Phobic Patients Research Articles

Psychotherapy Augmentation through Preconscious Priming

Objective: To test the hypothesis that repeated preconscious (masked) priming of personalized positive cognitions could augment cognitive change and facilitate achievement of patients’ goals following a therapy.Methods: Twenty social phobic patients (13 women) completed a 36-weeks study beginning by 12 weeks of group behavioral therapy. After the therapy, they received 6 weeks of preconscious priming and 6 weeks of a control procedure in a randomized cross-over design. The Priming condition involved listening twice daily with a passive attitude to a recording of individualized formulations of appropriate cognitions and attitudes masked by music. The Control condition involved listening to an indistinguishable recording where the formulations had been replaced by random numbers. Changes in social cognitions were measured by the Social Interaction Self Statements Test (SISST).Results: Patients improved following therapy. The Priming procedure was associated with increased positive cognitions and decreased negative cognitions on the SISST while the Control procedure was not. The Priming procedure induced more cognitive change when applied immediately after the group therapy.Conclusion: An effect of priming was observed on social phobia related cognitions in the expected direction. This self administered addition to a therapy could be seen as an augmentation strategy.

Effect of multiple context exposure on renewal in spider phobia

BackgroundRenewal of fear is one form of relapse that occurs after successful exposure therapy as a result of an encounter with a feared object in a context different from the exposure context. The current study is the first to examine whether virtual reality (VR) exposure conducted in multiple contexts reduces the likelihood of renewal. MethodThirty spider-phobic patients were randomly allocated to one of two groups that were exposed to a virtual spider four times either in a single context or in multiple contexts. All participants completed a renewal test in a novel virtual context, and an in-vivo behavior avoidance test with a real spider before and after exposure. ResultsAs reflected in the ratings, skin conductance level, and behavioral measures, the fear of spiders decreased significantly in both groups within and between the exposure trials and from pre to post exposure. Importantly, extinction in multiple contexts was able to significantly reduce renewal compared to extinction in a single context. ConclusionsBased on highly controlled context manipulations using VR, this study was able to successfully transfer animal work to phobic patients. These findings strongly suggest that exposure in multiple contexts improves the generalizability of exposure to a new context. Consequently, we recommend the application of multiple context exposures in a clinical setting to reduce the likelihood of renewal. In addition, virtual reality was demonstrated to be a helpful tool for inducing contextual shifts during the exposures.

Mechanisms of change: Effects of repetitive exposure to feared stimuli on the brain's fear network

Repetitive exposure to feared stimuli is considered as the essential element in therapy with phobic patients. However, the mechanisms mediating symptom reduction and their underlying neurobiological processes are poorly understood. Therefore, we presented the same fear-relevant and neutral stimuli repeatedly to individuals with high and low fear of animals during fMRI scanning. High-, but not low-fearful individuals showed an initial fear-stimulus-related potentiation of amygdala and insula activity. Potentiation of the amygdala in the high-fearful group habituated quickly, but insula activity was still potentiated during later repetition trials. Both groups showed an initial potentiation of the dorsomedial prefrontal cortex (dmPFC) that continuously decreased in low-, but not in high-fearful participants. Thus, within-session habituation may occur on an automatic processing level (amygdala), but does not cause lasting neural changes on a higher order cortical level (dmPFC).

P109 Introduction of an electronic patient proformer contributes to an increase in uptake of HIV testing

BackgroundThe BASHH MEDFASH Standards for the Management of STIs 2010 recommend that 100% of GUM patients should be offered an HIV test with a minimum uptake of 60% at their...

Stress‐Related Temporary Hearing Loss—Evaluation of Bio‐Humoral Parameters: Forensic and Criminological Applications

The body-alarm reaction results from the activation of hypothalamic-pituitary-adrenal axis, which can lead to physio-psychological phenomena such as an exclusion/occlusion of the sense of hearing. One hypothesis to explain this alteration consists in a hydromechanical dysfunction of the internal ear attributable to antidiuretic hormone. In this study, we evaluated the perception of acoustic stimuli administered in stressful conditions in 14 phobic patients and in 20 healthy subjects, in order to assess the influence of stress on perceiving capabilities. We also measured the concentration of salivary cortisol and IL-1β and neurovegetative parameters to objectivise and quantify the physiological reactions. Our results show a worse perception of the frequencies of the human voice under stress; these findings could have a dual value: in the legal field, concerning criminal liability, and on the operative context, regarding the efficiency of verbal communication among law enforcement officers in situations inducing intense emotional stress.

