The Effectiveness of Cognitive Rehabilitation on Anxiety Reduction and Brainwave Pattern in Patients with Anxiety Disorder

Objective: Previous randomised, double-blind, placebo-controlled studies have shown that Kava (a South Pacific medicinal plant) reduced anxiety during short-term administration. The objective of this randomised, double-blind, placebo-controlled study was to perform a larger, longer-term trial assessing the efficacy and safety of Kava in the treatment of generalised anxiety disorder and to determine whether gamma-aminobutyric acid transporter (SLC6A1) single-nucleotide polymorphisms were moderators of response. Methods: The trial was a phase III, multi-site, two-arm, 16-week, randomised, double-blind, placebo-controlled study investigating an aqueous extract of dried Kava root administered twice per day in tablet form (standardised to 120 mg of kavalactones twice/day) in 171 currently non-medicated anxious participants with diagnosed generalised anxiety disorder. The trial took place in Australia. Results: An analysis of 171 participants revealed a non-significant difference in anxiety reduction between the Kava and placebo groups (a relative reduction favouring placebo of 1.37 points; p = 0.25). At the conclusion of the controlled phase, 17.4% of the Kava group were classified as remitted (Hamilton Anxiety Rating Scale score < 7) compared to 23.8% of the placebo group ( p = 0.46). No SLC6A1 polymorphisms were associated with treatment response, while carriers of the rs2601126 T allele preferentially respond to placebo ( p = 0.006). Kava was well tolerated aside from poorer memory (Kava = 36 vs placebo = 23; p = 0.044) and tremor/shakiness (Kava = 36 vs placebo = 23; p = 0.024) occurring more frequently in the Kava group. Liver function test abnormalities were significantly more frequent in the Kava group, although no participant met criteria for herb-induced hepatic injury. Conclusion: While research has generally supported Kava in non-clinical populations (potentially for more ‘situational’ anxiety as a short-term anxiolytic), this particular extract was not effective for diagnosed generalised anxiety disorder.

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A Preliminary Attempt to Experimentally Induce Post Event Processing in Social Anxiety Disorder

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000143 ◽

2013 ◽

Vol 42 (2) ◽

pp. 238-242 ◽

Cited By ~ 6

Author(s):

Karen Rowa ◽

Martin M. Antony ◽

Richard P. Swinson ◽

Randi E. McCabe

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Anxiety Reduction ◽

Event Processing ◽

Experimental Task ◽

Short Term ◽

Speech Anxiety ◽

Social Events ◽

Distraction Task

Background: Post event processing (PEP) in social anxiety disorder involves rumination about social events after the fact, and is thought to be a crucial feature of the maintenance of the disorder. Aims: The current experiment aimed to manipulate the use of PEP in individuals with social anxiety disorder. Method: Forty-one individuals with social anxiety disorder completed a videotaped speech. Anxiety ratings and degree of PEP were measured after the task as well as the day following the experiment. Results: Individuals in the distract group reported a greater decrease in anxiety from baseline to post-experimental task than those asked to focus. Individuals in the distract group also reported higher PEP about the task than those instructed to complete a focus task, which appeared to be partially accounted for by baseline differences in symptom severity and state anxiety. Degree of PEP was positively correlated with anxiety ratings, both after the experimental task as well as 24 hours later. Conclusions: These findings suggest that naturalistic PEP is problematic for individuals with social anxiety disorder, especially for those with more severe symptoms. A distraction task, even with breakthrough PEP, appears to have useful short-term effects on anxiety reduction as compared to focus instructions.

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Cognitive Therapy for Social Anxiety Disorder: The Impact of the “Self-Focused Attention and Safety Behaviours Experiment” on the Course of Treatment

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000672 ◽

2013 ◽

Vol 43 (2) ◽

pp. 158-166 ◽

Cited By ~ 10

Author(s):

Franziska Schreiber ◽

Christiane Heimlich ◽

Clea Schweitzer ◽

Ulrich Stangier

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Therapy ◽

Social Anxiety Disorder ◽

Controlled Trial ◽

Complex Interventions ◽

The Self ◽

Anxiety Reduction ◽

Focused Attention ◽

The Impact

Background and Aims: Several studies have shown that cognitive therapy is an effective treatment for social anxiety disorder (SAD). However, it remains unclear which of the complex interventions are associated with an anxiety reduction during the course of treatment. The aim of this study was to examine the impact of the intervention referred to as the “self-focused attention and safety behaviours experiment” on treatment outcome. Method: This study was part of a randomized controlled trial including 16 sessions of either individual cognitive therapy (CT) or interpersonal therapy (IPT) for SAD. Of particular importance, a concomitant time-series analysis was used to investigate the impact of the self-focused attention and safety behaviours experiment on subsequent social anxiety (1, 2, 3, and 4 weeks after the intervention) in 32 patients with SAD, who are receiving cognitive treatment. Results: The results revealed a significant reduction of social anxiety after the self-focused attention and safety behaviours experiment during the subsequent month of treatment. Conclusion: The findings of the current study confirm current cognitive theories of SAD and demonstrate the importance of interventions that target self-focused attention and safety behaviour in cognitive therapy for SAD.

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Expectancy effects on serotonin and dopamine transporters during SSRI treatment of social anxiety disorder: a randomized clinical trial

Translational Psychiatry ◽

10.1038/s41398-021-01682-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Olof R. Hjorth ◽

Andreas Frick ◽

Malin Gingnell ◽

Johanna M. Hoppe ◽

Vanda Faria ◽

...

Keyword(s):

Clinical Trial ◽

Anxiety Disorder ◽

Social Anxiety ◽

Randomized Clinical Trial ◽

Social Anxiety Disorder ◽

Serotonin Transporter ◽

Psychological Factors ◽

Anxiety Reduction ◽

Symptom Improvement ◽

Ssri Treatment

AbstractIt has been extensively debated whether selective serotonin reuptake inhibitors (SSRIs) are more efficacious than placebo in affective disorders, and it is not fully understood how SSRIs exert their beneficial effects. Along with serotonin transporter blockade, altered dopamine signaling and psychological factors may contribute. In this randomized clinical trial of participants with social anxiety disorder (SAD) we investigated how manipulation of verbally-induced expectancies, vital for placebo response, affect brain monoamine transporters and symptom improvement during SSRI treatment. Twenty-seven participants with SAD (17 men, 10 women), were randomized, to 9 weeks of overt or covert treatment with escitalopram 20 mg. The overt group received correct treatment information whereas the covert group was treated deceptively with escitalopram, described as an active placebo in a cover story. Before and after treatment, patients underwent positron emission tomography (PET) assessments with the [11C]DASB and [11C]PE2I radiotracers, probing brain serotonin (SERT) and dopamine (DAT) transporters. SAD symptoms were measured by the Liebowitz Social Anxiety Scale. Overt was superior to covert SSRI treatment, resulting in almost a fourfold higher rate of responders. PET results showed that SERT occupancy after treatment was unrelated to anxiety reduction and equally high in both groups. In contrast, DAT binding decreased in the right putamen, pallidum, and the left thalamus with overt SSRI treatment, and increased with covert treatment, resulting in significant group differences. DAT binding potential changes in these regions correlated negatively with symptom improvement. Findings support that the anxiolytic effects of SSRIs involve psychological factors contingent on dopaminergic neurotransmission while serotonin transporter blockade alone is insufficient for clinical response.

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