David Lester Neumann

Relapse of Successfully Treated Anxiety and Fear: Theoretical Issues and Recommendations for Clinical Practice:

Despite the existence of effective interventions for anxiety disorders, relapse – or the return of fear – presents a significant problem for patients and clinicians in the longer term. The present paper draws on the experimental and clinical behavioural literature, reviewing the mechanisms by which the return of fear can occur. The aim of the paper was to generate a list of treatment recommendations for clinicians aimed at reducing relapse in successfully treated anxiety disorders. Clinical and experimental literature on the mechanisms of renewal, reinstatement, spontaneous recovery and reacquisition are reviewed. These are linked with the clinical and experimental literature on the return of fear in successfully treated anxiety. A list of recommendations to assist in reducing the probability of relapse in successfully treated anxiety is presented. This list includes methods for use in behavioural (exposure) treatment of anxiety disorders that aim to enhance clinical outcomes. Despite the significant problem of relapse in successfully treated anxiety, there are methods available to reduce the probability of relapse through return of fear. Clinicians engaging in treatment of anxiety disorders should be mindful of these methods to ensure optimal patient outcome.

Aversive Pavlovian conditioning in childhood anxiety disorders: Impaired response inhibition and resistance to extinction

Learning-based models of anxiety disorders emphasize the role of aversive conditioning and retarded extinction in the etiology and maintenance of anxiety disorders. Yet few studies have examined these underlying processes in children, despite that some anxiety disorders typically onset during childhood. The authors examined the acquisition and extinction of conditioned responses in 17 anxious children and 18 nonanxious control children between 8 and 12 years old using a discriminative Pavlovian conditioning procedure. One geometric shape conditional stimulus was paired with an unpleasant loud tone unconditional stimulus (CS+) whereas another geometric shape was presented alone (CS-). In the context of similar levels of discriminative conditioning in both groups, anxious children showed larger skin conductance responses to the CS+ and the CS- during acquisition and evaluated the CS+ as more arousing than the CS- compared with control children. They also showed greater resistance to extinction in skin conductance responses but not in arousal ratings to the CS+ vs. the CS- relative to control children. Results suggest that deficits in response inhibition to safety cues and retarded extinction may underlie learning processes involved in the pathogenesis of childhood anxiety disorders.

The use of an unpleasant sound as an unconditional stimulus in a human aversive Pavlovian conditioning procedure.

Ethical considerations can limit the use of traditional unconditional stimuli (US), such as electric shock and loud tones, when used in a human aversive Pavlovian conditioning procedure. The risk of the US causing pain or excessive anxiety is a particular concern when testing sensitive populations such as children, the elderly, and those with psychological or neurodevelopmental disorders. Two experiments used a differential conditioning procedure to determine whether an unpleasant sound (metal scraping on slate) could support the acquisition and extinction of conditioned responses to the same extent as either electric shock or a 100 dB(A) tone US. Experiment 1 (N=48) demonstrated equivalent or superior conditioning effects for the signal-based learning measures of US expectancy, skin conductance responses, and heart rate. Experiment 2 (N=57) yielded similar outcomes in the affective-based learning measures of startle blink modulation and pleasantness ratings. The results support the use of an unpleasant sound as a US in human Pavlovian conditioning experiments.

Baseline and affective startle modulation by angry and neutral faces in 4-8-year-old anxious and non-anxious children

The present study examined the magnitudes of startle blink reflexes and electrodermal responses in 4-8-year-old high anxious children (N=14) and non-anxious controls (N=11). Responses were elicited by 16 auditory startle trials during a baseline phase prior to an affective modulation phase involving 12 startle trials presented during angry and neutral faces. Results showed significant response habituation across baseline trials and equivalent response magnitudes between groups during the baseline phase. The modulation of response magnitudes during angry and neutral faces did not differ significantly in either group. However, high anxious children showed larger responses overall compared with non-anxious control children during the affective modulation phase. Moreover, greater anxiety severity and larger startle reflexes were associated with poorer accuracy in rating neutral faces as neutral in high anxious children. Results may reflect elevated reactivity to threat contexts in 4-8-year-old high anxious versus non-anxious children.

A topographical map of the causal network of mechanisms underlying the relationship between major depressive disorder and coronary heart disease

Objective: Major depressive disorder (MDD) and coronary heart disease (CHD) are both clinically important public health problems. Depression is linked with a higher incidence of ischaemic cardiac events and MDD is more prevalent in patients with CHD. No single comprehensive model has yet described the causal mechanisms linking MDD to CHD. Several key mechanisms have been put forward, comprising behavioural mechanisms, genetic mechanisms, dysregulation of immune mechanisms, coagulation abnormalities and vascular endothelial dysfunction, polyunsaturated omega-3 free fatty acid deficiency, and autonomic mechanisms. It has been suggested that these mechanisms form a network, which links MDD and CHD. The aim of this review is to examine the causal mechanisms underlying the relationship between MDD and CHD, with the aim of constructing a topological map of the causal network which describes the relationship between MDD and CHD. Methods: The search term ‘depression and heart disease’ was entered into an electronic multiple database search engine. Abstracts were screened for relevance and individually selected articles were collated. Results: This review introduces the first topological map of the causal network which describes the relationship between MDD and CHD. Conclusions: Viewing the causal pathways as an interdependent network presents a new paradigm in this field and provides fertile ground for further research. The causal network can be studied using the methodology of systems biology, which is briefly introduced. Future research should focus on the creation of a more comprehensive topological map of the causal network and the quantification of the activity between each node of the causal network.

