality traits related to risk and resilience for anxiety, namely Harm Avoidance, Stress Reaction, and Wellbeing (MPQ; Tellegen and Waller, 2008). Heterogeneity in fear learning was evident, with fit indices suggesting subgroups for each outcome measure. Identified subgroups showed adaptive, maladaptive, or limited-responding patterns. For subjective distress, fear and safety learning was more maladaptive in the subgroups high on Harm Avoidance, while more adaptive learning was observed in subgroups with medium Harm Avoidance and the limited- or non-responders were lowest in Harm Avoidance. Distress subgroups did not differ in Stress Reaction or Wellbeing. Startle and SCR subgroups did not differ on selected personality traits. The heterogeneity in fear-learning patterns resembled risk and resilient anxiety development observed in real life, which supports the associative fear-learning paradigm as a useful translational model for pathological fear development. ispartof: INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY vol:158 pages:271-287 ispartof: location:Netherlands status: published

Background and objectivesInterpretation bias modification can affect stress reactivity, yet results have not been consistent. This inconsistency may be partly due to variability in the degree to which training procedures alter interpretation at a more automatic, rather than strategic, level of processing, and a mismatch in available resources between the training and the stress situation. We tested this possibility by investigating whether imposing a secondary cognitive load during interpretation bias modification would strengthen training-induced effects on both interpretation bias and emotional reactivity.MethodWe trained 71 participants in a single session to interpret ambiguity either positively or negatively. Half of our participants did so while performing a cognitively demanding secondary task. We assessed the effects of these different training regimes on interpretation bias and both self-reported and physiological indices of stress reactivity.ResultsPositive and negative interpretation bias modification resulted in training-congruent changes in interpretation bias. There were no group differences in self-reported stress reactivity, but positive interpretation training did improve recovery from stress as indexed by the heart rate measurement. Countering our hypothesis, the addition of cognitive load during the training increased neither the induced interpretive change nor its emotional impact.LimitationsSample size was relatively small, though sufficient to detect medium sized effects.ConclusionsAdding cognitive load to interpretation bias modification does not alter training-induced change in interpretation bias or emotional reactivity.

Background: Guideline-recommended therapies are moderately successful in the treatment of obsessive-compulsive disorder (OCD) and anorexia nervosa (AN), leaving room for improvement. Cognitive inflexibility, a common trait in both disorders, is likely to prevent patients from engaging in treatment and from fully benefiting from existing therapies. Cognitive remediation therapy (CRT) is a practical augmentation intervention aimed at ameliorating this impairing cognitive style prior to disorder-specific therapy. Objective: To compare the effectiveness of CRT and a control treatment that was not aimed at enhancing flexibility, named specialized attention therapy (SAT), as add-ons to treatment as usual (TAU). Methods: In a randomized controlled multicenter clinical trial, 71 adult patients with OCD and 61 with AN were randomized to ten twice-weekly sessions with either CRT or SAT, followed by TAU. Patients were evaluated at baseline, post-CRT/SAT, and after 6 and 12 months, with outcomes being quantified using the Yale-Brown Obsessive Compulsive Scale for OCD and the Eating Disorder Examination Questionnaire for AN. Results: Across study groups, most importantly CRT+TAU was not superior to control treatment (SAT)+TAU in reducing OCD and AN pathology. Contrary to expectations, SAT+TAU may have been more effective than CRT+TAU in patients being treated for OCD. Conclusions: CRT did not enhance the effect of TAU for OCD and AN more than SAT. Unexpectedly, SAT, the control condition, may have had an augmentation effect on TAU in OCD patients. Although this latter finding may have been due to chance, the effect of SAT delivered as a pretreatment add-on intervention for adults with OCD and AN merits future efforts at replication.

Purpose of Review This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD). Recent Findings Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a stand-alone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo. Summary Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.

