A thalamo-centric neural signature for restructuring negative self-beliefs

Negative self-beliefs are a core feature of psychopathology. Despite this, we have a limited understanding of the brain mechanisms by which negative self-beliefs are cognitively restructured. Using a novel paradigm, we had participants use Socratic questioning techniques to restructure negative beliefs during ultra-high resolution 7-Tesla functional magnetic resonance imaging (UHF 7 T fMRI) scanning. Cognitive restructuring elicited prominent activation in a fronto-striato-thalamic circuit, including the mediodorsal thalamus (MD), a group of deep subcortical nuclei believed to synchronize and integrate prefrontal cortex activity, but which has seldom been directly examined with fMRI due to its small size. Increased activity was also identified in the medial prefrontal cortex (MPFC), a region consistently activated by internally focused mental processing, as well as in lateral prefrontal regions associated with regulating emotional reactivity. Using Dynamic Causal Modelling (DCM), evidence was found to support the MD as having a strong excitatory effect on the activity of regions within the broader network mediating cognitive restructuring. Moreover, the degree to which participants modulated MPFC-to-MD effective connectivity during cognitive restructuring predicted their individual tendency to engage in repetitive negative thinking. Our findings represent a major shift from a cortico-centric framework of cognition and provide important mechanistic insights into how the MD facilitates key processes in cognitive interventions for common psychiatric disorders. In addition to relaying integrative information across basal ganglia and the cortex, we propose a multifaceted role for the MD whose broad excitatory pathways act to increase synchrony between cortical regions to sustain complex mental representations, including the self.

Stress and coping strategies in parents of children with special needs (SN)

Objectives: To identify the stress level and commonly used coping strategies of parents of children with SN (SN)Methodology: The sample for the study was 150 parents of children with SN selected from three different special schools of Lahore, by using convenient sampling technique from January 2019 to April 2019. The parents were required to fill Perceived Stress Scale and Coping Strategies Inventory.Results: The results revealed that 20.6% parents face high level of stress when managing their children with SN. While, problem-solving (14.66), cognitive restructuring (14.64) and social contact (14.38) were more frequently used coping strategies. Correlation analysis showed a significant negative correlation of stress with cognitive restructuring (r=-.26, p<0.01), problem focused engagement (r=-.237, p<.05) and positive correlation with self-criticism (r=.455, p<.001), social withdrawal (r= .27, p=<.01), and emotion focused disengagements (r=-.431, p<.001). Further, high level of stress was positively associated with high level of disengagement.Conclusion: The currents study concludes that parents use more positive and practical coping strategies to cope with stress induced by taking care of children with SN. Therefore, there is great need of introducing management mechanisms and intervention programs based on these coping strategies Continuous...

Enhancing Cognitive Restructuring with Concurrent fMRI-guided Neurostimulation for Emotional Dysregulation: A Randomized Controlled Trial

Background: Transdiagnostic clinical emotional dysregulation is a key component of psychopathology and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot a one-time intervention that combines cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted using functional magnetic resonance imaging (fMRI). Methods: Thirty-seven clinical adults with high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the target while practicing CR following autobiographical emotional induction. Results: Receiving active versus sham rTMS led to significantly higher high frequency heart rate variability during regulation, lower regulation duration, and higher likelihood to use CR during the week following the intervention. There were no differences between conditions when administering neurostimulation without CR compared to sham. Participants in the sham versus active condition experienced less distress the week after the intervention. There were no differences between conditions at the one-month follow up. Conclusion: This study demonstrated that combining active rTMS with emotion regulation training significantly enhances emotion regulation and augments the impact of training for as long as a week. These findings are a promising step towards a combined intervention for transdiagnostic emotion dysregulation.

The Potential of Video Game Streaming as Exposure Therapy for Social Anxiety

Social anxiety is a prevalent problem that affects many people with varying severity; digital exposure therapy-which involves controlled exposure to simulations of feared social situations alongside cognitive restructuring-can help treat patients with anxieties. However, the need to personalize exposure scenarios and simulate audiences are barriers to treating social anxieties through digital exposure. In this paper, we propose game streaming as an exposure therapy paradigm for social anxiety, supporting it with data from two studies. We first propose a framework describing requirements for exposure therapy and how game streaming can fulfill them. We select demand and performance visibility from these characteristics to showcase how to manipulate them for experiences of gradual exposure. With Study 1, we provide evidence for these characteristics and support for the framework by showing that a game's demand affected expected fear of streaming games. In Study 2, we show that the prospect of streaming led to elevated fear, a necessary property for effective exposure therapy. Further, we show that the effect of streaming on expected fear was similar for participants who can be considered socially anxious. These findings provide evidence for the essential effect of exposure therapy, which serves as a first step towards the validation of streaming as a social anxiety treatment. Our paper provides an initial, important step towards a novel, broadly applicable, and widely accessible digital approach for the treatment of social anxiety.

Imagery rescripting versus cognitive restructuring for social anxiety: Treatment effects and working mechanisms

Background Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Method Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Results Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. Conclusions The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.

Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation: A Transdiagnostic Randomized Controlled Trial

<b><i>Introduction:</i></b> Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. <b><i>Objective:</i></b> To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). <b><i>Methods:</i></b> Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (<i>n</i> = 17) or left (<i>n</i> = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (<i>n</i> = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. <b><i>Results:</i></b> Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (<i>d</i>s = 0.21–0.62) as measured by psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration). Those who received active rTMS over the left dlPFC also self-reported reduced distress throughout the intervention (<i>d</i> = 0.30), higher likelihood to use CR, and lower daily distress during the week following the intervention. The procedures were acceptable and feasible with few side effects. <b><i>Conclusions:</i></b> These findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS may be clinically feasible, well-tolerated and may show promise for the treatment of transdiagnostic emotional dysregulation. Larger follow-up studies are needed to confirm the efficacy of this novel therapeutic approach.