Effects of Acute Stress or Centrally Injected Interleukin-1beta on Neuropeptide Expression in the Immune System

Acute stress stimulates the expression and release of corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) from the hypothalamus, and the pro-opiomelanocortin products beta-endorphin and ACTH from the anterior pituitary. These neuropeptides are also expressed in immune tissues, and it has been proposed that they may modulate immune responses to stress through paracrine mechanisms. We subjected rats to restraint stress or central injection of interleukin (IL)-1beta to determine whether these acute stimuli can alter the expression of neuropeptides in the spleen and thymus. Restraint stress significantly increased the contents of all these neuropeptides in thymic, but not splenic, extracts. A single icv injection of IL-1beta increased contents of CRH, AVP, ACTH and beta-endorphin in the spleens of both sham-operated and adrenalectomised (ADX) rats. IL-1beta increased thymic contents of CRH and ACTH in sham-operated rats but these increases were not observed in ADX rats. These results suggest that the effects of IL-1beta on neuropeptide expression in the spleen are independent of glucocorticoids, whereas IL-1beta stimulation of neuropeptide expression in the thymus is dependent on circulating glucocorticoids. There were significant correlations between increases in CRH, ACTH and beta-endorphin in the spleen, and between CRH and ACTH in the thymus, consistent with the suggestion that IL-1beta-induced increases in ACTH and beta-endorphin may be mediated through CRH. These results provide evidence that stressors can directly influence neuropeptide expression in immune tissues. Thus stress may influence immune functions through paracrine mechanisms involving locally synthesised neuropeptides as well as through activation of the hypothalamo-pituitary-adrenal axis.     

Efficacy of telephone-administered cognitive behaviour therapy for obsessive-compulsive spectrum disorders: case studies

Cognitive behaviour therapy is effective for obsessive-compulsive disorder and for obsessive-compulsive spectrum disorders such as trichotillomania. Unfortunately, many people with these disorders, especially those living in rural areas, have limited access to treatment. Telephone-administered cognitive behaviour therapy may help address this problem. In a recent study of telephone treatment for obsessive-compulsive disorder, we found that such treatment was often effective (42% in remission at post-treatment, and 47% in remission at 12-week follow-up). This article presents 2 case reports of the same treatment, applied to obsessive-compulsive spectrum disorders (trichotillomania and compulsive skin picking). Treatment was associated with symptom reduction for both participants, although one subsequently relapsed. Possible reasons for relapse are discussed. The findings encourage further studies to identify the characteristics of people most likely to benefit from telephone treatment for spectrum disorders.     

Women with low activity are at increased risk for depression

This study assessed if there are sex differences in the relationship between amount of physical activity and depression in primary care outpatients. Participants (N= 111), referred by their family physicians, wore a heart-rate monitor for 24 hr. The two-lead monitor collected the number of beats per minute and minute-averaged horizontal movement data, e.g., from walking or moving about. All participants underwent structured clinical interviewing using the Structured Clinical Interview for DSM-IV and completed the Beck Depression Inventory-II and the Symptom Checklist-90-Revised. For the total sample, patients with low activity were more likely to be depressed (p<.006). Adults under the age of 45 (n=85) with low activity were 7.4 times more likely to be depressed than young adults who showed normal activity. However, in adults 45 or older, there was no relationship between activity and depression. In a subsample of women under the age of 55 (n=70), 91% of the low activity group and 39% of the normal activity group were diagnosed with depression (p<.003). Women in the low activity group were 15.7 times more likely to be depressed than women in the normal activity group. In contrast, there was no relationship between activity and depression in men. Additional research is needed to assess whether low activity is a potent predictor of depression in women.     

Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder--particularly those living in rural areas--do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.     

