Improving Exposure Therapy: Rationale and Design of an International Consortium.

The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, this article describes the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team science and larger-scale collaborative research in this area. Clinical working groups have begun to identify opportunities to enhance access to helpful resources for implementing exposure therapy effectively. This article discusses directions for expanding the consortium's activities and its impact on a global scale.

Age and pre quit-day attrition during smoking cessation treatment.

The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (Mage = 44.2 years, SD = 11.3 years; age = 22-64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.

The effects of exercise on transdiagnostic treatment targets: A meta-analytic review.

BACKGROUND: The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE). METHODS: We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target. RESULTS: The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26). CONCLUSIONS: This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.

Effects of acute exercise on fear extinction in rats and exposure therapy in humans: Null findings from five experiments.

BACKGROUND: Exposure therapy is an established learning-based intervention for the treatment of anxiety disorders with an average response rate of nearly 50%, leaving room for improvement. Emerging strategies to enhance exposure therapy in humans and fear extinction retention in animal models are primarily pharmacological. These approaches are limited as many patients report preferring non-pharmacological approaches in therapy. With general cognitive enhancement effects, exercise has emerged as a plausible non-pharmacological augmentation strategy. The present study tested the hypothesis that fear extinction and exposure therapy would be enhanced by a pre-training bout of exercise. METHODS: We conducted four experiments with rats that involved a standardized conditioning and extinction paradigm and a manipulation of exercise. In a fifth experiment, we manipulated vigorous-intensity exercise prior to a standardized virtual reality exposure therapy session among adults with fear of heights. RESULTS: In experiments 1-4, exercise did not facilitate fear extinction, long-term memory, or fear relapse tests. In experiment 5, human participants showed an overall reduction in fear of heights but exercise did not enhance symptom improvement. CONCLUSIONS: Although acute exercise prior to fear extinction or exposure therapy, as operationalized in the present 5 studies, did not enhance outcomes, these results must be interpreted within the context of a broader literature that includes positive findings. Taken all together, this suggests that more research is necessary to identify optimal parameters and key individual differences so that exercise can be implemented successfully to treat anxiety disorders.

Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success.

BACKGROUND: While important for substance use outcomes, knowledge about treatment attendance patterns, and their relation with clinical outcomes is limited. We examined the association between attendance patterns and smoking outcomes in a randomized, controlled smoking cessation intervention trial. METHODS: In addition to standard smoking cessation treatment, participants were randomized to 15 weeks of an exercise intervention (n=72) or an education control condition (n=64). Latent class growth analysis (LCGA) tested whether intervention attendance would be better modeled as qualitatively distinct attendance patterns rather than as a single mean pattern. Multivariate generalized linear mixed modeling (GLMM) was used to evaluate associations between the attendance patterns and abstinence at the end of treatment and at 6-month follow-up. RESULTS: The LCGA solution with three patterns characterized by high probability of attendance throughout (Completers, 46.3%), gradual decreasing probability of attendance (Titrators, 23.5%), and high probability of dropout within the first few weeks (Droppers, 30.1%) provided the best fit. The GLMM analysis indicated an interaction of attendance pattern by treatment condition, such that titration was associated with lower probability of quit success for those in the control condition. Probability of quit success was not significantly different between Titrators and Completers in the exercise condition. CONCLUSIONS: These findings underscore the importance of examining how treatment efficacy may vary as a function of attendance patterns. Importantly, treatment discontinuation is not necessarily indicative of poorer abstinence outcome.

Correction: Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease.

[This corrects the article DOI: 10.1371/journal.pone.0123861.].

BDNF Val66Met Polymorphism as a Moderator of Exercise Enhancement of Smoking Cessation Treatment in Anxiety Vulnerable Adults.

