Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study

Exposure is a highly effective treatment for pathological fear and anxiety, but rarely used in routine care. Issues of practicability and lack of therapists in rural areas are main barriers for the dissemination of exposure. Smartglass devices may enable therapists to guide exposure from their own office via real-time feedback and may thereby increase practicability. The present study explored the technological usability and clinical feasibility of Smartglass-guided exposure in a behavioral approach test in spider-fearful individuals (N = 40).Fearful individuals were asked to start the Smartglass themselves and established a connection to a therapist, who guided the exposure test from afar. Clinical severity of spider fear was assessed via questionnaire. Technological usability was assessed with established measures of usability, user experience, and user acceptance. Exploratory, individual characteristics of exposure were collected (e.g., within-session fear reduction, duration, safety behavior).Overall, fearful individuals (94.9%) and therapists (100%) were able to establish a connection. Usability of Smartglass-guided exposure was evaluated as positive. Within-session fear reduction was large (d = 1.91). Adverse events were minimal. There were, however, some associations between exposure characteristics and usability evaluation (e.g., lower user-friendliness and exposure duration). Two case examples further highlight chances and risks of Smartglass-guided exposure.These findings provide first evidence that Smartglass-guided exposure could be useful in exposure therapy. Smartglass-guided exposure may ultimately help to increase practicability of exposure and increase dissemination, also in rural areas. These findings are promising for future research on the long-term outcome of evidence-based exposure in treatment seeking patients.     

Correction to: A Family Socialization Model of Transdiagnostic Risk for Psychopathology in Preschool Children

Research on Child and Adolescent Psychopathology - A correction to this paper has been published: https://doi.org/10.1007/s10802-021-00812-1     

Prenatal maternal representations: Mothers at psychosocial risk

The aim of the study was to explore differences in the content of prenatal mental representations between a risk group (n = 84) and a low‐risk group (n = 296) of pregnant women, enrolled from maternity care centers in southwestern Finland. The method used was semantic differentials of IRMAG (Interview of Maternal Representations During Pregnancy). The risk group was defined by means of questionnaire screens that concerned chemical dependency, depression, difficulties in social environment, and low social support. The ratings on all target subjects, i.e., child, self, partner, self‐as‐mother and own mother‐as‐mother, were significantly more negative in the risk group. The representation profiles of the groups differed: especially the ratings of partner and own mother‐as‐mother were more consistently and strongly negative among the risk mothers. © 2001 Michigan Association for Infant Mental Health.     

Hippocampal Mek/Erk signaling mediates extinction of contextual freezing behavior

Fear memories elicit multiple behavioral responses, encompassing avoidance, or behavioral inhibition in response to threatening contexts. Context-specific freezing, reflecting fear-induced behavioral inhibition, has been proposed as one of the main risks factors for the development of anxiety disorders. We attempted to define the key hippocampal mediators of extinction in a mouse model of context-dependent freezing. Nine-week-old male C57BL/6J mice were trained and tested for contextual fear conditioning and extinction. Freezing behavior scored by unbiased sampling, was used as an index of fear. Proteomic, immunoblot, and immunohistochemical approaches were employed to identify, verify, and analyze the alterations of the hippocampal extracellular signal-regulated kinases 1 and 2 (Erk-1/2). Targeted pharmacological inhibition of the Erk-1/2 activating kinase, the mitogen activated and extracellular signal-regulated kinase (Mek), served to establish the role of Mek/Erk signaling in extinction. When compared to acquisition, extinction of contextual freezing triggered a rapid activation of Erk-1/2 showing a distinctive time-course, nuclear localization, and subcellular isoform distribution. These differences suggested that the upstream regulation and downstream effects of this pathway might be specific for each process. Dorsohippocampal injections of the Mek inhibitors U0126 (0.5 microg/site) and PD98059 (1.5 microg/site) immediately after the nonreinforced trials prevented Erk-1/2 activation and significantly impaired extinction. This effect was dissociable from potential actions on memory retrieval or reconsolidation. On the basis of these findings, we propose that hippocampal Mek/Erk signaling might serve as one of the key mediators of contextual fear extinction.     

Merah and Breivik: A Reflection of the European Identity Crisis

While the cases of Anders Behring Breivik and Mohamed Merah clearly demonstrate the impact of social networks and the role of the Internet and prison on the radicalization process, the killings in Norway and France in fact expose larger issues that exist within contemporary Europe, including profound identity crises manifesting as Islamist extremism in some quarters and far-right extremism in others. This article discusses the individual pathways towards extremism of Merah and Breivik, the interconnectivity of two extremisms and how these can be understood as mirrored manifestations of an identity crisis in Europe.¹1. A shorter version of this article was presented at the international conference on “Europe and Islam in the 21st Century,” organized by the Monash European and EU Centre, Monash University, Prato, Italy, June 20–21, 2013. I would also like to thank Associate Professor Pete Lentini, and Dr Natalie Doyle for having inspired me to continue this research that is close to my heart.     

Optimierung expositionsbasierter Therapie

Exposure is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear. Research results suggest that anxious individuals show deficits in the mechanisms underlying exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure; however, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy, in ways that distinguish it from a fear habituation approach and a belief disconfirmation approach. Optimization strategies include (1) expectancy violation, (2) deepened extinction, (3) occasional reinforced extinction, (4) removal of safety signals, (5) variability, (6) retrieval cues, (7) multiple contexts and (8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders.     

Children's Depression Inventory: invariance across children and adolescents with and without depressive disorders

In the study, the authors examined the measurement (configural, factor loadings, thresholds, and error variances) and structural (factor variances, covariances, and mean scores) invariance of the Children's Depression Inventory (CDI; Kovacs, 1992) across ratings provided by clinic-referred children and adolescents with (N = 383) and without (N = 412) depressive disorders. Multiple-group confirmatory factor analysis of the Craighead, Smucker, Craighead, and Ilardi (1998) CDI model supported full measurement invariance and invariance for structural variances and covariances. Invariance for thresholds was also supported by multiple indicators multiple causes (MIMIC) procedures that controlled for the effects of age; sex; and the presence or absence of anxiety disorders, attention-deficit/hyperactivity disorder, and oppositional defiant/conduct disorders. The MIMIC analyses showed that for latent mean scores, the group with depressive disorders had higher scores, with at least medium effect sizes, for Self-Deprecation and Biological Dysregulation. The theoretical, psychometric, and clinical implications of the findings are discussed.     

An item response theory analysis of the Problem Gambling Severity Index

Increases in the availability of gambling heighten the need for a short screening measure of problem gambling. The Problem Gambling Severity Index (PGSI) is a brief measure that allows for the assessment of characteristics of gambling behavior and severity and its consequences. The authors evaluate the psychometric properties of the PGSI using item response theory methods in a representative sample of the urban adult population in South Africa (N = 3,000). The PGSI items were evaluated for differential item functioning (DIF) due to language translation. DIF was not detected. The PGSI was found to be unidimensional, and use of the nominal categories model provided additional information at higher values of the underlying construct relative to a simpler binary model. This study contributes to the growing literature supporting the PGSI as the screen of choice for assessing gambling problems in the general population.