Mental Retrieval of Treatment Context in Dental Phobia

The effect of mental retrieval of an exposure session was investigated during a follow-up examination in dental phobia patients. The exposure session took place at the psychology unit and the follow-up a week later at the dental clinic prior to dental treatment while patients were seated in the dental chair. During exposure, individuals with dental phobia (N = 72) were shown a video of a dental appointment, after which they were instructed to imagine themselves receiving dental treatment. During follow-up half of the participants received instructions to mentally retrieve the exposure session and the other half were asked to recall everyday activities. Before and after exposure treatment, and after mental retrieval, participants were shown three dental instruments while heart rate (HR) and avoidance and subjective units of discomfort (SUD) were recorded. Questionnaires of phobic anxiety administered before and after treatment indicated significant improvement. Mental retrieval of treatment was moderately superior to the control condition with regard to avoidance. Over 80% of patients underwent the subsequent dental treatment session. Those not adhering showed initially more dysfunctional cognitions and more desire for control. There is some evidence that retrieval of treatment context may have a moderately beneficial effect on avoidance.

Defensive Mobilization in Specific Phobia: Fear Specificity, Negative Affectivity, and Diagnostic Prominence

Understanding of exaggerated responsivity in specific phobia-its physiology and neural mediators-has advanced considerably. However, despite strong phenotypic evidence that prominence of specific phobia relative to co-occurring conditions (i.e., principal versus nonprincipal disorder) is associated with dramatic differences in subjective distress, there is yet no consideration of such comorbidity issues on objective defensive reactivity. A community sample of specific phobia (n = 74 principal; n = 86 nonprincipal) and control (n = 76) participants imagined threatening and neutral events while acoustic startle probes were presented and eyeblinks (orbicularis occuli) recorded. Changes in heart rate, skin conductance level, and facial expressivity were also measured. Principal specific phobia patients far exceeded control participants in startle reflex and autonomic reactivity during idiographic fear imagery. Distinguishing between single and multiple phobias within principal phobia and comparing these with nonprincipal phobia revealed a continuum of decreasing defensive mobilization: single patients were strongly reactive, multiple patients were intermediate, and nonprincipal patients were attenuated-the inverse of measures of pervasive anxiety and dysphoria (i.e., negative affectivity). Further, as more disorders supplanted specific phobia from principal disorder, overall defensive mobilization was systematically more impaired. The exaggerated responsivity characteristic of specific phobia is limited to those patients for whom circumscribed fear is the most impairing condition and coincident with little additional affective psychopathology. As specific phobia is superseded in severity by broad and chronic negative affectivity, defensive reactivity progressively diminishes. Focal fears may still be clinically significant but not reflected in objective defensive mobilization.

Affirmation de soi, régulation émotionnelle et phobie sociale : étude pilote

Cognitive-behavioural therapy (CBT) is recognised as one of the most effective treatments of social phobia. In spite of this, important emotional dysfunctions remain problematic in these patients. The third wave of CBT offers new possibilities for therapeutic care that are both interesting and relevant. Thus, this exploratory study aims to analyse and compare the impact of these techniques between therapeutic groups for emotional regulation and self assertiveness. The results obtained with nine social phobic patients show, for the most part, reduced symptoms and improved cognitive, behavioural and emotional functioning.

Virtual reality exposure in the treatment of social phobia.

Social phobia is one of the most frequent psychiatric disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive-behavioral therapies. Graded exposure to feared social situations (either in vivo or by imagining the situations) is fundamental to obtain an improvement of the anxious symptoms. Virtual reality (VR) may be an alternative to these standard exposure techniques and seems to bring significant advantages by allowing exposures to numerous and varied situations. Moreover studies have shown that human subjects are appropriately sensitive to virtual environments. This chapter reports the definition of a VR-based clinical protocol and a study to treat social phobia using virtual reality techniques. The virtual environments used in the treatment reproduce four situations that social phobics feel the most threatening: performance, intimacy, scrutiny and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors when coping with social situations, with the aim of reducing her or his anxiety in the corresponding real life situations. Some studies have been carried out using virtual reality in the treatment of fear of public speaking, which is only a small part of the symptomatology of most of social phobic patients. The novelty of our work is to address a larger group of situations that the phobic patients experience with high anxiety. In our protocol, the efficacy of the virtual reality treatment is compared to well established and well validated group cognitive-behavioral treatment.