BACKGROUND: Exercise interventions facilitate odds of quit success among high-anxiety sensitive adults smokers. We examined the dependency of these benefits on the genetic BDNF Val66Met (rs6265) polymorphism; individuals who are Met carriers have lower BDNF responses and reduced associated benefits from exercise. Accordingly, we hypothesized that the efficacy of vigorous exercise for smoking cessation would be specific to high-anxiety sensitive Val/Val carriers. METHODS: Participants were adults (N=55) of European ancestry who had participated in a randomized controlled trial comparing a smoking cessation program augmented with exercise vs. augmented with a wellness control treatment. In this secondary analysis, growth curve models for point-prevalence abstinence (PPA) and prolonged abstinence (PA) employed for the main outcome analyses were amended to test the moderator effects of the BDNF Val66Met polymorphism. RESULTS: Consistent with prediction, the advantage of exercise over control for PPA was significantly greater among high-anxiety sensitive persons with the Val/Val genotype than for those with the Val/Met genotype. This advantage did not reach statistical significance for PA. Differences in abstinence between the exercise and control interventions among low-anxiety sensitive smokers were not dependent on the BDNF Val66Met polymorphism. CONCLUSIONS: We found that the efficacy of exercise for augmenting smoking cessation treatment is intensified among high-anxiety sensitive smokers who are Val/Val carriers. This observation is consistent with findings documenting BDNF mediation of exercise benefits and greater negative affect among smokers who are Val/Val carriers. These data encourage further evaluation of the association between the BDNF polymorphism, exercise, anxiety sensitivity, and smoking cessation.

Optimizing the Exercise Prescription for Depression: The Search for Biomarkers of Response.

There is growing support for the efficacy of exercise interventions for the treatment of individuals who present with mild-to-moderate depression. The variability in treatment response across studies and individuals suggests that the efficacy of exercise for depression will be most optimal when prescribed to individuals who are most prone to respond. The present article reviews contemporary theoretical accounts and recent empirical data pointing to neuroinflammatory states and neurotrophin production as possible biomarkers of the antidepressant response to exercise. The larger exercise and depression literatures provide justification for elevated levels of pro-inflammatory cytokines and deficits in BDNF production as putative matching variables. Although there is some empirical support for these hypotheses, it is clear that this research warrants replication and extension. We offer a few suggestions for future research in this emerging area.

Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease.

INTRODUCTION: Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) can profoundly affect quality of life and are influenced by stress and resiliency. The impact of mind-body interventions (MBIs) on IBS and IBD patients has not previously been examined. METHODS: Nineteen IBS and 29 IBD patients were enrolled in a 9-week relaxation response based mind-body group intervention (RR-MBI), focusing on elicitation of the RR and cognitive skill building. Symptom questionnaires and inflammatory markers were assessed pre- and post-intervention, and at short-term follow-up. Peripheral blood transcriptome analysis was performed to identify genomic correlates of the RR-MBI. RESULTS: Pain Catastrophizing Scale scores improved significantly post-intervention for IBD and at short-term follow-up for IBS and IBD. Trait Anxiety scores, IBS Quality of Life, IBS Symptom Severity Index, and IBD Questionnaire scores improved significantly post-intervention and at short-term follow-up for IBS and IBD, respectively. RR-MBI altered expression of more genes in IBD (1059 genes) than in IBS (119 genes). In IBD, reduced expression of RR-MBI response genes was most significantly linked to inflammatory response, cell growth, proliferation, and oxidative stress-related pathways. In IBS, cell cycle regulation and DNA damage related gene sets were significantly upregulated after RR-MBI. Interactive network analysis of RR-affected pathways identified TNF, AKT and NF-κB as top focus molecules in IBS, while in IBD kinases (e.g. MAPK, P38 MAPK), inflammation (e.g. VEGF-C, NF-κB) and cell cycle and proliferation (e.g. UBC, APP) related genes emerged as top focus molecules. CONCLUSIONS: In this uncontrolled pilot study, participation in an RR-MBI was associated with improvements in disease-specific measures, trait anxiety, and pain catastrophizing in IBS and IBD patients. Moreover, observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD-and that its regulation may contribute to counteracting the harmful effects of stress in both diseases. Larger, controlled studies are needed to confirm this preliminary finding. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02136745.

A healthy aging program for older adults: effects on self-efficacy and morale.

