Randomized controlled trial of computerized approach/avoidance training in social anxiety disorder: Neural and symptom outcomes.

Social anxiety is associated with diminished automatic approach toward positive social cues that may limit the ability to connect with others. This diminished approach bias may be a modifiable treatment target. We evaluated the effects of an approach avoidance training procedure on positive emotions, social relationship outcomes, clinical symptoms, and neural indices of social approach and reward processing. Forty-five individuals with social anxiety disorder were randomized (parallel 1:1 randomization) to complete computerized Approach Positive training (n = 21) or Balanced training(n = 24). Sessions included a standardized social interaction task. Participants were blind to training group. Participants completed clinical outcome measures and functional magnetic resonance imaging at baseline and post intervention with an MRI-compatible AAT and the social incentive delay task (SID). Both groups displayed significant improvements of similar magnitude on the primary outcome of social connectedness (between group post-treatment d = -0.21) but not positive affect (d = -0.09), from before to after treatment, persisting through follow-up. Groups demonstrated significant improvements on additional outcomes including anxiety, depression, and anhedonia symptoms. Participants in Approach Positive AAT demonstrated increased activation in the thalamus and medial prefrontal cortex during social versus neutral- approach relative to Balanced AAT during the fMRI AAT. Participants in Balanced AAT showed increased activation in regions within an a priori-defined striatum region of interest mask during anticipation of social reward (vs. baseline) in the SID relative to Approach Positive AAT. At a neural processing level AAT may influence the valuation and motivations associated with positive social cues regulated by the mPFC and thalamus. NCT02136212, NIMH R00MH090243.

The power of negative mood in predicting posttraumatic stress disorder and alcohol abuse comorbidity.

OBJECTIVE: Individuals with posttraumatic stress disorder (PTSD) show a high risk of developing substance use disorders (SUD). Many studies have shown that PTSD often precedes SUD, and some studies have been able to identify factors that might predict which individuals might develop subsequent SUD. Attempts to treat PTSD and SUD comorbidity have proven difficult, but new methods for simultaneous treatment have shown promise for treating PTSD. The ability to identify factors that predict PTSD/SUD comorbidity and the advent of new combined treatment methods warrant investigation of how differences in specific types of PTSD symptoms individuals experience might predict who will go on to develop SUD symptoms and thus benefit from new combined treatments. METHOD: In this study, we analyzed which clusters of PTSD symptoms predicted whether individuals with PTSD met criteria for alcohol use disorder. RESULTS: Analyses revealed that frequency and intensity of negative alterations in cognition and mood predicted SUD, but re-experiencing symptoms, hyperarousal, and avoidance did not. CONCLUSIONS: Our results indicate that those who experience negative alterations in cognition and mood may be at increased risk of developing SUD, and that we may be able to predict which individuals in clinical settings will be strong candidates for new combined PTSD/SUD treatments. Further considerations for our results and for future directions are also discussed. (PsycINFO Database Record

Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms.

The present studies examined whether a tendency to accept negative emotional experiences buffers individuals from experiencing elevated negative affect during negative emotional situations (Study 1) and from developing depressive symptoms in the face of life stress (Study 2). Both studies examined female samples. This research expands on existing acceptance research in four ways. First, it examined whether acceptance has beneficial correlates when it matters most: in emotionally taxing (versus more neutral) contexts. Second, in Study 2 a prospective design was used in which acceptance was measured before stress was encountered and before outcomes were measured. Third, depressive symptoms (rather than general functioning or trauma symptoms) were examined as a particularly relevant outcome in the context of stress. Fourth, to enhance generalizability, a community sample (versus undergraduates or a purely clinical sample) was recruited. Results indicated that acceptance was correlated with decreased negative affect during a negative emotion induction but not an affectively neutral condition (Study 1). In Study 2, acceptance interacted with life stress such that acceptance predicted lower levels of depressive symptoms after higher, but not lower, life stress. These results suggest that accepting negative experiences may protect individuals from experiencing negative affect and from developing depressive symptoms.