Adolescents with mild to borderline intellectual disability (MBID) show more daily life risk taking than typically developing adolescents. To obtain insight in when these “risk-taking adolescents” especially take risks, we investigated main and interaction effects of (a) MBID, (b) sex, and (c) type of peer influence on risk taking. The Balloon Analogue Risk Task (BART) was used as a proxy of real-life risk taking. 356 adolescents (12–19 years, 51.7% MBID, 63.4% boys) were randomly assigned to one of three BART peer-influence conditions: solo (no peers), positive risk encouragement (e.g., ‘You are cool if you continue’) or negative risk encouragement (e.g., ‘You are a softy if you do not continue’). The main finding was that boys with MBID took more risks than typically developing boys in the negative risk encouragement condition. Boys with MBID also took more risks in the negative risk encouragement condition compared to the solo condition, whereas typically developing boys did not. There were no such effects for girls. Surprisingly, boys with MBID took less risks in the solo condition than typically developing boys. We conclude that boys with MBID especially show high risk taking when peers belittle or threat with exclusion from the peer group. Prevention and intervention programs should specifically target boys with MBID to teach them to resist negative risk encouragement by peers.

BACKGROUND AND OBJECTIVES: Research on the social effects of intranasal oxytocin in children is scarce. Oxytocin has been proposed to have clearer beneficial effects when added to social learning paradigms. The current study tested this proposition in middle childhood by assessing effects of cognitive bias modification (CBM) training and oxytocin on trust in maternal support. METHODS: Children (N = 100, 8-12 years) were randomly assigned to one of two training conditions: CBM training aimed at increasing trust or neutral placebo training. Within each training condition, half the participants received oxytocin and half a placebo. Main and interaction effects were assessed on measures of trust-related interpretation bias and trust. We explored whether child characteristics moderated intervention effects. RESULTS: Children in the CBM training were faster to interpret maternal behaviour securely versus insecurely. Effects did not generalize to interpretation bias measures or trust. There were no main or interaction effects of oxytocin. Exploratory moderation analyses indicated that combining CBM training with oxytocin had less positive effects on trust for children with more internalizing problems. LIMITATIONS: As this was the first study combining CBM and oxytocin, replication of the results is needed. CONCLUSIONS: This study combined a social learning paradigm with oxytocin in children. CBM training was effective at an automatic level of processing. Oxytocin did not enhance CBM effects or independently exert effects. Research in larger samples specifying when oxytocin might have beneficial effects is necessary before oxytocin can be used as intervention option in children. ispartof: Journal Of Behavior Therapy And Experimental Psychiatry vol:66 pages:1-9 ispartof: location:Netherlands status: Published online

Dual taxation of the working memory during recall is an effective strategy to reduce the emotionality and vividness of visual intrusive memories and potentially changes dysfunctional beliefs associated with the memories. This study tested the hypothesis that dual tasking decreases emotionality, vividness and credibility of auditory intrusive images (i.e., memories of auditory hallucinations) with a two-level (time: pre and post; condition: dual tasking and recall only) within-subjects design. Thirty-seven voice-hearing participants selected two negative voice-hearing experiences. They recalled one of these experiences while performing a lingual dual task (i.e., language game on smartphone app) and recalled one memory without a dual task (in counterbalanced order). During the pre-test and post-test, emotionality and vividness of the voice-hearing memories were rated, as well as the credibility of the voice statements. There was a significantly greater decrease in emotionality, vividness and credibility during dual tasking than during recall only. This study provides proof of principle that the salience and credibility of the content of auditory hallucinations can be reduced by dual tasking; the clinical implications are also discussed.

Negative interpretation biases have been found to characterize adults with depression and to be involved in the development and maintenance of the disorder. However, less is known about their role in youth depression. The present study investigated i) whether negative interpretation biases characterize children and adolescents with depression and ii) to what extent these biases are more pronounced in currently depressed youth compared to youth at risk for depression (as some negative interpretation biases have been found already in high-risk youth before disorder onset). After a negative mood induction interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in three groups of 9–14-year-olds: children and adolescents with a diagnosis of major depression (n = 32), children and adolescents with a high risk for depression (children of depressed parents; n = 48), as well as low-risk children and adolescents (n = 42). Depressed youth exhibited substantially more negative interpretation biases than both high-risk and low-risk groups (as assessed with both tasks), while the high-risk group showed more negative interpretation biases than the low-risk group only as assessed via the SST. The results indicate that the negative interpretation biases that are to some extent already present in high-risk populations before disorder onset are strongly amplified in currently depressed youth. The different findings for the two tasks suggest that more implicit interpretation biases (assessed with the SST) might represent cognitive vulnerabilities for depression whereas more explicit interpretation biases (assessed with the AST) may arise as a consequence of depressive symptomatology. Electronic supplementary material The online version of this article (10.1007/s10802-020-00670-3) contains supplementary material, which is available to authorized users.