Treatment Of Emotional Disorders Research Articles

An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children

BackgroundThis case report discusses the presentation and treatment of a nine-year-old female with a history of significant weight loss and food refusal using a combined approach of Family-Based Treatment (FBT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C).Case presentationThe patient was diagnosed with avoidant/restrictive food intake disorder (ARFID), separation anxiety disorder, and a specific phobia of choking, and subsequently treated with a modified version of FBT, in conjunction with the UP-C. At the end of treatment, improvements were seen in the patient’s weight and willingness to eat a full range of foods. Decreases in anxiety regarding eating/choking, fears of food being contaminated with gluten, and fears of eating while being away from parents were also observed.ConclusionsThese findings highlight promising results from this combined treatment approach, referred to as FBT + UP for ARFID. Further research is needed to evaluate the use of this treatment in patients presenting with a variety of ARFID symptoms.

Stakeholder Preferences on Transdiagnostic Psychosocial Treatment for Trauma-Exposed Veterans.

While modular and transdiagnostic approaches may address implementation challenges, there remains limited investigation into the fit within large healthcare systems. The current study examines qualitative interviews from patients, clinicians and administrative stakeholders in the Veterans Administration about experiences with, and views of, the Unified Protocol (UP; Barlow et al. in The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide, Oxford University Press, New York, 2011) to understand potential for implementation. Qualitative interviews were conducted based on an established implementation framework and speak to implementation of transdiagnostic treatment in veterans, including insight into barriers, facilitators, intervention characteristics, patient characteristics, and system level variables. The UP demonstrated promise for improving efficiency, satisfaction and personalizing mental healthcare.

Role of Intolerance of Uncertainty (IU) in the etiology and treatment of emotional disorder: A mini review

Role of Intolerance of Uncertainty (IU) in the etiology and treatment of emotional disorder: A mini review

A meta-analysis and systematic review of Memory Specificity Training (MeST) in the treatment of emotional disorders

The tendency to recall events from one's past in a non-specific and overgeneral way has been found to predict the onset and severity of a range of emotional disorders. Memory Specificity Training (MeST) was devised a decade ago in order to target and modify this tendency so as to reduce the symptoms of emotional disorder or to reduce the risk that such disorders might emerge over time. We present a meta-analytical review of research into the effects of MeST on autobiographical memory specificity in the context of emotional disorders (k = 13). MeST was associated with substantial improvement in memory specificity (d = −1.21) and depressive symptoms (d = 0.47) and MeST groups outperformed control groups at post-intervention in terms of specificity (d = 1.08) and depressive symptoms (d = −0.29). However, these effects were transitory and the benefit of MeST over control groups was mostly lost by follow-up assessment. There was mixed evidence in terms of MeST's effects on other processes associated with reduced specificity but MeST showed evidence of improving problem solving abilities and hopelessness. MeST holds promise as a novel intervention targeting reduced specificity but future studies are warranted with control groups that enable the investigation of MeST's mechanism of action and in studies with larger and more varied samples.

Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial.

Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the “Unified Protocol (UP) for the transdiagnostic treatment of EDs.” This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse.Clinical Trial Registration: ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017.

Comorbidity and diagnosis distribution in transdiagnostic treatments for emotional disorders: A systematic review of randomized controlled trials.

The advantages of transdiagnostic protocols for emotional disorders (ED) (anxiety and depression) include the ability to treat multiple psychological disorders using the same treatment protocol, and the capacity to better address comorbidity. Comorbidity in ED has been associated with higher rates of severity, functional impairment, and chronicity. However, no attempts have been made in the literature to systematically review whether these studies include assessments to evaluate the treatment response in comorbid diagnoses, in addition to the principal diagnosis. Moreover, transdiagnostic treatments have been developed for a range of ED, but to date no study has analyzed the real distribution of diagnoses in these studies. The current study aimed to analyze: a) whether treatment response in comorbidity is evaluated in transdiagnostic treatments for ED; b) what diagnoses are targeted in transdiagnostic treatments for ED; and c) the real distribution of the diagnoses at baseline in these studies. A systematic search of the literature was conducted in PsycINFO, PubMed, EMBASE, and the Cochrane Library. Fifty-two randomized controlled trials were identified, with a total of 7007 adult participants. The results showed that, although most of the studies reported data on comorbidity at baseline, only 40% of them examined the effects of the intervention on the comorbid disorders. The most commonly targeted diagnoses in transdiagnostic protocols were panic/agoraphobia, generalized anxiety, social anxiety, and depression. Other disorders, such as obsessive-compulsive disorder, posttraumatic stress disorder, and anxiety/depression not otherwise specified, were marginally included in these studies. Regarding the distribution of diagnoses at baseline, generalized anxiety, panic/agoraphobia, social anxiety, and depression were the most frequently observed, whereas depression not otherwise specified was the least represented. The results highlight the importance of assessing comorbidity in addition to the principal diagnoses in transdiagnostic treatments, in order to draw conclusions about the true potential of these interventions to improve comorbid symptoms. Implications of the current study and directions for future research are discussed.

