TY  - JOUR
A1  - Pittig, Andre
A1  - Heinig, Ingmar
A1  - Goerigk, Stephan
A1  - Thiel, Freya
A1  - Hummel, Katrin
A1  - Scholl, Lucie
A1  - Deckert, Jürgen
A1  - Pauli, Paul
A1  - Domschke, Katharina
A1  - Lueken, Ulrike
A1  - Fydrich, Thomas
A1  - Fehm, Lydia
A1  - Plag, Jens
A1  - Ströhle, Andreas
A1  - Kircher, Tilo
A1  - Straube, Benjamin
A1  - Rief, Winfried
A1  - Koelkebeck, Katja
A1  - Arolt, Volker
A1  - Dannlowski, Udo
A1  - Margraf, Jürgen
A1  - Totzeck, Christina
A1  - Schneider, Silvia
A1  - Neudeck, Peter
A1  - Craske, Michelle G.
A1  - Hollandt, Maike
A1  - Richter, Jan
A1  - Hamm, Alfons
A1  - Wittchen, Hans-Ulrich
T1  - Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial
JF  - Depression and Anxiety
N2  - Background

The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions.

Methods

This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression.

Results

Both treatments resulted in substantial improvements at post (PeEx-I: d\(_{within}\) = 1.50, PeEx-S: d\(_{within}\) = 1.78) and follow-up (PeEx-I: d\(_{within}\) = 2.34; PeEx-S: d\(_{within}\) = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR\(_{PeEx-I}\)-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse.

Conclusions

Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
KW  - randomized controlled trial
KW  - anxiety disorders
KW  - exposure therapy
KW  - intensified treatment
KW  - public health
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257331
VL  - 38
IS  - 11
ER  - 
TY  - JOUR
A1  - Kleint, Nina I.
A1  - Wittchen, Hans-Ulrich
A1  - Lueken, Ulrike
T1  - Probing the interoceptive network by listening to heartbeats: an fMRI study
JF  - PLoS ONE
N2  - Exposure to cues of homeostatic relevance (i.e. heartbeats) is supposed to increase the allocation of attentional resources towards the cue, due to its importance for self-regulatory, interoceptive processes. This functional magnetic resonance imaging (fMRI) study aimed at determining whether listening to heartbeats is accompanied by activation in brain areas associated with interoception, particularly the insular cortex. Brain activity was measured with fMRI during cue-exposure in 36 subjects while listening to heartbeats vs. sinus tones. Autonomic markers (skin conductance) and subjective measures of state and trait anxiety were assessed. Stimulation with heartbeat sounds triggered activation in brain areas commonly associated with the processing of interoceptive information, including bilateral insular cortices, the inferior frontal operculum, and the middle frontal gyrus. A psychophysiological interaction analysis indicated a functional connectivity between the middle frontal gyrus (seed region) and bilateral insular cortices, the left amygdala and the supplementary motor area. The magnitude of neural activation in the right anterior insular cortex was positively associated with autonomic arousal. The present findings indicate that listening to heartbeats induced activity in areas of the interoception network as well as changes in psychophysiological arousal and subjective emotional experience. As this approach constitutes a promising method for studying interoception in the fMRI environment, a clinical application in anxiety prone populations should be addressed by future studies.
KW  - inferior parietal lobule
KW  - brain activation
KW  - cortex
KW  - awareness
KW  - perception
KW  - cardiovascular arousal
KW  - panic disorder
KW  - humans
KW  - anterior insula
KW  - emotional experience
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148330
VL  - 10
IS  - 7
ER  -