Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

学步儿母亲过度投入/未解决的依恋表征与控制行为：婚姻质量及儿童性别的调节作用

采用追踪设计,以北京市94名学步儿及其母亲为被试,系统考察学步儿期母亲过度投入/未解决的依恋表征对控制行为的影响,以及婚姻质量、儿童性别的调节作用。结果发现：(1)过度投入/未解决的依恋表征对3岁时的强制性控制具有显著的正向预测作用。(2)过度投入/未解决的依恋表征对3岁时温和控制及命令性控制的影响受到婚姻质量的调节。(3)婚姻质量及儿童性别共同调节过度投入/未解决的依恋表征与3岁强制性控制之间的关系。     

Temperament,coping, and involuntary stress responses in preadolescent children: the moderating role of achievement goal orientation

Background and objectives: Developmental theorists posit that temperament contributes to preadolescent’s stress response styles. Findings from empirical studies, however, have yielded mixed results, thus indicating a need to consider moderators of this relation. Utilizing an analytic framework guided by resiliency theory [Zimmerman, M. A. (2013). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education &; Behavior, 40, 381–383], this study examined achievement goal orientation as a moderator of the relation between temperament and stress response styles.

Methods: 96 preadolescent–parent dyads (M_age?=?10.30 years, range?=?9–12 years) participated in the study. Preadolescents reported on their achievement goal orientation, coping and involuntary stress responses (ISRs) styles and a parent reported on children’s temperament.

Results: Multiple regressions revealed that effortful control positively predicted preadolescent’s predominant use of engagement coping and negatively predicted predominance of ISRs, but only for children with a predominant mastery goal orientation. For preadolescents with a predominant performance goal orientation, effortful control negatively predicted the predominant use of engagement coping and positively predicted predominance of ISRs. Negative affectivity and its interaction with goal orientation did not predict coping or ISR styles.

Conclusions: Findings suggest that a predominant mastery goal orientation may function as a promotive factor by enhancing the contribution of effortful control to engagement coping styles and buffering against unmanaged reactivity.     

Identifying the level of trunk control of healthy term infants aged from 6 to 9 months

This study identified the level of trunk control of healthy term infants aged from six to nine months. This cross-sectional study included fifty-five infants aged from six to nine months. The levels of trunk control was investigated by using the Segmental Assessment Trunk Control (SATCo). The infants remained seated on a wooden bench and a neutral pelvic position was maintained. The SATCo score was considered as dependent variable. The results showed that infants aged six and seven months presented levels of trunk control in the thoracic region while infants aged from eight to nine months presented full trunk control. These results demonstrate that younger infants present less levels of trunk control while older infants present full trunk control, confirming that trunk control development takes place in a segmental way and in a cephalocaudal direction. These results also might be used as a reference to distinguish infants that show a delay in trunk control from those who have suitable motor development and, thus intervene at an early stage to minimize later delays in these infantś global motor development.     

Calming an aggressor through spontaneous post‐conflict triadic contacts: Appeasement in Macaca tonkeana

Peaceful third‐party interventions usually occur after an aggressive encounter and can be directed toward the victim or the aggressor. Macaca tonkeana, a cercopithecine species characterized by high levels of tolerance, frequently engage in consolatory contacts, which both calm the victim and reduce the probability of further attacks against him/her. Other post‐conflict affiliative interventions such as reconciliation and quadratic affiliation are also common in this species. However, little attention has been given to contacts directed toward the aggressor. Here, we explore the role of bystander affiliative interventions toward the aggressor in influencing the affective state of the aggressor and the consequences of triadic interventions at group level. We found that triadic post‐conflict affiliation occurred independently from the intensity of the conflict and that it was more frequent in absence of the conciliatory contact between the opponents (reconciliation). Bystanders showed a higher amount of post‐conflict affiliation toward low ranking aggressors. Post‐conflict triadic affiliation functioned as a tension reduction mechanism by lowering the arousal of the aggressor, which less frequently engaged in renewed aggression. All these findings suggest that post‐conflict triadic contacts in Tonkean macaques can be considered as a strategic mechanism to calm the aggressor and reduce the risk of retaliatory aggression.

     

The contribution of executive control to semantic cognition: Convergent evidence from semantic aphasia and executive dysfunction

Semantic cognition, as described by the controlled semantic cognition (CSC) framework (Rogers et al., 2015 , Neuropsychologia, 76, 220), involves two key components: activation of coherent, generalizable concepts within a heteromodal ‘hub’ in combination with modality‐specific features (spokes), and a constraining mechanism that manipulates and gates this knowledge to generate time‐ and task‐appropriate behaviour. Executive–semantic goal representations, largely supported by executive regions such as frontal and parietal cortex, are thought to allow the generation of non‐dominant aspects of knowledge when these are appropriate for the task or context. Semantic aphasia (SA) patients have executive–semantic deficits, and these are correlated with general executive impairment. If the CSC proposal is correct, patients with executive impairment should not only exhibit impaired semantic cognition, but should also show characteristics that align with those observed in SA. This possibility remains largely untested, as patients selected on the basis that they show executive impairment (i.e., with ‘dysexecutive syndrome’) have not been extensively tested on tasks tapping semantic control and have not been previously compared with SA cases. We explored conceptual processing in 12 patients showing symptoms consistent with dysexecutive syndrome (DYS) and 24 SA patients, using a range of multimodal semantic assessments which manipulated control demands. Patients with executive impairments, despite not being selected to show semantic impairments, nevertheless showed parallel patterns to SA cases. They showed strong effects of distractor strength, cues and miscues, and probe–target distance, plus minimal effects of word frequency on comprehension (unlike semantic dementia patients with degradation of conceptual knowledge). This supports a component process account of semantic cognition in which retrieval is shaped by control processes, and confirms that deficits in SA patients reflect difficulty controlling semantic retrieval.     

Safety Behavior After Extinction Triggers a Return of Threat Expectancy

Safety behavior is involved in the maintenance of anxiety disorders, presumably because it prevents the violation of negative expectancies. Recent research showed that safety behavior is resistant to fear extinction. This fear conditioning study investigated whether safety behavior after fear extinction triggers a return of fear in healthy participants. Participants learned that two stimuli (A and C) were followed by an aversive loud noise (“threat”), and one stimulus (B) was not. Participants then learned to use safety behavior that prevented the loud noise. Next, A and C were no longer followed by the loud noise, which typically led to extinction of threat expectancy. Safety behavior then became available again for C, but not for A and B. All participants used safety behavior on these C trials. In a final test phase, A, B, and C were presented once without the availability to use safety behavior. At each stimulus presentation, participants rated threat expectancy by indicating to what extent they expected that the loud noise would follow. Compared with the last extinction trial, threat expectancy increased for C in the test phase, whereas it did not increase for A and B. Hence, safety behavior after the extinction of classically conditioned fear caused a partial return of fear. The findings suggest that safety behavior may be involved in relapse after exposure-based therapy for anxiety disorders.     

New Directions in the Cognitive-Behavioral Treatment of OCD: Theory,Research, and Practice

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.