Extinction treatment in multiple contexts attenuates ABC renewal in humans

Renewal has been implicated as one of the underlying mechanisms in return of fear following exposure therapy. ABC renewal is clinically more relevant than ABA renewal and yet it is a weaker form of renewal, suggesting that conducting extinction treatment in multiple contexts may be sufficient to attenuate ABC renewal. Using self-reported expectancy of shock and startle blink responses the current study examined the effects of conducting extinction treatment in multiple contexts on ABC fear renewal. Participants (N = 68) received conditional stimulus (CS) and unconditional stimulus (US) pairings in one context (A) followed by extinction treatment (CS presentations alone) in either one other context (B) or three other contexts (BCD). Non-reinforced test trials in a novel context (E) resulted in renewal of extinguished conditioned behaviour for those who received extinction in only one context. However, renewal was attenuated for those who received extinction treatment in three contexts. No renewal was found for the control group that received the test trial in the same context as during extinction. Suggestions are provided for clinicians seeking to prevent or attenuate return of fear following exposure therapy.

Effect of varying levels of mental workload on startle eyeblink modulation.

Previous research using punctuate reaction time and counting tasks has found that the startle eyeblink reflex is sensitive to attentional demands. The present experiment explored whether startle eyeblink is also modulated during a complex continuous task and is sensitive to different levels of mental workload. Participants (N = 14) performed a visual horizontal tracking task either alone (single-task condition) or in combination with a visual gauge monitoring task (multiple-task condition) for three minutes. On some task trials, the startle eyeblink reflex was elicited by a noise burst. Results showed that startle eyeblink was attenuated during both tasks and that the attenuation was greater during the multiple-task condition than during the single-task condition. Subjective ratings, endogenous eyeblink rate, heart period, and heart period variability provided convergent validity of the workload manipulations. The findings suggest that the startle eyeblink is sensitive to the workload demands associated with a continuous visual task. The application of startle eyeblink modulation as a workload metric and the possibility that it may be diagnostic of workload demands in different stimulus modalities is discussed.

The role of environmental print in emergent literacy

Young children are surrounded by environmental print on a daily basis. Through their visual exploration of environmental print, coupled with sociocultural experiences, children gain valuable semantic and symbolic knowledge as they make sense of their world. The aim of this review is to examine the question of whether environmental print has value as a literacy learning resource, and if so, the mechanisms by which it promotes literacy development. It is shown that interactions with environmental print in the childs sociocultural context can develop their logographic reading skills. These skills, in turn, promote the development of emergent literacy skills that are the precursors to conventional reading skills. Environmental print may also be used more directly when parents and childhood educators use it to scaffold the learning of emergent literacy skills. It is recommended that parents and early childhood educators capitalize on childrens natural attraction to environmental print by using it to promote their literacy development.

The relationship between skill level and patterns in cardiac and respiratory activity during golf putting

Individual differences in skill level during sport-related motor tasks, such as golf putting, can be related to not only performance, but also patterns in psychophysiological activity. The present study examined the similarities and differences in cardiac and respiratory activity among elite, experienced, and novice golfers. Participants attempted flat putts 2.4 m from the hole. Performance was better in elite and experienced golfers than in novice golfers. Compared to novice golfers, the experienced and elite golfers showed a pronounced phasic deceleration in heart rate immediately prior to the putt, greater heart rate variability in the very low frequency band, and a greater tendency to show a respiratory pattern of exhaling immediately prior to the putt. The psychophysiological patterns may be related to differences in attentional processes or task familiarity between the groups. The implications of the results for the assessment and training of athletes in precision sports are discussed.

Mind and Heart: Heart Rate Variability in Major Depressive Disorder and Coronary Heart Disease − a Review and Recommendations

Objective: There is a reciprocal association between major depressive disorder (MDD) and coronary heart disease (CHD). These conditions are linked by a causal network of mechanisms. This causal network should be quantitatively studied and it is hypothesised that the investigation of vagal function represents a promising starting point. Heart rate variability (HRV) has been used to investigate cardiac vagal control in the context of MDD and CHD. This review aims to examine the relationship of HRV to both MDD and CHD in the context of vagal function and to make recommendations for clinical practice and research. Methods: The search terms ‘heart rate variability’, ‘depression’ and ‘heart disease’ were entered into an electronic multiple database search engine. Abstracts were screened for their relevance and articles were individually selected and collated. Results: Decreased HRV is found in both MDD and CHD. Both diseases are theorised to disrupt autonomic control feedback loops on the heart and are linked to vagal function. Existing theories link vagal function to both mood and emotion as well as cardiac function. However, several factors can potentially confound HRV measures and would thus impact on a complete understanding of vagal mechanisms in the link between MDD and CHD. Conclusions: The quantitative investigation of vagal function using HRV represents a reasonable starting point in the study of the relationship between MDD and CHD. Many psychotropic and cardiac medications have effects on HRV, which may have clinical importance. Future studies of HRV in MDD and CHD should consider antidepressant medication, as well as anxiety, as potential confounders.