@article{SchwarzmeierLeehrBoehnleinetal.2020, author = {Schwarzmeier, Hanna and Leehr, Elisabeth Johanna and B{\"o}hnlein, Joscha and Seeger, Fabian Reinhard and Roesmann, Kati and Gathmann, Bettina and Herrmann, Martin J. and Siminski, Niklas and Jungh{\"o}fer, Markus and Straube, Thomas and Grotegerd, Dominik and Dannlowski, Udo}, title = {Theranostic markers for personalized therapy of spider phobia: Methods of a bicentric external cross-validation machine learning approach}, series = {International Journal of Methods in Psychiatric Research}, volume = {29}, journal = {International Journal of Methods in Psychiatric Research}, number = {2}, doi = {10.1002/mpr.1812}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-213430}, year = {2020}, abstract = {Objectives Embedded in the Collaborative Research Center "Fear, Anxiety, Anxiety Disorders" (CRC-TRR58), this bicentric clinical study aims at identifying biobehavioral markers of treatment (non-)response by applying machine learning methodology with an external cross-validation protocol. We hypothesize that a priori prediction of treatment (non-)response is possible in a second, independent sample based on multimodal markers. Methods One-session virtual reality exposure treatment (VRET) with patients with spider phobia was conducted on two sites. Clinical, neuroimaging, and genetic data were assessed at baseline, post-treatment and after 6 months. The primary and secondary outcomes defining treatment response are as follows: 30\% reduction regarding the individual score in the Spider Phobia Questionnaire and 50\% reduction regarding the individual distance in the behavioral avoidance test. Results N = 204 patients have been included (n = 100 in W{\"u}rzburg, n = 104 in M{\"u}nster). Sample characteristics for both sites are comparable. Discussion This study will offer cross-validated theranostic markers for predicting the individual success of exposure-based therapy. Findings will support clinical decision-making on personalized therapy, bridge the gap between basic and clinical research, and bring stratified therapy into reach. The study is registered at ClinicalTrials.gov (ID: NCT03208400).}, language = {en} } @article{BoehmeRitterTefikowetal.2015, author = {Boehme, Stephanie and Ritter, Viktoria and Tefikow, Susan and Stangier, Ulrich and Strauss, Bernhard and Miltner, Wolfgang H. R. and Straube, Thomas}, title = {Neural correlates of emotional interference in social anxiety disorder}, series = {PLoS ONE}, volume = {10}, journal = {PLoS ONE}, number = {6}, doi = {10.1371/journal.pone.0128608}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-148534}, pages = {e0128608}, year = {2015}, abstract = {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.}, language = {en} } @article{PittigHeinigGoerigketal.2021, author = {Pittig, Andre and Heinig, Ingmar and Goerigk, Stephan and Thiel, Freya and Hummel, Katrin and Scholl, Lucie and Deckert, J{\"u}rgen and Pauli, Paul and Domschke, Katharina and Lueken, Ulrike and Fydrich, Thomas and Fehm, Lydia and Plag, Jens and Str{\"o}hle, Andreas and Kircher, Tilo and Straube, Benjamin and Rief, Winfried and Koelkebeck, Katja and Arolt, Volker and Dannlowski, Udo and Margraf, J{\"u}rgen and Totzeck, Christina and Schneider, Silvia and Neudeck, Peter and Craske, Michelle G. and Hollandt, Maike and Richter, Jan and Hamm, Alfons and Wittchen, Hans-Ulrich}, title = {Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial}, series = {Depression and Anxiety}, volume = {38}, journal = {Depression and Anxiety}, number = {11}, doi = {10.1002/da.23204}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257331}, pages = {1169-1181}, year = {2021}, abstract = {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.}, language = {en} } @article{BuffBrinkmannBruchmannetal.2017, author = {Buff, Christine and Brinkmann, Leonie and Bruchmann, Maximilian and Becker, Michael P.I. and Tupak, Sara and Herrmann, Martin J. and Straube, Thomas}, title = {Activity alterations in the bed nucleus of the stria terminalis and amygdala during threat anticipation in generalized anxiety disorder}, series = {Social Cognitive and Affective Neuroscience}, volume = {12}, journal = {Social Cognitive and Affective Neuroscience}, number = {11}, doi = {10.1093/scan/nsx103}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-173298}, pages = {1766-1774}, year = {2017}, abstract = {Sustained anticipatory anxiety is central to Generalized Anxiety Disorder (GAD). During anticipatory anxiety, phasic threat responding appears to be mediated by the amygdala, while sustained threat responding seems related to the bed nucleus of the stria terminalis (BNST). Although sustained anticipatory anxiety in GAD patients was proposed to be associated with BNST activity alterations, firm evidence is lacking. We aimed to explore temporal characteristics of BNST and amygdala activity during threat anticipation in GAD patients. Nineteen GAD patients and nineteen healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) during a temporally unpredictable threat anticipation paradigm. We defined phasic and a systematic variation of sustained response models for blood oxygen level-dependent responses during threat anticipation, to disentangle temporally dissociable involvement of the BNST and the amygdala. GAD patients relative to HC responded with increased phasic amygdala activity to onset of threat anticipation and with elevated sustained BNST activity that was delayed relative to the onset of threat anticipation. Both the amygdala and the BNST displayed altered responses during threat anticipation in GAD patients, albeit with different time courses. The results for the BNST activation hint towards its role in sustained threat responding, and contribute to a deeper understanding of pathological sustained anticipatory anxiety in GAD.}, language = {en} } @article{FigelBrinkmannBuffetal.2019, author = {Figel, Benedikt and Brinkmann, Leonie and Buff, Christine and Heitmann, Carina Y. and Hofmann, David and Bruchmann, Maximilian and Becker, Michael P. I. and Herrmann, Martin J. and Straube, Thomas}, title = {Phasic amygdala and BNST activation during the anticipation of temporally unpredictable social observation in social anxiety disorder patients}, series = {NeuroImage: Clinical}, volume = {22}, journal = {NeuroImage: Clinical}, doi = {10.1016/j.nicl.2019.101735}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228071}, year = {2019}, abstract = {Anticipation of potentially threatening social situations is a key process in social anxiety disorder (SAD). In other anxiety disorders, recent research of neural correlates of anticipation of temporally unpredictable threat suggests a temporally dissociable involvement of amygdala and bed nucleus of the stria terminalis (BNST) with phasic amygdala responses and sustained BNST activation. However, the temporal profile of amygdala and BNST responses during temporal unpredictability of threat has not been investigated in patients suffering from SAD. We used functional magnetic resonance imaging (fMRI) to investigate neural activation in the central nucleus of the amygdala (CeA) and the BNST during anticipation of temporally unpredictable aversive (video camera observation) relative to neutral (no camera observation) events in SAD patients compared to healthy controls (HC). For the analysis of fMRI data, we applied two regressors (phasic/sustained) within the same model to detect temporally dissociable brain responses. The aversive condition induced increased anxiety in patients compared to HC. SAD patients compared to HC showed increased phasic activation in the CeA and the BNST for anticipation of aversive relative to neutral events. SAD patients as well as HC showed sustained activity alterations in the BNST for aversive relative to neutral anticipation. No differential activity during sustained threat anticipation in SAD patients compared to HC was found. Taken together, our study reveals both CeA and BNST involvement during threat anticipation in SAD patients. The present results point towards potentially SAD-specific threat processing marked by elevated phasic but not sustained CeA and BNST responses when compared to HC.}, language = {en} }