P-230 - Emotional (anxiety and depressive) disorders in young persons wih psychosomatic diseases (clinical structure and pathogenesis-based psychotherapy)

Anxiety and depressive disorders may provoke its appearance and also lead to recurrence of psychosomatic diseases (PSD). In 956 young people with psychosomatic diseases (bronchial asthma (BA), with peptic ulcer of the stomach and duodenum (PU) and arterial hypertension (AH)) investigated the clinical features of the structure and formation of emotional disorders in young persons with psychosomatic diseases. pathogenetically substantiated system of forecasting and theirpsychological adjustment and medical and psychological rehabilitation of these patients, based on a systematic approach to evaluating the clinical features of the structure and formation of emotional disorders in young persons with psychosomatic illnesses. Clinical-psychopathological, psychodiagnostical. In the clinical structure of emotional disorders (ED) dominated depressive disorders (43,4 ± 2,2%) and anxiety disorders (25,1 ± 1,2%). In patients with asthma significantly more frequently met panic disorder, agoraphobia, isolated phobia in patients with hypertension in many cases found generalized anxiety disorder (p < 0,01). Identified pathogenetically significant clinical, biological, psychological and psychosocial factors in the development of ED in young people with PSD. Pathogenetic role of psychological characteristics in the development of EP in patients with PSD determined by a combination of psychological traits: aleksytymia, low productivity of psychological defense, low predictive ability, high levels of aggression and hostility (p < 0,05). Developed and implemented in practice the system of psychotherapy and medical and social rehabilitation of patients with PSD, which confirmed the effectiveness of data of observation after 12 month.

Psychotherapy for social phobia: How do alliance and cognitive process interact to produce outcome?

The purpose of this study was to ascertain whether and how alliance and specific cognitive process may interact to influence outcome. Eighty social phobic patients were randomized to 10-week residential cognitive or interpersonal therapy, conducted mostly in groups. They completed process and outcome measures weekly. The ratings were analyzed with mixed models. It was found that initial patient-rated alliance predicted the course of social anxiety throughout therapy and that this effect was indirect through the cognitive process. However, this indirect effect did not interact with treatment. There was a trend toward an indirect effect of weekly variations in alliance rated by the individual therapist through weekly variations in subsequent cognitive process on weekly variations in subsequent social anxiety. Thus, the results support a facilitative rather than an active ingredient perspective on the role of alliance.

The effects of mixing different insulin analogues

Frequently doctors, specialist nurses and patients are unaware of the interaction between different insulins. We reviewed a needle phobic patient using a subcutaneous cannula device. The patient was using insulin glargine (Lantus) and insulin aspart (Novorapid). He had been advised to use two separate devices to keep the insulins apart. However, he was using the one device to give both insulin types and had experienced no problems. Unlike most other insulins which are soluble at a neutral pH, insulin glargine is soluble at a pH of 4. The slightly acidic nature of glargine is the reason it can sting when injected. The manufacturer (Sanofi-Aventis) advises that it is never diluted or mixed with other insulins and that it should only be used if it is clear and colourless with no particles visible. We demonstrate the effects of mixing insulin glargine with short acting insulin analogues. In each of six 1ml syringes we mixed 50 units of a long acting insulin analogue, either glargine (Lantus) or detemir (Levemir), with 50 units of a short acting analogue: aspart (Novorapid), lispro (Humalog) or glulisine (Apidra).

P.4.b.007 Resting-state fMRI in social phobia patients

P.4.b.007 Resting-state fMRI in social phobia patients

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.

A study on the executive function and working memory ability in patients with social phobia

Objective To explore the executive function and working memory ability of patients with social phobia. Methods The study included 42 social phobia patients whose age, sex, and level of education were matched with those of a healthy control group. Wisconsin Card Sorting Test and Digit Span, Spatial Span, Multiple-Objects-Spatial span were used to study the executive function and working memory. Results Patients with social phobia scored higher than the control group in terms of the number of non perseverative errors on the Wisconsin Card Sorting Test ( 18. 75 ± 6. 20, 8. 89 ± 3. 22 respectively ). No differences were observed in perseverative errors and other scores between the patient and control group. Patients with social phobia scored lower than the control group in terms of Digit Span(7.25 ±1.35,8.03 ±2. 30 respectively) ,Spatial Span(6. 11±1.85,8.61 ±2.87 respectively) and Multiple-Objects-Spatial span(4.03 ± 1. 39 ,5. 18 ± 1.07 respectively). Conclusion Working memory ability in the social phobia patients is impaired, and this may cause the poor performance in patients with the social phobia in academic and social working. Key words: Social phobia; Executive functions; Working memory