Coping styles and personality: a biometric analysis

Previous research suggests that coping styles are modestly heritable and that this genetic influence is shared in large part with genetic influences on personality. To test this hypothesis, we estimated the heritable basis of the Coping Inventory for Stressful Situations in a sample of 91 monozygotic and 80 dizygotic twin pairs. Task-oriented, emotion-oriented, and social diversion coping styles were modestly heritable (h(2)=.17 to .20), whereas the use of distraction appeared to be influenced solely by environmental factors. Multivariate analyses showed that genetic contributions to coping styles were, at best, only modestly related to genetic contributions to personality (r=-.03 to .35). Environmental contributions to personality were unrelated to environmental factors in coping style. These results suggest that coping style is not merely a manifestation of basic personality traits but does support the possibility that the genetic factors in personality influences have a modest influence on an individual's preferred coping style or strength (e.g., rigidity vs flexibility).     

Evaluation of a preventive intervention for child anxiety in two randomized attention-control school trials

The present research examined the effectiveness of a cognitive-behavioral therapy (CBT) based intervention program, FRIENDS, for children from grades 4 to 6, using random assignment at the school-level and an attention-control design in two longitudinal studies. The first study targeted children with anxiety symptoms (N = 191, mean age = 10.1) as screened with self, parent, and teacher-reports; the second study took a universal approach with full classrooms of children participating (N = 253, mean age = 9.8). The results showed no intervention effect in both studies, with children’s anxiety symptoms decreasing over time regardless of whether they were in the story-reading (attention control) or FRIENDS condition. The findings also indicated that girls reported a higher level of anxiety than boys and children in higher grades reported lower anxiety relative to younger children in both studies. In addition, similar patterns were found using a subgroup of children with high-anxiety symptoms from both studies.     

Regulation of Peripheral Catecholamine Responses to Acute Stress in Young Adult and Aged F-344 Rats

Young adult (3-month-old) and aged (24-month-old) Fischer-344 male rats received i.v. infusions of 3H-labeled norepinephrine (NE) and epinephrine (EPI) to examine the effects of aging on the neuronal uptake of NE and sympathoadrenal release of NE and EPI. Spillovers of NE and EPI into plasma and their clearance from the circulation were estimated from plasma concentrations of endogenous and 3H-labeled NE and EPI. The efficiency of neuronal uptake was assessed from changes in plasma clearance of NE and concentrations of its intraneuronal metabolite, dihydroxyphenylglycol (DHPG), during immobilization stress or neuronal uptake blockade with desipramine. Stress-induced increases in plasma NE and higher plasma NE concentrations in aged compared to young adult rats were due to both decreases in NE clearance and increases in NE spillover. EPI spillover and clearance were reduced in aged compared to young adult rats, so that plasma EPI levels did not differ between groups. Young adult and aged rats had similar desipramine-induced decreases in NE clearance, whereas desipramine-sensitive decreases and stress-induced increases in plasma DHPG were larger in aged rats. This indicates that neuronal uptake is intact and that increased NE spillover at rest and during stress in aged rats reflects increased NE release from sympathetic nerves. The results show that aging is associated with divergent decreases in EPI release from the adrenal medulla and increases in NE release from sympathetic nerves. Increased plasma concentrations of NE in aged compared to young adult rats also result from decreased circulatory clearance of NE, but this does not reflect any age-related impairment of NE reuptake.     

Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.     

We’ve Come a Long Way,Baby!: Evolution and Revolution in CBT with Youth

As the gold standard in psychotherapy with children and adolescents, cognitive behavioral therapy (CBT) earned its stripes through the years. CBT evolved from treating individual disorders with single protocols to embracing a modular and transdiagnostic approach. Despite this impressive evolution, CBT initiated a revolution that continues to provide services to patients in this new era. CBT must maintain momentum to fuel progress and drive clinical reform. In this article, the need for training and dissemination are discussed. Revolutionary practices and delivery methods are suggested. CBT continues to push the envelope of revolution by partnering with neuroscience to bridge the gap between brain and body. Integrating findings from neuroscience with CBT-spectrum approaches and non-traditional treatment formats provides theoretical flexibility and additional treatment options for clinicians. Culturally-friendly applications to treat diverse youth and the use of common modules from third wave approaches are suggested. The use of technology such as smartphones, computers, and videogames is encouraged. Offering treatment in non-traditional settings and formats such as CBT-based camp programs is also addressed.