TY - JOUR A1 - Schwarzmeier, Hanna A1 - Leehr, Elisabeth Johanna A1 - Böhnlein, Joscha A1 - Seeger, Fabian Reinhard A1 - Roesmann, Kati A1 - Gathmann, Bettina A1 - Herrmann, Martin J. A1 - Siminski, Niklas A1 - Junghöfer, Markus A1 - Straube, Thomas A1 - Grotegerd, Dominik A1 - Dannlowski, Udo T1 - Theranostic markers for personalized therapy of spider phobia: Methods of a bicentric external cross‐validation machine learning approach JF - International Journal of Methods in Psychiatric Research N2 - 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 Würzburg, n = 104 in Münster). 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). KW - machine learning KW - spider phobia KW - theranostic markers Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213430 VL - 29 IS - 2 ER - TY - JOUR A1 - Boehme, Stephanie A1 - Ritter, Viktoria A1 - Tefikow, Susan A1 - Stangier, Ulrich A1 - Strauss, Bernhard A1 - Miltner, Wolfgang H. R. A1 - Straube, Thomas T1 - Neural correlates of emotional interference in social anxiety disorder JF - PLoS ONE N2 - 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. KW - threat-related stimuli KW - prefrontal cortex KW - stroop interference KW - processing bias KW - phobia KW - single subject KW - cognitive control KW - amygdala response KW - cytoarchitectonic maps KW - anterior cingulate cortex Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148534 VL - 10 IS - 6 ER - 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 - Buff, Christine A1 - Brinkmann, Leonie A1 - Bruchmann, Maximilian A1 - Becker, Michael P.I. A1 - Tupak, Sara A1 - Herrmann, Martin J. A1 - Straube, Thomas T1 - Activity alterations in the bed nucleus of the stria terminalis and amygdala during threat anticipation in generalized anxiety disorder JF - Social Cognitive and Affective Neuroscience N2 - 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. KW - medicine KW - anticipatory anxiety KW - anxiety KW - fMRI KW - sustained threat responding KW - phasic threat responding Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173298 VL - 12 IS - 11 ER -