Enhancement of exposure therapy in participants with specific phobia: A randomized controlled trial comparing yohimbine, propranolol and placebo

Meyerbröker, Katharina; Morina, Nexhmedin; Emmelkamp, Paul M. G.

doi:10.1016/j.janxdis.2018.05.001

Cited by 29 publications

(27 citation statements)

References 44 publications

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“…While the effects of yohimbine have been investigated more extensively in other anxiety disorders and also in VRET with specific phobias [39], research into the effects of yohimbine in the treatment of SAD is scarce. Only one RCT has been done in individuals with SAD [40], but this has not been studied yet in VRET.…”

Section: Pharmacological Augmentation Of Vretmentioning

confidence: 99%

Virtual Reality Therapy in Social Anxiety Disorder

Emmelkamp

Meyerbröker

Morina

2020

Curr Psychiatry Rep

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Purpose of Review This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD). Recent Findings Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a standalone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo. Summary Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.

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Section: Pharmacological Augmentation Of Vretmentioning

confidence: 99%

Virtual Reality Therapy in Social Anxiety Disorder

Emmelkamp

Meyerbröker

Morina

2020

Curr Psychiatry Rep

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“…Psychological treatments using virtual reality (VR) have shown promising results for different psychopathologies (Riva et al, 2016; Freeman et al, 2017), including specific phobia (Shiban et al, 2017; Meyerbröker et al, 2018), social phobia (Bouchard et al, 2017), PTSD (Rothbaum et al, 2014; Beidel et al, 2017), eating disorders (Manzoni et al, 2016; Ferrer-García et al, 2017), and schizophrenia (du Sert et al, 2018; Pot-Kolder et al, 2018), among others. To date, the most evidence for the efficacy of VR treatments has been shown in phobic disorders (Parsons and Rizzo, 2008; Powers and Emmelkamp, 2008; Opris et al, 2012; Turner and Casey, 2014; Morina et al, 2015), where pioneering studies established VR as a treatment medium as early as the late 1990s (e.g., for claustrophobia treatment, Botella et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Causal Interactive Links Between Presence and Fear in Virtual Reality Height Exposure

et al. 2019

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Virtual reality plays an increasingly important role in research and therapy of pathological fear. However, the mechanisms how virtual environments elicit and modify fear responses are not yet fully understood. Presence, a psychological construct referring to the ‘sense of being there’ in a virtual environment, is widely assumed to crucially influence the strength of the elicited fear responses, however, causality is still under debate. The present study is the first that experimentally manipulated both variables to unravel the causal link between presence and fear responses. Height-fearful participants (N = 49) were immersed into a virtual height situation and a neutral control situation (fear manipulation) with either high versus low sensory realism (presence manipulation). Ratings of presence and verbal and physiological (skin conductance, heart rate) fear responses were recorded. Results revealed an effect of the fear manipulation on presence, i.e., higher presence ratings in the height situation compared to the neutral control situation, but no effect of the presence manipulation on fear responses. However, the presence ratings during the first exposure to the high quality neutral environment were predictive of later fear responses in the height situation. Our findings support the hypothesis that experiencing emotional responses in a virtual environment leads to a stronger feeling of being there, i.e., increase presence. In contrast, the effects of presence on fear seem to be more complex: on the one hand, increased presence due to the quality of the virtual environment did not influence fear; on the other hand, presence variability that likely stemmed from differences in user characteristics did predict later fear responses. These findings underscore the importance of user characteristics in the emergence of presence.

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“…patients have led to mixed effects [57]. Propranolol has also been shown to have no lasting or even detrimental effects on fear extinction and exposure therapy in humans [58][59][60][61], possibly by interfering with threat processing crucial to exposure success: while increased amygdala sensitivity before exposure predicts improved clinical outcome, single-dose propranolol dampens amygdala response [62]. In contrast, losartan appears to have sustained effects on fear extinction [7] and to maintain amygdala threat response [56], suggesting mechanisms of action that might -different from propranolol -synergistically overlap with exposure.…”

mentioning

confidence: 99%

Angiotensin involvement in trauma processing—exploring candidate neurocognitive mechanisms of preventing post-traumatic stress symptoms

Shkreli

Woud

Ramsbottom

et al. 2019

Neuropsychopharmacol.

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The angiotensin-II antagonist losartan is a promising candidate that has enhanced extinction in a post-traumatic stress disorder (PTSD) animal model and was related to reducing PTSD symptom development in humans. Here, we investigate the neurocognitive mechanisms underlying these results, testing the effect of losartan on data-driven and contextual processing of traumatic material, mechanisms proposed to be relevant for PTSD development. In a double-blind between-subject design, 40 healthy participants were randomized to a single oral dose of losartan (50mg) or placebo, 1 hr before being exposed to distressing films as a trauma analogue while heart rate (HR) was measured. Peritraumatic processing was investigated using blurry picture stimuli from the films, which transformed into clear images. Data-driven processing was measured by the level of blurriness at which contents were recognized. Contextual processing was measured as the amount of context information retrieved when describing the pictures' contents. Negative-matched control images were used to test perceptual processing of peripheral trauma-cues. Post-traumatic stress symptoms were assessed via self-report questionnaires after analogue trauma and an intrusion diary completed over 4 days following the experiment. Compared to placebo, losartan facilitated contextual processing and enhanced detail perception in the negativematch pictures. During the films, the losartan group recorded lower HR and higher HR variability, reflecting lower autonomic stress responses. We discuss potential mechanisms of losartan in preventing PTSD symptomatology, including the role of reduced arousal and increased contextual processing during trauma exposure, as well as increased threat-safety differentiation when encountering peripheral trauma-cues in the aftermaths of traumatic events.

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Enhancement of exposure therapy in participants with specific phobia: A randomized controlled trial comparing yohimbine, propranolol and placebo

Cited by 29 publications

References 44 publications

Virtual Reality Therapy in Social Anxiety Disorder

Virtual Reality Therapy in Social Anxiety Disorder

Causal Interactive Links Between Presence and Fear in Virtual Reality Height Exposure

Angiotensin involvement in trauma processing—exploring candidate neurocognitive mechanisms of preventing post-traumatic stress symptoms

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