Deane E. Aikins

Cognitive behavioral therapy for nocturnal panic

Nocturnal panic (NP), or waking abruptly from sleep in a state of panic, is a common phenomenon among patients with panic disorder. The purpose of this study was to test the efficacy of an adaptation of cognitive-behavioral treatment for NP. Forty-three participants were randomly assigned to immediate CBT or to a wait-list control condition. The results showed that CBT was more effective than the passage of time alone. The effects of CBT were repeated in the previously wait-listed condition. Treatment-related gains were maintained over a 9-month follow-up period. In addition, symptom improvement was accompanied by lessened subjective and heart rate reactivity to laboratory stressors, as well as lowered arousal and increased cardiac variability during sleep. This is the first controlled treatment outcome trial demonstrating the efficacy of a treatment program for panic disorder patients with NP.

Neuroplasticity as a target for the pharmacotherapy of anxiety disorders, mood disorders, and schizophrenia

Current treatments for psychiatric disorders were developed with the aim of providing symptomatic relief rather than reversing underlying abnormalities in neuroplasticity or neurodevelopment that might contribute to psychiatric disorders. This review considers the possibility that psychiatric treatments might be developed that target neuroplasticity deficits or that manipulate neuroplasticity in novel ways. These treatments might not provide direct symptomatic relief. However, they might complement or enhance current pharmacotherapies and psychotherapies aimed at the prevention and treatment of psychiatric disorders. In considering neuroplasticity as a target for the treatment of psychiatric disorders, we build on exciting new findings in the areas of anxiety disorders, mood disorders, and schizophrenia.

Emotion-related regulatory difficulties contribute to negative psychological outcomes in active-duty Iraq war soldiers with and without posttraumatic stress disorder

Data suggest military personnel involved in U.S. military initiatives in Iraq and Afghanistan are returning from deployment with elevated rates of mental health diagnoses, including posttraumatic stress disorder (PTSD). The aim of this study was to examine difficulties with emotion regulation as a potential contributory mechanism by which soldiers have poorer psychological outcomes, such as depression, dissociation, alcohol abuse, and interpersonal difficulties. Participants were 44 active‐duty male service members who comprised three groups, including those deployed with and without diagnosed PTSD and those prior to deployment. Participants in the PTSD group scored significantly higher on measures of self‐reported depression, trauma‐related dissociation, alcohol misuse, and social adjustment difficulties than did comparison groups. Importantly, difficulties with emotion regulation were found to partially mediate the relationship between PTSD and depression, poor social adjustment, and trauma‐related depersonalization but not alcohol misuse. Emotion‐regulation difficulties are important to consider in the relationship between PTSD and additional psychological outcomes in recently deployed personnel. Implications for treatment are briefly discussed.

Issues of measurement and mechanism in meta-analyses: comment on Westen and Morrison (2001).

The authors suggest that D. Westen and K. Morrisons (2001) meta-analysis of treatment is critically limited in the consideration of measurement and mechanisms of therapeutic change. The measures included in the analysis fail to represent a comprehensive coverage of the domains within which change is expected. Moreover, they do not measure the theoretically derived constructs currently conceived as being central to each disorder. Further, the particular meta-analytical approach taken prohibits evaluation of the treatment components responsible for change. The authors reviewed the most recent data on comorbidity as an issue of treatment efficacy and generalizability, proffer an interpretation for the difference in outcome results across the 3 diagnostic groups, and discuss internally valid methodologies for the bridging from research to clinical practice.

Differential conditioned fear response predicts duloxetine treatment outcome in male veterans with PTSD: a pilot study.

This pilot study tested whether posttraumatic stress disorder (PTSD) patients with impaired conditioned fear acquisition were refractory to open-label duloxetine treatment. Patients with a differential conditioned fear response at pre-treatment subsequently demonstrated significant reductions in PTSD symptoms. These data provide initial evidence of a putative biomarker of selective treatment response in PTSD.

Decreased respiratory sinus arrhythmia in individuals with deceptive intent.

In detecting deception, the Cognitive Load hypothesis states that lying requires more cognitive resources compared to truth telling. Further, increases in cognitive load are predicted to decrease respiratory sinus arrhythmia (RSA). We evaluated the impact of cognitive tasks and the intent to deceive on RSA in 40 male, native Arabic-speaking participants quasi-randomized into truthful (n=14) or deceptive (n=26) groups. Participants donned an ambulatory physiologic recording device and completed cognitive testing after receiving translated instructions about their role in an impending mock crime. The results show that a decrease in RSA recorded during the cognitive testing was greater in individuals who were about to commit a deceptive act.

Sex-related differences in amygdala activity influences immediate memory.

Despite a well-established relationship between amygdala activation during learning and long-term memory, contributions of amygdala to immediate memory have not been studied to date. We used functional magnetic resonance imaging at 1.5-T field strength to determine whether amygdala responses to emotional pictures would predict performance on an immediate recognition memory test. Sex differences in amygdala activation were related to false-positive error rates in recognizing unpleasant pictures. Specifically, increased right amygdala activation during unpleasant picture viewing was related to lower false-positive rates for men and higher false-positive rates for women. Our results indicate that increased amygdala activation while viewing unpleasant pictures may preferentially facilitate immediate recognition memory in men relative to women.