CONTEXT: As of 2012, 810 million people worldwide were older than 60 y, accounting for 11% of the population. That number is expected to rise to 2 billion by 2050 or to 22% of the overall population. As a result, a growing need exists to understand the factors that promote mental and physical health in older populations. OBJECTIVES: The purpose of this study was to develop a healthy aging program for older adults and to measure the changes from baseline to the end of the program in participants' relevant psychosocial outcomes (ie, self-efficacy and morale). DESIGN: The study's healthy aging mind-body intervention (MBI) was adapted from the Relaxation Response Resiliency Program (3RP) at the Benson-Henry Institute for Mind Body Medicine, which incorporates elements from the fields of stress management, cognitive behavioral therapy, and positive psychology. That program was modified with examples and exercises targeted to an older population and evaluated in the current single-arm pilot study. SETTING: The program took place at the Massachusetts General Hospital (MGH). PARTICIPANTS: The 9-wk healthy aging MBI was developed for participants aged 65 y and older. Fifty-one older adults from the surrounding community participated in the study's groups. INTERVENTION: A new intervention group began the program every 3 mo, with a maximum of 12 individuals per group. For each group, the MBI consisted of weekly 90-min sessions for 9 consecutive wk, directed by a psychologist. The program included sessions that taught participants (1) a variety of methods to elicit the relaxation response (RR), (2) the practice of adaptive coping and cognitions, (3) behaviors necessary to create a healthy lifestyle, and (4) methods of building social support. OUTCOME MEASURES: The research team chose to focus on 2 psychological variables of interest for aging populations: morale and self-efficacy. The study used 2 questionnaires to measure those outcomes, the Philadelphia Geriatric Center Morale Scale (PGCMS), a multidimensional measure of the psychological state of older people, and the Coping Self-efficacy Scale (CSES), a measure that addresses the multiple dimensions of self-efficacy. RESULTS: Data from 5 intervention groups were combined for the current analysis. Forty-six participants enrolled and completed questionnaires. Of those participants, 41 attended at least 7 of the 9 sessions. Significant increases in self-efficacy and morale were observed for program completers. After a highly conservative sensitivity analysis, the change for the measure of self-efficacy remained significant, and the change for the measure of morale trended toward significance. CONCLUSIONS: The study's healthy aging program appears to be a feasible intervention for older adults, with the potential to increase levels of self-efficacy and morale in participants. Further research is warranted to determine its effects on other psychosocial outcomes and health care utilization in aging populations.

Mind-body group treatment for women coping with infertility: a pilot study.

OBJECTIVES: To evaluate the feasibility of a 10-week mind-body intervention (MBI) for women coping with fertility challenges, examine the impact of an MBI on psychological distress and cortisol levels, and assess adherence to MBI skills 12-months after completion of the intervention. DESIGN: Prospective open pilot study of 51 women with infertility enrolled in a group MBI. Psychological variables and salivary cortisol levels were obtained pre- and post-intervention; a 12-month follow-up survey assessed MBI skill adherence. Participants completed practice logs throughout the intervention. RESULTS: Participants attended an average of eight sessions (SD = 2.0), and practiced mind-body techniques which elicited the relaxation response (RR) an average of 5.9 (SD = 0.8) days/week and 20.1 (SD = 9.9) min/day; 80% completed the post-treatment assessment. The intervention resulted in a significant increase in perceived social support and a decrease in depressive symptoms and perceived stress; however, there were no significant changes in cortisol levels. Sixty-eight percent of the participants completed the 12-month follow-up, with 51% reporting continuation of RR-eliciting practice. CONCLUSION: This group of women with infertility provided with an MBI showed decreased symptoms of depression and stress and increased perceived social support. The protocol was feasible and participants reported a high degree of adherence and maintenance to the skills taught during the intervention. The findings indicate the value of appropriate evaluation against a control group.

Effectiveness of the relaxation response-based group intervention for treating depressed chinese american immigrants: a pilot study.

BACKGROUND: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. METHODS: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. RESULTS: Participants (N = 22) were 82% female, mean age was 53 (± 12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. DISCUSSION: The RR-based group is feasible and safe in treating Chinese American immigrants with depression.

The effectiveness of a community-based, mind-body group for symptoms of depression and anxiety.