A Double-Blind Placebo Controlled Study of Intranasal Oxytocin's Effect on Emotion Recognition and Visual Attention in Outpatients with Emotional Disorders.

The current study used double-blind, placebo-controlled design to examine the effect of intranasal oxytocin (OT) on emotion recognition (ER) and visual attention in 60 outpatients presenting for assessment and treatment of emotional disorders. Our primary hypothesis was that OT would improve recognition of happy faces in depressed participants. The main effect of OT on ER accuracy, speed, and proportion of fixations in the eye region was not significant. Diagnostic group (i.e., presence/absence of a depressive disorder) moderated the effect of OT on ER, but not as expected: OT significantly slowed ER speed for all emotions in participants with anxiety disorders, but did not affect performance in participants with depressive disorders. Depressed participants fixated significantly less in the eye region of sad faces than anxious participants. Before OT can be used to target ER biases, additional research is needed to explicate the differential impact of OT on ER speed in patients with anxiety versus mood disorders.

Is the glass half empty or half full and does it even matter? Cognition, emotion, and psychopathology

ABSTRACTThis contribution examines the outcomes of recent decades of research on the interaction between cognition and emotion and how it has informed our understanding and treatment of emotional disorders with a special focus on depression. The review identifies important challenges to this work including the dynamic nature of cognitive processes and emotional responding, the bidirectional relation of cognition and emotion, the need for new tasks and for studies conducted outside of the laboratory, and the consideration of context such as interpersonal factors. Examining interactions between cognition and emotion and integrating basic research on cognition into the scientific understanding of emotional difficulties in psychopathology has contributed in many ways to what the field currently knows about the origins and the treatment of emotional disorders. Important challenges lie ahead – especially the integration of this work into the development of novel treatment approaches.

Afecto negativo como mediador entre intolerancia a la incertidumbre, ansiedad y depresión

The transdiagnostic model has demonstrated its relevance in the understanding and treatment of emotional disorders that share cognitive and behavioral processes. The objective of this research is to analyze the mediating role of negative affect (NA) in the relationship between intolerance to uncertainty (IU) and anxious and depressive symptoms following a transdiagnostic model. The sample consisted of 506 participants aged between 18 and 64 years (M=31.9, SD=11.26); the levels of NA as state and trait was obtained using the scale of positive and negative affect (PANAS), the IU with the scale of intolerance to uncertainty, and the anxious and depressive symptoms with the BAI and BDI-II. The results indicate that affective measures of state and trait NA, and cognitive measures such as uncertainty of inhibition and bewilderment correlated with symptoms of anxiety and depression. In addition, the cognitive measures and their dimensions when associated with measures of depression and anxiety decreased significantly controlling the AN, obtaining a mediating model for the affective and cognitive measures in anxiety and depression in a path model adjusted according to the mediation and indirect effects analyses in a model of structural equations. It is concluded that the state and trait NA is considered a mediating factor between IU and anxiety symptoms in a total and partial way with depression. New evidence of the role of affect is generated as a trait and state in the approach of a transdiagnostic model in the area of clinical intervention.

Transdiagnostic cognitive behavioral therapy based on unified protocol: new approach to emotional disorders

One of the new and evidence-based interventions recently developed to address psychological disorders is the unified protocol for transdiagnostic treatment of emotional disorders. The protocol was designed using transdiagnostic theories emphasizing the commonalities between disorders. The present work aimed to provide an overview of the unified protocol by reviewing the theories and studies carried out in this area.

The theta burst transcranial magnetic stimulation over the right PFC affects electroencephalogram oscillation during emotional processing

Prefrontal cortex (PFC) plays an important role in emotional processing and therefore is one of the most frequently targeted regions for non-invasive brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) in clinical trials, especially in the treatment of emotional disorders. As an approach to enhance the effectiveness of rTMS, continuous theta burst stimulation (cTBS) has been demonstrated to be efficient and safe. However, it is unclear how cTBS affects brain processes related to emotion. In particular, psychophysiological studies on the underlying neural mechanisms are sparse. In the current study, we investigated how the cTBS influences emotional processing when applied over the right PFC. Participants performed an emotion recognition Go/NoGo task, which asked them to select a GO response to either happy or fearful faces after the cTBS or after sham stimulation, while 64-channel electroencephalogram (EEG) was recorded. EEG oscillation was examined using event-related spectral perturbation (ERSP) in a time-interval between 170 and 310ms after face stimuli onset.In the sham group, we found a significant difference in the alpha band between response to happy and fearful stimuli but that effect did not exist in the cTBS group. The alpha band activity at the scalp was reduced suggesting the excitatory effect at the brain level. The beta and gamma band activity was not sensitive to cTBS intervention.The results of the current study demonstrate that cTBS does affect emotion processing and the effect is reflected in changes in EEG oscillations in the alpha band specifically. The results confirm the role of prefrontal cortex in emotion processing. We also suggest that this pattern of cTBS results elucidates mechanisms by which mood improvement in depressive disorders is achieved using cTBS intervention.

