Neurocircuitry of treatment in anxiety disorders

Baumel, W. Thomas; Lu, Lu; Huang, Xiaoqi; Drysdale, Andrew T.; Sweeny, John A.; Gong, Qiyong

doi:10.1016/j.bionps.2022.100052

Cited by 12 publications

(5 citation statements)

References 70 publications

(113 reference statements)

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“…Amygdala hyperactivity and hypoactivity in the ACC and PFC have been implicated in the development and maintenance of anxiety disorders (Brooks & Stein, 2015 ; Holzschneider & Mulert, 2011 ) and likely underly physiological reactivity and neuroendocrine changes related to both sustained and acute stress responses through the HPA-axis (Hoge et al, 2018 ; Patriquin & Mathew, 2017 ). In line with this, a recent review found functional changes have mainly been observed within amygdala-prefrontal circuits following treatment (predominantly CBT) in anxiety disorders (Baumel et al, 2022 ). Thus, our findings suggest that 8-week mindfulness training programs similarly target underlying brain-circuitry mechanisms involved in GAD.…”

Section: Discussionmentioning

confidence: 73%

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

et al. 2023

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This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.

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Section: Discussionmentioning

confidence: 73%

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

et al. 2023

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“…The value of such an approach is beginning to find support in the evidence from current treatments. For instance, positive clinical effects of cognitive behavioral therapy and SSRIs are associated with demonstrable changes in brain circuits linked to cognition and emotion (reviewed in ( Baumel et al, 2022 ; Murphy et al, 2021 ; Sartori and Singewald, 2019 ).…”

Section: Convergent Themes and Future Directionsmentioning

confidence: 99%

Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder

Singewald¹,

Sartori²,

Reif

et al. 2023

Neuropharmacology

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“…Likewise, anxiety disorders are associated with serotonergic dysfunction and altered activity in limbic and prefrontal circuits which may contribute to altered interoceptive processing. Importantly, SSRIs in youth with anxiety disorders may normalize aberrant functional activation and inter-network connectivity (Baumel et al 2022).…”

Section: Functional Gastrointestinal Syndromes In Adolescents With An...mentioning

confidence: 99%

Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and their Relationship to Treatment with Escitalopram or Placebo

Baumel

Mills

Schroeder

et al. 2023

Preprint

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Gastrointestinal symptoms are commonly reported as adverse effects of selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacologic treatment for pediatric anxiety disorders; however, the temporal course of these symptoms during treatment, although believed to be transient, has never been prospectively evaluated. Additionally, rates of gastrointestinal symptoms and functional gastrointestinal syndromes in anxious youth are poorly understood. We examined gastrointestinal symptoms in youth with anxiety disorders during a double-blind, placebo-controlled trial of escitalopram (n = 51). Then, in a separate sample of prospectively treated children and adolescents with generalized, social and/or separation anxiety disorders (n = 56), we examined the frequency of gastrointestinal symptoms based on the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) and ROME III criteria and the association of these symptoms with clinical and demographic characteristics using logistic regression. The frequency/severity of abdominal pain, diarrhea, bloating constipation or total gastrointestinal symptoms did not differ between patients receiving placebo (n = 25) or escitalopram (n = 26). However, escitalopram-treated youth had transient improvement in nausea/vomiting and total upper gastrointestinal symptoms during the first two weeks of treatment. ROME III criteria for functional gastrointestinal syndromes were present in 12/56 patients (21.4%). QPGS-related functional gastrointestinal syndromes and symptoms were unrelated to treatment, treatment type, or clinical or demographic variables. Gastrointestinal symptoms are common in youth with anxiety and SSRIs produce transient—rather than sustained—gastrointestinal symptoms. Assessing gastrointestinal symptoms prior to pharmacotherapy and discussing factors that increase (or decrease) the likelihood of transient SSRI-related symptoms in youth may decrease patient uncertainty related to side effects and decrease medication-related anxiety.

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Neurocircuitry of treatment in anxiety disorders

Cited by 12 publications

References 70 publications

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder

Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and their Relationship to Treatment with Escitalopram or Placebo

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