D-cycloserine for the augmentation of an attentional training intervention for trait anxiety.
ABSTRACT The present study investigates the combination of two novel strategies for the treatment of anxiety that resulted from translational research. We examined whether the putative memory enhancer, d-cycloserine (DCS), offered benefit to procedures designed to train attention away from threat. Participants were 44 adults selected on the basis of high trait anxiety. In this randomized study, DCS or placebo was administered 1h prior to attentional training away from threat using the dot probe task. On the following day, the effectiveness of this training was assessed along with emotional reactivity following two stressful tasks. We found that the addition of DCS resulted in significantly stronger reduction in attentional bias toward threat relative to placebo, but found no additive effects for the DCS condition on subsequent emotional reactivity. These results provide initial support for the efficacy of DCS for augmenting attentional training tasks; potential strategies for enhancing these results are discussed.
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ABSTRACT: Prominent cognitive theories postulate that an attentional bias towards threatening information contributes to the etiology, maintenance, or exacerbation of fear and anxiety. In this review, we investigate to what extent these causal claims are supported by sound empirical evidence. Although differences in attentional bias are associated with differences in fear and anxiety, this association does not emerge consistently. Moreover, there is only limited evidence that individual differences in attentional bias are related to individual differences in fear or anxiety. In line with a causal relation, some studies show that attentional bias precedes fear or anxiety in time. However, other studies show that fear and anxiety can precede the onset of attentional bias, suggesting circular or reciprocal causality. Importantly, a recent line of experimental research shows that changes in attentional bias can lead to changes in anxiety. Yet changes in fear and anxiety also lead to changes in attentional bias, which confirms that the relation between attentional bias and fear and anxiety is unlikely to be unidirectional. Finally, a similar causal relation between interpretation bias and anxiety has been documented. In sum, there is evidence in favor of causality, yet a strict unidirectional cause-effect model is unlikely to hold. The relation between attentional bias and fear and anxiety is best described as a bidirectional, maintaining, or mutually reinforcing relation.Psychological Bulletin 09/2013; 140(3):682–721. DOI:10.1037/a0034834 · 14.39 Impact Factor
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ABSTRACT: Uncertainty about a possible future threat disrupts our ability to avoid it or to mitigate its negative impact and thus results in anxiety. Here, we focus the broad literature on the neurobiology of anxiety through the lens of uncertainty. We identify five processes that are essential for adaptive anticipatory responses to future threat uncertainty and propose that alterations in the neural instantiation of these processes result in maladaptive responses to uncertainty in pathological anxiety. This framework has the potential to advance the classification, diagnosis and treatment of clinical anxiety.Nature Reviews Neuroscience 06/2013; 14(7):488-501. DOI:10.1038/nrn3524 · 31.38 Impact Factor
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ABSTRACT: This study examined the efficacy of combining two promising approaches to treating children’s specific phobias, namely attention training and one 3-hour session of exposure therapy (‘one-session treatment’, OST). Attention training towards positive stimuli (ATP) and OST (ATP+OST) was expected to have more positive effects on implicit and explicit cognitive mechanisms and clinical outcome measures than an attention training control (ATC) condition plus OST (ATC+OST). Thirty-seven children (6-17 years) with a specific phobia were randomly assigned to ATP+OST or ATC+OST. In ATP+OST, children completed 160 trials of attention training responding to a probe that always followed the happy face in happy-angry face pairs. In ATC+OST, the probe appeared equally often after angry and happy faces. In the same session, children completed OST targeting their phobic situation/object. Clinical outcomes included clinician, parent and child report measures. Cognitive outcomes were assessed in terms of change in attention bias to happy and angry faces and in danger and coping expectancies. Assessments were completed before and after treatment and three-months later. Compared to ATC+OST, the ATP+OST condition produced (a) significantly greater reductions in children’s danger expectancies about their feared situations/object during the OST and at three-month follow-up, and (b) significantly improved attention bias towards positive stimuli at post-treatment, which in turn, predicted a lower level of clinician-rated phobia diagnostic severity three-months after treatment. There were no significant differences between ATP+OST and ATC+OST conditions in clinician, parent, or child-rated clinical outcomes. Training children with phobias to focus on positive stimuli is effective in increasing attention towards positive stimuli and reducing danger expectancy biases. Studies with larger sample sizes and a stronger ‘dose’ of ATP prior to the OST may reveal promising outcomes on clinical measures for training attention towards positive stimuli.Behaviour Research and Therapy 11/2014; 62. DOI:10.1016/j.brat.2014.07.020 · 3.85 Impact Factor