Working with anxiety and depression from a Buddhism framework

Buddhism as a spiritual discipline is concerned with freedom from suffering, conceptualizing suffering as originating in false views about the nature of self and reality. Buddhist psychology conceptualizes emotions and mental habits as being wholesome or unwholesome based on the tendency of these habits to promote or hinder the quest for enlightenment, and contains a rich diversity of methods to transform unwholesome emotional tendencies. Many of these emotions, such as anger, fear, and despair, are commonly dealt with in clinical or therapy settings. Buddhist ideas about the genesis and cessation of suffering can be used as an overarching model to organize a diversity of therapeutic techniques, bridge different therapy models, and select particular techniques at particular times in the treatment of emotional disorders. Learning objectives: after this session, participants will be able to use the Buddhist Yogacara model of mind and karma as a model of how negative emotions are transformed. After this session, participants will be able to describe indirect methods (evoking wholesome feelings) in order to transform negative emotional tendencies and how this overlaps with current therapy models such as supportive and compassion-focused therapy. After the session, participants will be able to conceptualize how Buddhist “direct methods” of mindful awareness and contemplating right view overlaps with methods used in cognitive behavioural therapy, marital therapy, or acceptance and commitment therapy. Self-assessment questions: according to Buddhist psychology, what is the primary cause of negative emotions? Broadly speaking, what are 3 types of techniques for transforming emotional habits?Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial.

BackgroundDemand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)—anxiety, depression, and somatic symptom disorders—and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate.ObjectiveWe aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction.MethodsHere we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain.ResultsThis study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018.ConclusionsWe expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3)

Loss of divalent metal transporter 1 function promotes brain copper accumulation and increases impulsivity.

The divalent metal transporter 1 (DMT1) is a major iron transporter required for iron absorption and erythropoiesis. Loss of DMT1 function results in microcytic anemia. While iron plays an important role in neural function, the behavioral consequences of DMT1 deficiency are largely unexplored. The goal of this study was to define the neurobehavioral and neurochemical phenotypes of homozygous Belgrade (b/b) rats that carry DMT1 mutation and explore potential mechanisms of these phenotypes. The b/b rats (11-12weeks old) and their healthy littermate heterozygous (+/b) Belgrade rats were subject to elevated plus maze tasks. The b/b rats spent more time in open arms, entered open arms more frequently and traveled more distance in the maze than +/b controls, suggesting increased impulsivity. Impaired emotional behavior was associated with down-regulation of GABA in the hippocampus in b/b rats. Also, b/b rats showed increased GABAA receptor α1 and GABA transporter, indicating altered GABAergic function. Furthermore, metal analysis revealed that b/b rats have decreased total iron, but normal non-heme iron, in the brain. Interestingly, b/b rats exhibited unusually high copper levels in most brain regions, including striatum and hippocampus. Quantitative PCR analysis showed that both copper importer copper transporter 1 and exporter copper-transporting ATPase 1 were up-regulated in the hippocampus from b/b rats. Finally, b/b rats exhibited increased 8-isoprostane levels and decreased glutathione/glutathione disulfide ratio in the hippocampus, reflecting elevated oxidative stress. Combined, our results suggest that copper loading in DMT1 deficiency could induce oxidative stress and impair GABA metabolism, which promote impulsivity-like behavior. Iron-copper model: Mutations in the divalent metal transporter 1 (DMT1) decrease body iron status and up-regulate copper absorption, which leads to copper loading in the brain and consequently increases metal-induced oxidative stress. This event disrupts GABAergic neurotransmission and promotes impulsivity-like behavior. Our model provides better understanding of physiological risks associated with imbalanced metal metabolism in mental function and, more specifically, the interactions with GABA and redox control in the treatment of emotional disorders.

Anger: The unrecognized emotion in emotional disorders.

Anger plays a prominent definitional role in some psychological disorders currently widely scattered across DSM-5 categories (e.g., intermittent explosive disorder, borderline personality disorder). But the presence and consequences of anger in the emotional disorders (e.g., anxiety disorders, depressive disorders) remain sparsely examined. In this review, we examine the presence of anger in the emotional disorders and find that anger is elevated across these disorders and, when it is present, is associated with negative consequences, including greater symptom severity and worse treatment response. Based on this evidence, anger appears to be an important and understudied emotion in the development, maintenance, and treatment of emotional disorders.

Cognitive Hypnotherapy as a Transdiagnostic Protocol for Emotional Disorders

This article describes cognitive hypnotherapy (CH), an integrative treatment that provides an evidence-based framework for synthesizing clinical practice and research. CH combines hypnotherapy with cognitive-behavior therapy in the management of emotional disorders. This blended version of clinical practice meets criteria for an assimilative model of integrative psychotherapy, which incorporates both theory and empirical findings. Issues related to (a) additive effect of hypnosis in treatment, (b) transdiagnostic consideration, and (c) unified treatment protocols in the treatment of emotional disorders are considered in light of cognitive hypnotherapy.

The Attention Training Technique: A Review of a Neurobehavioral Therapy for Emotional Disorders

Wells’s (1990) attention training technique (ATT) is a neurobehavioral therapy for emotional disorders that purportedly can improve upon existing treatment efforts for these disorders. Yet, ATT remains underutilized in the treatment of emotional disorders. One tenable reason for the underutilization of ATT is that researchers and clinicians alike may generally be unfamiliar with ATT and studies supporting its use. We sought to: (a) outline the setup and potential barriers to implementing ATT, (b) describe the distinctiveness of ATT from related interventions, (c) update readers on studies that have examined ATT since an earlier review, (d) discuss limitations surrounding extant ATT studies that preclude us from fully understanding the therapeutic benefits of ATT and describe how future studies can address these limitations, and (e) extend prior discussions of potential mechanisms of change underlying ATT. Our review of empirical evidence for ATT suggests that ATT could be considered a possibly efficacious treatment for emotional disorders, with a great need existing for future efficacy studies that evaluate ATT as a standalone intervention. We offer recommendations for future research interested in shedding further light onto the therapeutic benefits of ATT.

The Zar in the Persian Gulf: Performative dimensions

This article explores the performative dimensions of the Zar ceremony as carried out throughout the Persian Gulf. This ceremony is mirrored by similar ones throughout North and East Africa, suggesting that the Zar may have resulted from cultural diffusion along historical trade routes. The Zar practitioners, the baba and the mama, have extensive demands in musical performance, movement and coordination in order to affect a palliative relief for persons affected by spirit ‘winds’ that inhabit them. The analysis in this paper uses the framework of ritual structure developed by Arnold Van Gennep and Victor Turner to show how the practitioners skilfully guide the person at the centre of the ceremony and the community of the ‘People of the Wind’ to a successful conclusion by bringing persons under treatment from a ‘normal’ state through a ‘liminal’ state to an eventual ‘reincorporated’ state in which relief is experienced. The performative aspects of the ceremony move those who are being treated through stages in which the inhabiting spirit is addressed: induction, movement into a trance state both for the practitioner and the person being treated, addressing of the spirit by the practitioners and return of the person being treated to normal life. All of these stages are marked by special music, chanting and movement. The Zar ceremony is an important method of non-allopathic treatment for emotional disorders that might elsewhere be treated through psychiatry in clinical settings.

Explanatory flexibility and explanatory style in treatment-seeking clients with Axis I psychopathology.

Cognitive diathesis stress models of depression emphasize individual styles of attributing causal explanations to negative and positive events in life. The Attributional Style Questionnaire (ASQ) has traditionally been used to measure explanatory style, defined as an individual's habitual way of assigning causes to negative events. Explanatory flexibility, rather than focusing on the content of one's thoughts, emphasizes the extent to which individuals are able to make different attributions depending on the particular context of each event. The underlying notion is that individuals who are better able to adapt to the cues and demands of a stressful situation may be able to respond more effectively and are thereby less vulnerable to depression. Despite evidence attesting to its relevance to depression and anxiety disorders, explanatory flexibility has yet to be examined in a purely treatment-seeking sample of patients clinically diagnosed with Axis I psychopathology. The current study examined baseline levels of explanatory flexibility, along with explanatory style, in a sample of 171 treatment-seeking patients diagnosed with either major depressive disorder (MDD), generalized anxiety disorder (GAD), or at least one other Axis I disorder. Overall, the results replicate and extend past results indicating a distinction between explanatory flexibility and explanatory style. Furthermore, patients with MDD and GAD demonstrated lower levels of explanatory flexibility relative to patients with other Axis I disorders. Thus, explanatory flexibility may assist in our understanding of the etiology, maintenance, and treatment of emotional disorders, with particular relevance to MDD and GAD.

Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services.

The effectiveness of evidence-based practice in the treatment of children with conduct disorder (n = 186) or emotional disorders (n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.