The Pathology of Social Phobia Is Independent of Developmental Changes in Face Processing

While social phobia in adolescence predicts the illness in adulthood, no study has directly compared the neural responses in social phobia in adults and adolescents. The authors examined neural responses to facial expressions in adults and adolescents with social phobia to determine whether the neural correlates of adult social phobia during face processing also manifest in adolescent social phobia. Blood-oxygen-level-dependent (BOLD) responses were compared in 39 medication-free participants with social phobia (25 adults and 14 adolescents) and 39 healthy comparison subjects (23 adults and 16 adolescents) matched on age, IQ, and gender. During fMRI scans, participants saw angry, fearful, and neutral expression stimuli while making a gender judgment. Significant diagnosis-by-emotion interactions were observed within the amygdala and the rostral anterior cingulate cortex, as has previously been hypothesized. In these regions, both the adolescent and adult social phobia patients showed significantly increased BOLD responses relative to their respective age-matched comparison subjects, and there was no evidence of age-related modulation of between-group differences. These enhanced responses occurred specifically when viewing angry (rostral anterior cingulate cortex) and fearful (amygdala and rostral anterior cingulate cortex) expressions but not when viewing neutral expressions. In addition, the severity of social phobia was significantly correlated with the enhanced rostral anterior cingulate cortex response in the adults. The neural correlates of adult social phobia during face processing also manifest in adolescents. Neural correlates that are observed in adult social phobia may represent the persistence of profiles established earlier in life rather than adaptive responses to such earlier perturbations or maturational changes. These cross-sectional observations might encourage longitudinal fMRI studies of adolescent social phobia.

Finding social phobia patients from the Internet

Patients with social phobia commonly resist face-to-face assessments, and a number of alternative assessment methods based on the Internet are being developed. The aim of this study was to identify patients with social phobia on the Internet and characterize their condition, using the Social Phobia Inventory (SPIN). In Stage I, this study recruited 1307 participants from the Internet, most of whom were well-educated young females, who had remained unmarried and unemployed. The Internet-based SPIN demonstrated excellent internal consistency (Cronbach's α=0.937) and good test-retest reliability (intraclass correlation coefficient=0.942). In Stage II, we examined the discriminant validity of the SPIN via structured telephone interviews. The area under the receiver operating characteristic curve used to discriminate social phobia was 0.871 with an optimal cut-off point of 24 on the total score for the SPIN. According to the SPIN scores, 919 of Stage I participants (70.3%) reached the threshold of social phobia, 531 of which (57.8%) had never sought professional help. These results suggest that the Internet is a potential avenue through which to find untreated patients with social phobia.

Behandeling van extreme angst voor tandheelkundige behandelingen en levenskwaliteit

Phobia for dental treatment often has a considerable influence on a person's perceived quality of life. In this research project, the relationship and interactions between dental anxiety, oral health and quality of life were studied. Scores on the basis of several parameters of these factors were analyzed prior to and following dental treatment. It appeared that quality of life was associated with both dental anxiety and oral health. When improvement in quality of life was investigated, it appeared that this was only statistically correlated with a reduction in dental anxiety. These findings suggest that treatment of dental phobia patients should focus not only on making patients treatable (pharmacologically), but also on reducing anxiety.

Help your phobic patients

Help your phobic patients

The phobic brain: white matter integrity in patients with spider phobia

Spider phobia is characterized by excessive and unreasonable fear and avoidance-behaviour when exposed to a phobic stimulus. Previous research suggests that visually elicited phobic reactions deactivate prefrontal areas involved in cognitive control over emotion-triggering areas like the amygdala. The fear mechanisms in specific phobias could be explained by microstructural abnormalities in white matter integrity and may contribute to the understanding of the occurrence of irrational anxiety symptoms. A diffusion tensor imaging (DTI) sequence was used to acquire images in 30 patients with spider phobia and 30 matched healthy control subjects. This study assess whether spider phobic patients show abnormalities in association with white matter fiber tracts compared to healthy controls. Mean diffusivity (MD) is a directionally averaged measure of diffusion; whereas, fractional anisotropy (FA) is a measure of how much the diffusion tensor deviates from the isotropic form (diffusion occurs equally in all directions). These measures are compared to specify regions of interest and investigate structural connectivity. Combining fMRI and DTI, the neuronal activation of the fear-related brain areas are used as seed points for probabilistic fiber tractography.