CONTEXT: The prevalence of depression and other mental health conditions is on the rise, with an estimated 350 million people affected. Populations with lower socioeconomic status are at higher risk for mental health problems, including depression and anxiety. Community health centers (CHCs) often have wait lists for individual counseling. Group mind-body interventions (MBIs) that are based on the relaxation response (RR) are plausible options for treating mental health conditions at CHCs. OBJECTIVE: The study examined the feasibility and effectiveness of an 8-wk MBI developed at the Benson-Henry Institute for Mind Body Medicine (BHI) for treatment of symptoms of depression and anxiety in a community-based population. DESIGN: The research team designed a retrospective, open-label study of 124 patients with symptoms of depression or anxiety enrolled in an MBI as a group. SETTING: The setting for the study was 2 CHCs at Massachusetts General Hospital (MGH) in Boston, MA, USA. PARTICIPANTS: Participants were adult patients at MGH with symptoms of depression and/or anxiety. The program was billed as treatment related to behavioral health and accessible to people with all levels of education. INTERVENTION: The MBI for depression and/or anxiety in the current study teaches techniques that elicit a relaxation response (RR), in combination with additional resiliencyenhancing components. OUTCOME MEASURES: To examine effects of the program, self-report clinical measures were administered pre- and postintervention: (1) for depression, the Center for Epidemiologic Studies Depression Scale (CES-D10); (2) for anxiety, the State-Trait Anxiety Inventory-State Subscale (STAI-State); and (3) for perceived stress, the Perceived Stress Scale (PSS-10). RESULTS: The intervention was associated with a significant decrease in depressive symptoms: 95% CI, -6.0 to -2.6 (P < .001); anxiety--95% CI -12.6 to -2.2 (P = .007); and perceived stress--95% CI -7.6 to -2.0 (P = .001). Approximately 52.4% of the participants completed at least 75% of the 8 sessions, with 5 sessions attended on average. CONCLUSIONS: Participation in this MBI was associated with an improvement in symptoms of depression and anxiety as well as decreases in perceived stress among CHC patients.

Temporal dynamics of emotional responding: amygdala recovery predicts emotional traits.

An individual's affective style is influenced by many things, including the manner in which an individual responds to an emotional challenge. Emotional response is composed of a number of factors, two of which are the initial reactivity to an emotional stimulus and the subsequent recovery once the stimulus terminates or ceases to be relevant. However, most neuroimaging studies examining emotional processing in humans focus on the magnitude of initial reactivity to a stimulus rather than the prolonged response. In this study, we use functional magnetic resonance imaging to study the time course of amygdala activity in healthy adults in response to presentation of negative images. We split the amygdala time course into an initial reactivity period and a recovery period beginning after the offset of the stimulus. We find that initial reactivity in the amygdala does not predict trait measures of affective style. Conversely, amygdala recovery shows predictive power such that slower amygdala recovery from negative images predicts greater trait neuroticism, in addition to lower levels of likability of a set of social stimuli (neutral faces). These data underscore the importance of taking into account temporal dynamics when studying affective processing using neuroimaging.

The effectiveness of a comprehensive mind body weight loss intervention for overweight and obese adults: a pilot study.

OBJECTIVES: This pilot study evaluated the effectiveness of a comprehensive mind body intervention for weight loss in overweight and obesity and the maintenance of weight loss at 6-month follow-up. DESIGN: Thirty-one overweight and obese employees (Body Mass Index (BMI) 28.6-47.9 kg/m²) from a large corporation participated in a 20-week comprehensive mind body intervention targeting weight loss. MAIN OUTCOME MEASURES: Weight, BMI, waist and hip circumference, rate pressure product (RPP), blood pressure, fasting blood glucose, cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and psychological variables were collected at baseline, post-intervention, and 6-month follow-up. RESULTS: Using linear mixed model analyses, the intervention resulted in significant mean weight loss (-4.3 kg, 95% CI -5.8 to -2.8), decreases in BMI (-1.51, 95% CI -2.1 to -1.0), hip circumference measurement (-4.3 cm, 95% CI -6.9 to -1.5), and triglyceride levels (95% CI -33.1 to -4.8). In 6-month follow-up after intervention, statistically significant improvements in weight, BMI and waist measurement were sustained. Participants also showed positive changes in self-reported psychological indices: food-related disinhibition, and hunger both decreased significantly (p<0.01); general self-efficacy increased (p<0.05); positive affect increased (p<0.001); physical function and self-esteem increased (p<0.01); and measures of health-promoting behaviors on 4 subscales (health responsibility, physical activity, nutrition, and stress management) also showed statistically significant improvements (p<0.001) at post-intervention and 6-month follow-up. CONCLUSIONS: This comprehensive mind body intervention showed modest effects on physical, laboratory, and psychological outcomes, both immediately following treatment and at 6-month follow-up, in overweight and obese individuals.

The treatment of depressed chinese americans using qigong in a health care setting: a pilot study.

Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD). Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17); the Clinical Global Impressions-Severity (CGI-S) and -Improvement (CGI-I), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), and the Multidimensional Scale of Perceived Social Support (MSPSS) were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N = 14) were 64% female, with a mean age of 53 (±14). A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted.