Neural correlates of emotional interference in social anxiety disorder.

Disorder-relevant but task-unrelated stimuli impair cognitive performance in social anxiety disorder (SAD); however, time course and neural correlates of emotional interference are unknown. The present study investigated time course and neural basis of emotional interference in SAD using event-related functional magnetic resonance imaging (fMRI). Patients with SAD and healthy controls performed an emotional stroop task which allowed examining interference effects on the current and the succeeding trial. Reaction time data showed an emotional interference effect in the current trial, but not the succeeding trial, specifically in SAD. FMRI data showed greater activation in the left amygdala, bilateral insula, medial prefrontal cortex (mPFC), dorsal anterior cingulate cortex (ACC), and left opercular part of the inferior frontal gyrus during emotional interference of the current trial in SAD patients. Furthermore, we found a positive correlation between patients' interference scores and activation in the mPFC, dorsal ACC and left angular/supramarginal gyrus. Taken together, results indicate a network of brain regions comprising amygdala, insula, mPFC, ACC, and areas strongly involved in language processing during the processing of task-unrelated threat in SAD. However, specifically the activation in mPFC, dorsal ACC, and left angular/supramarginal gyrus is associated with the strength of the interference effect, suggesting a cognitive network model of attentional bias in SAD. This probably comprises exceeded allocation of attentional resources to disorder-related information of the presented stimuli and increased self-referential and semantic processing of threat words in SAD.

Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder.

OBJECTIVE: Relatively few studies have examined the long-term outcome of psychotherapy in social anxiety disorder. The authors previously reported findings of a clinical trial comparing cognitive-behavioral therapy (CBT), psychodynamic therapy, and a wait-list control. The purpose of the present study was to follow the participants' status over the ensuing 24 months. METHOD: Outpatients with social anxiety disorder who were treated with CBT (N=209) or psychodynamic therapy (N=207) in the previous trial were assessed 6, 12, and 24 months after the end of therapy. Primary outcome measures were rates of remission and response. RESULTS: For both CBT and psychodynamic therapy, response rates were approximately 70% by the 2-year follow-up. Remission rates were nearly 40% for both treatment conditions. Rates of response and remission were stable or tended to increase for both treatments over the 24-month follow-up period, and no significant differences were found between the treatment conditions after 6 months. CONCLUSIONS: CBT and psychodynamic therapy were efficacious in treating social anxiety disorder, in both the short- and long-term, when patients showed continuous improvement. Although in the short-term, intention-to-treat analyses yielded some statistically significant but small differences in favor of CBT in several outcome measures, no differences in outcome were found in the long-term.

Brain activation during anticipatory anxiety in social anxiety disorder.

Exaggerated anticipatory anxiety during expectation of performance-related situations is an important feature of the psychopathology of social anxiety disorder (SAD). The neural basis of anticipatory anxiety in SAD has not been investigated in controlled studies. The current study used functional magnetic resonance imaging (fMRI) to investigate the neural correlates during the anticipation of public and evaluated speaking vs a control condition in 17 SAD patients and 17 healthy control subjects. FMRI results show increased activation of the insula and decreased activation of the ventral striatum in SAD patients, compared to control subjects during anticipation of a speech vs the control condition. In addition, an activation of the amygdala in SAD patients during the first half of the anticipation phase in the speech condition was observed. Finally, the amount of anticipatory anxiety of SAD patients was negatively correlated to the activation of the ventral striatum. This suggests an association between incentive function, motivation and anticipatory anxiety when SAD patients expect a performance situation.

Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial.

OBJECTIVE Various approaches to cognitive-behavioral therapy (CBT) have been shown to be effective for social anxiety disorder. For psychodynamic therapy, evidence for efficacy in this disorder is scant. The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter randomized controlled trial. METHOD In an outpatient setting, 495 patients with social anxiety disorder were randomly assigned to manual-guided CBT (N=209), manual-guided psychodynamic therapy (N=207), or a waiting list condition (N=79). Assessments were made at baseline and at end of treatment. Primary outcome measures were rates of remission and response, based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment. Several secondary measures were assessed as well. RESULTS Remission rates in the CBT, psychodynamic therapy, and waiting list groups were 36%, 26%, and 9%, respectively. Response rates were 60%, 52%, and 15%, respectively. CBT and psychodynamic therapy were significantly superior to waiting list for both remission and response. CBT was significantly superior to psychodynamic therapy for remission but not for response. Between-group effect sizes for remission and response were small. Secondary outcome measures showed significant differences in favor of CBT for measures of social phobia and interpersonal problems, but not for depression. CONCLUSIONS CBT and psychodynamic therapy were both efficacious in treating social anxiety disorder, but there were significant differences in favor of CBT. For CBT, the response rate was comparable to rates reported in Swedish and German studies in recent years. For psychodynamic therapy, the response rate was comparable to rates reported for pharmacotherapy and cognitive-behavioral group therapy.

[Psychological interventions in surgical care: a narrative review of current meta-analytic evidence]. / Psychologische Interventionen im Rahmen chirurgischer Eingriffe: eine narrative Übersicht über vorliegende Meta-Analysen.

Studies investigating the effects of adjunctive psychological interventions to surgical routine care are summarized as a narrative review of existing meta-analyses. Primary studies evaluate the effects of the provision of information, supportive approaches, coping skills training, behavioural instructions, cognitive-behavioural strategies, relaxation, and hypnosis. The meta-analyses include studies of different methodological quality, also considering non-randomized trials, and indicate small to large effects depending on the type of intervention and outcome measure. The greatest effects were achieved on patient satisfaction, recovery, and the reduction of postoperative pain, with a slight advantage of complex interventions. Since most of the meta-analyses reveal methodological limitations, an updated and methodologically improved quantitative research synthesis seems to be required.

[Psychosocial interventions in somatic diseases]. / Psychosoziale Interventionen bei körperlichen Erkrankungen.

The literature dealing with the topic of this paper seems almost unmanageable. Accordingly, a schema to sort research results is proposed discriminating goal population, service model, indication as well as the treatment model and setting of psychosocial interventions. The state of the art is exemplarily described by testing the integration of psychosocial research results into current guidelines for the treatment of somatic diseases. Results related to psychosocial factors actually have been integrated into guidelines. Nevertheless, questions related to the implementation of guidelines into the reality of the health service system as well as numerous methodological problems connected with an adequate evaluation of psychosocial interventions still need to be solved.

[Psychodynamic short-term group treatment for social phobia: description of the treatment concept and a case study]. / Psychodynamische Kurzzeitgruppentherapie der sozialen Phobie: Beschreibung des Therapiekonzepts und einer Fallstudie.

Based upon the concept of supportive-expressive therapy (SET), we developed a psychodynamic group treatment manual for social phobia, with a special focus on the patients' individual core conflictual relationship themes, their universality, as well as interventions promoting group processes and therapeutic factors of group therapy. We introduce the new concept and report results of a pilot case study (N=8). Analyses revealed a pre-post-treatment effect size of g=0.64 (95% CI [0.29; 1.00]) on the primary outcome measure, the Liebowitz Social Anxiety Scale (LSAS). Furthermore we obtained positive evidence with regard to acceptance, safety and feasibility of the psychodynamic group therapy concept for social phobia. Subsequent proof-of-concept studies are required to foster treatment development and to proof the replicability of results.