Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments.

OBJECTIVES: Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences. METHODS: A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardised exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages. RESULTS: In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable. CONCLUSIONS: Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardised exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

High place phenomenon: prevalence and clinical correlates in two German samples.

BACKGROUND: The high place phenomenon, that is, a sudden urge to jump when in a high place, is an experience known to many people, that has rarely been studied. The present study aimed to assess the prevalence of the high place phenomenon in a non-clinical and a clinical German sample. Furthermore, clinical correlates of the experience were assessed. METHODS: The study sample comprised 276 participants (67% female; Mage = 32.08, SDage = 10.73) who took part in an online assessment and 94 patients (73.4% female; Mage = 49.26, SDage = 13.32) suffering from clinically relevant fear of flying. Participants filled out questionnaires on experiences with the high place phenomenon, depression, anxiety, suicide ideation and anxiety sensitivity. RESULTS: The high place phenomenon was known to nearly 60% of the online sample and to 45% of the patient sample. Suicide ideation as well as anxiety sensitivity were positively associated with experiences with the high place phenomenon in the online sample. Depression, anxiety and suicide ideation were unrelated to experiences with the phenomenon in the patient sample. CONCLUSION: The high place phenomenon is commonly reported by (lifetime/current) suicide ideators. However, it is also a common experience in individuals who have never suffered from suicide ideation. It is therefore cautioned not to interpret such experiences as an expression of a hidden death wish.

Large-group one-session treatment: Feasibility and efficacy in 138 individuals with phobic fear of flying.

Recent research suggests that exposure-based large-group one-session treatments (LG-OSTs) may represent useful and efficient treatment options for different types of phobic fear. Although there are effective single session- and small group-interventions for the treatment of clinically relevant Fear of Flying (FoF), no LG-OST for this type of phobic fear has been realized so far. The present study aimed to investigate feasibility and efficacy of an LG-OST for the treatment of clinically relevant FoF. Two months after an initial diagnostics to assess FoF severity and confirm the underlying diagnoses (89% specific flight phobia; 10% agoraphobia), 138 patients attended the LG-OST consisting of psychoeducation, imparting of a breathing technique and a joint 2 ½ hour exposure flight in a chartered airplane (Airbus A320). FoF again was assessed at pre- and post-treatment as well as at 6-months follow-up with the latter again containing clinical diagnostics. Only a small decrease in FoF emerged in the pre-treatment interval. From pre-to post-treatment however, substantial reductions in FoF were observed with a large mean 'intention-to-treat' effect size of Cohen's d = 1.42 that remained stable over time (mean d = 1.44). At follow-up, 71% of the patients were rated as fully (55%) or partially remitted (16%). Also concerning the treatment of clinically relevant FoF, a LG-OST proved feasible and effective. Therefore, LG-OST can be regarded as a highly efficient and promising treatment tool which in terms of efficiency combines the advantages of one-session individual and group treatments.

Large-Group One-Session Treatment: Feasibility in Highly Height Fearful Individuals and Predictors of Outcome.

OBJECTIVE: Exposure based large-group one-session treatments (LG-OSTs) proved feasible in different situational fears and showed promising short- and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). Moreover, we aimed to identify predictors of LG-OST outcome in order to provide individualized treatment recommendations in the future. METHODS: Participants' fear of heights was assessed at pre- and post-treatment as well as at 5 months follow-up using questionnaires and a behavioral approach test (BAT). Pre-treatment indices of negative emotional traits and positive mental health, the extent by which fear-evoking expectancies were violated during exposure, and post-treatment group perception processes were assessed in order to predict the outcome. RESULTS: The LG-OST procedure proved feasible and effective in terms of both subjective and behavioral fear of heights. Post-treatment effects sizes of questionnaires assessing fear of heights ranged between d = 0.94 - 1.43. After the treatment, about half of the participants (49.5%) were able to ascend an aerial fire ladder up to a maximum of 30 m (vs. pre-treatment 17.3%). Follow up results showed the long-term stability of effects. Among psychological constructs, positive mental health and expectancy violation were the strongest predictors of LG-OST long-term outcome. CONCLUSION: We conclude that exposure based LG-OSTs are feasible, effective and very efficient compared to individual face-to-face settings. Thus, they represent very promising treatment alternatives for situational fears including fear of heights. Moreover, clinical research may benefit from LG-OST protocols as its high standardization may facilitate the search for mediators and moderators of exposure outcomes.

Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals.

Objective: Large-group one-session treatments (LG-OSTs) might represent a promising treatment tool as increasing evidence suggests their effectiveness in individuals with different situational fears. In the present study, we explored feasibility and effectiveness of an exposure-based LG-OST protocol applying applied tension and diaphragmatic breathing as coping strategies in a sample of 40 individuals, highly fearful of blood-injury-injection (BII). Method: We assessed participants' BII-fear using questionnaires and a behavioral approach test (BAT) before and after treatment, consisting of a blood-drawing procedure. Stability of treatment effects was assessed via online-survey at 7-month follow-up. Results: The LG-OST procedure evidenced feasible and effective. Pre-post treatment comparisons showed medium to large treatment effects (d = 0.40-0.93) regarding the questionnaire measures. After being treated, 70% of the individuals successfully underwent a blood drawing. Moreover, participants continued to improve in the post follow-up interval leading to large treatment effects (d = 1.19-1.62). Conclusion: In treating BII-fear, LG-OSTs might not only serve within a framework of a stepped care approach but also could represent a useful single-treatment option. Additionally, due to their high efficiency and standardization of treatment delivery, LG-OST protocols might foster research at the interface of basic and clinical research.