scholarly journals Imagery Rescripting Versus Extinction: Distinct and Combined Effects on Expectancy and Revaluation Learning

2021 ◽  
pp. 216770262110551
Author(s):  
Mandy Woelk ◽  
Julie Krans ◽  
Filip Raes ◽  
Bram Vervliet ◽  
Muriel A. Hagenaars
Keyword(s):  
Clinical Practice ◽  
Anxiety Disorders ◽  
Unconditioned Stimulus ◽  
Exposure Therapy ◽  
Combined Effects ◽  
Film Clip ◽  
The Us ◽  
Imagery Rescripting

Anxiety disorders are effectively treated with exposure therapy, but relapse remains high. Fear may reinstate after reoccurrence of the negative event because the expectancy of the aversive outcome (unconditioned stimulus [US]) is adjusted but not its evaluation. Imagery rescripting (ImRs) is an intervention that is proposed to work through revaluation of the US. The aim of our preregistered study was to test the effects of ImRs and extinction on US expectancy and US revaluation. Day 1 ( n = 106) consisted of acquisition with an aversive film clip as US. The manipulation (ImRs + extinction, extinction-only, or ImRs-only) took place on Day 2. Reinstatement of fear was tested on Day 3. Results showed expectancy learning in both extinction conditions but not in the ImRs-only condition and no enhanced revaluation learning in ImRs. The combination of ImRs and extinction slowed down extinction but did not protect against reinstatement, which pleads in favor of stand-alone interventions in clinical practice.

scholarly journals Utilisation and predictors of use of exposure therapy in the treatment of anxiety, OCD and PTSD in an Australian sample: a preliminary investigation

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Karen Moses ◽  
Craig Gonsalvez ◽  
Tanya Meade
Keyword(s):  
Clinical Practice ◽  
Anxiety Disorders ◽  
Professional Training ◽  
Exposure Therapy ◽  
Preliminary Investigation ◽  
Post Traumatic Stress ◽  
Clinical Practices ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Level Of Training

Abstract Background Cognitive-behavior therapy (CBT) is known to be an effective treatment for the anxiety and related disorders, with exposure therapy being a key component of this treatment package. However, research on the use of exposure therapy in clinical practice has presented mixed results, potentially due to differences in samples and training programs across countries. The present study aimed to extend upon existing research by examining the use and predictors of use of exposure therapy in a sample of psychologists working in clinical practice in Australia who treat clients with an anxiety disorder, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD). Methods One hundred registered psychologists (Mage = 40.60; SD = 10.78; range 23 to 71 years; 84% female) participated in an online study investigating their clinical practices. Results Results suggested that while the general use of exposure therapy is high, the use of disorder specific techniques was considerably lower, particularly for anxiety disorders and PTSD but not OCD. Psychology registration status and level of training were positively associated with use of exposure therapy as was the experience in treating anxiety disorders. Conclusions These findings suggest that further or ongoing professional training may be required to optimize the use of disorder specific techniques.

scholarly journals International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations

2020 ◽  
pp. neurintsurg-2020-017053
Author(s):  
Emanuele Orru' ◽  
Miklos Marosfoi ◽  
Neil V Patel ◽  
Alexander L Coon ◽  
Christoph Wald ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
High Resolution ◽  
Situational Awareness ◽  
Flow Diverter ◽  
Multiple Sources ◽  
Remote Supervision ◽  
Angiography Suite ◽  
The Us ◽  
Travel Restrictions

BackgroundExisting travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures.MethodsInternational teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner.ResultsAll three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution.ConclusionsInternational teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.

scholarly journals No Evaluative Conditioning Effects with Briefly Presented Stimuli

2018 ◽  
Author(s):  
Tobias Heycke ◽  
Christoph Stahl
Keyword(s):  
Conditioned Stimulus ◽  
Unconditioned Stimulus ◽  
Visual Stimuli ◽  
Neutral Stimulus ◽  
Evaluative Conditioning ◽  
Visual Modality ◽  
Contingency Awareness ◽  
The Us

Evaluative Conditioning (EC) changes the preference towards a formerly neutral stimulus (Conditioned Stimulus; CS), by pairing it with a valent stimulus (Unconditioned Stimulus; US), in the direction of the valence of the US. When the CS is presented subliminally (i.e., too briefly to be consciously perceived), contingency awareness between CS and US can be ruled out. Hence, EC effects with subliminal CSs would support theories claiming that contingency awareness is not necessary for EC effects to occur. Recent studies reported the absence of EC with briefly presented CSs when both CS and US were presented in the visual modality, even though the CSs were identified at above-chance levels. Challenging this finding, Heycke and colleagues (2017) found some evidence for an EC effect with briefly presented visual stimuli in a cross-modal paradigm with auditory USs, but that study did not assess CS visibility. The present study attempted to replicate this EC effect with different stimuli and a CS visibility check. Overall EC for briefly presented stimuli was absent, and results from the visibility check show that an EC effect with briefly presented CSs was only found, when the CSs were identified at above-chance levels.

scholarly journals Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study

10.2196/17807 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e17807 ◽  
Author(s):  
Philip Lindner ◽  
Alexander Rozental ◽  
Alice Jurell ◽  
Lena Reuterskiöld ◽  
Gerhard Andersson ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorders ◽  
Exposure Therapy ◽  
Real Life ◽  
Spider Phobia ◽  
Semistructured Interview ◽  
User Experiences ◽  
Virtual Reality Exposure Therapy ◽  
Virtual Reality Exposure

Background Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. Objective The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. Methods Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. Results Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. Conclusions Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.

Exposure Therapy for Anxiety Disorders

2016 ◽  
pp. 186-191
Author(s):  
S.A. Steinman ◽  
B.M. Wootton ◽  
D.F. Tolin
Keyword(s):  
Anxiety Disorders ◽  
Exposure Therapy

Abstract 17027: Generalizability of the US FDA Label for Dapagliflozin to Patients With Heart Failure With Reduced Ejection Fraction in the GWTG-HF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muthiah Vaduganathan ◽  
Stephen Greene ◽  
Shuaiqi Zhang ◽  
maria v grau-sepulveda ◽  
Adam D Devore ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ejection Fraction ◽  
Care Facility ◽  
Eligibility Criteria ◽  
Discharge Data ◽  
Reduced Ejection Fraction ◽  
Type 2 Dm ◽  
The Us ◽  
Us Fda

Background: In May 2020, dapagliflozin was approved by the US FDA as the first SGLT-2 inhibitor for HF with reduced ejection fraction (HFrEF) based on the pivotal DAPA-HF trial. Limited data are available characterizing its generalizability to US clinical practice. Methods: We studied patients with HFrEF (≤40%) hospitalized at 406 sites in the Get With The Guidelines (GWTG)-HF registry admitted between Jan 2014 - Sept 2019. We excluded patients who left against medical advice, transferred to an acute care facility or to hospice, or had missing critical data. We applied the FDA label (excluding eGFR<30 mL/min/1.73 m 2 , dialysis, or type 1 DM) and eligibility criteria of DAPA-HF to the GWTG-HF registry sample. Results: Among 154,714 patients hospitalized with HFrEF, 125,497 (81.1%) would be candidates for dapagliflozin under the FDA label. Across 355 sites with ≥10 hospitalizations, median proportion of FDA label candidates was 81.1% (77.8%-84.6%). This proportion was similar across all study years (80.4-81.7%) and higher among those without type 2 DM than with type 2 DM (85.5% vs. 75.6%). Among GWTG-HF participants, the most frequent reason for not meeting the FDA label was eGFR<30 mL/min/1.73 m 2 (n=28,605). Among patients with available paired admission and discharge data, 14.2% had eGFR<30 mL/min/1.73 m 2 at both time points, while 3.8% developed eGFR<30 mL/min/1.73 m 2 by discharge. While there were more women, more Black patients, and less Asian patients in GWTG-HF, clinical characteristics were qualitatively similar between DAPA-HF trial and GWTG-HF registry participants. Compared with the DAPA-HF trial cohort, there was lower use of evidence-based HF therapies among GWTG-HF patients ( Table ). Conclusions: These data from a large, contemporary US hospitalized HF registry suggest that 4 out of 5 patients with HFrEF (with or without type 2 DM) would be candidates for initiation of dapagliflozin, and support its broad generalizability to US clinical practice.

Why Do People Get Better With Exposure Therapy?

2019 ◽  
pp. 19-32
Author(s):  
Carolyn Black Becker ◽  
Nicholas R. Farrell ◽  
Glenn Waller
Keyword(s):  
Eating Disorders ◽  
Anxiety Disorders ◽  
Therapeutic Intervention ◽  
Exposure Therapy ◽  
Therapeutic Benefit ◽  
Evidence Based ◽  
Systematic Desensitization ◽  
Evidence Based Treatments ◽  
Inhibitory Learning

This chapter outlines a theoretically based rationale for using exposure consistently in the treatment of individuals with eating disorders. Due to the substantial overlap between eating disorders and anxiety disorders (both in symptom content and in comorbidity between the conditions), exposure therapy is a sound choice for therapeutic intervention. Indeed, the most evidence-based treatments for eating disorders contain a number of exposure-based strategies that drive much of the therapeutic benefit. The chapter discusses habituation, systematic desensitization, and inhibitory learning and differentiates exposure therapy from systematic desensitization. Using a case study to consider how exposure therapists can help patients learn to tolerate their anxiety by leaning into it rather than engaging in safety behaviors, this chapter lays the foundation for the application of exposure therapy to patients with eating disorders.

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