Recent investigations have suggested that the use of emotion-avoidance or emotion- suppression strategies to cope with anxiety contributes to the development and maintenance of anxiety disorders, and that substituting these strategies with emotional acceptance can lead to effective symptom reduction. We wished to consider whether attempts to suppress the negative emotions associated with exposure therapy would serve to impede emotional processing and symptom reduction, and conversely, whether acceptance of these emotions would augment treatment efficacy. Fifty-nine participants displaying marked claustrophobic fear were assigned to receive 30 minutes of exposure (enclosure in a small chamber) while receiving, A) instructions to accept and allow the experience of unpleasant emotions (ACC), B) instructions to control and suppress the experience of unpleasant emotions (SUP), or C) no instructions regarding emotion regulation (exposure only; EO). Outcome assessments were conducted prior to treatment, immediately following treatment, and at one-month follow-up, and included fear and heart rate reactivity in response to a behavioral approach test. We predicted that ACC participants would display greater reductions in claustrophobic fear than EO participants, and that EO participants would in turn display greater reductions in claustrophobic fear than SUP participants. These hypotheses were not supported. In addition, a detailed analysis of treatment process data was conducted. Peak fear ratings, claustrophobic threat expectancies, self-efficacy, and acceptance of anxiety were collected over the course of the treatment session, and hierarchical linear modeling (HLM) was used to produce individual growth curves for these variables. Three hypotheses were formulated: 1) ACC participants would display a more rapid improvement in these measures than SUP and EO participants, 2) threat expectancies, self-efficacy and anxiety would mediate reductions in fear over the course of treatment, and 3) mediational pathways would be moderated by treatment condition. Though no support was found for our first process hypothesis, treatment specific mediation was found. Among ACC participants, self-efficacy and suffocation expectancies mediated the session-fear relationship, and among EO participants, entrapment expectancies mediated this relationship. Among SUP participants, no significant mediators were identified. / text

Understanding the neuronal basis of learning and memory is a fundamental problem in neuroscience. A leading theory, the origins of which date back to the beginning of the twentieth century, is that the neural basis for memory resides in engrams (also called memory traces), ensembles of cells that are activated during learning and reactivated during memory retrieval. Recent genetic tools have allowed researchers to visualize and manipulate memory traces in small brain regions; however, the ultimate goal is to analyze memory traces across the entire brain in order to better understand how memories are stored in neural networks and how multiple memories may coexist. In order to do so, methods and technologies need to be developed that allow labeling of engram cells throughout the brain, visualization of these cells, and automated quantification of cells in an anatomically precise manner. The first of these challenges has been addressed through the development over the past several years of different mouse models that permit the labeling of active cells throughout the brain at multiple time points. One of the most powerful models, the ArcCreERT2 mouse line, uses drug-induced genetic recombination to indelibly label cells throughout the brain in an activity-dependent manner. In this thesis, I present our work utilizing this model to solve the second and third challenges: imaging of brain-wide memory traces and automated quantification of labeled cells, as well as the application of these novel methods to understanding the engram network changes following fear extinction. Intact tissue clearing and imaging is a new and rapidly growing area of focus that holds great promise for enabling the brain-wide visualization of memory traces. We utilized the leading protocols for whole-brain clearing and applied them to the ArcCreERT2 mice. We found that CLARITY and passive clarity technique (PACT) greatly distorted the tissue, and immunolabeling-enabled three-dimensional imaging of solvent-cleared organs (iDISCO) quenched enhanced yellow fluorescent protein (eYFP) fluorescence and hindered immunolabeling. Alternative clearing solutions, such as tert-Butanol, circumvented these harmful effects, but still did not permit whole-brain immunolabeling. Clear unobstructed brain imaging cocktails and computational analysis (CUBIC) and CUBIC with Reagent 1A produced improved antibody penetration and preserved eYFP fluorescence, but also did not allow for whole-brain memory trace visualization. We developed CUBIC with Reagent-1A*, a modified CUBIC protocol that resulted in eYFP fluorescence preservation and immunolabeling of the immediate early gene (IEG) Arc in deep brain areas; however, optimized memory trace labeling still required tissue slicing into mm-thick tissue sections. Nonetheless, our data show that CUBIC with Reagent-1A* is the ideal method for reproducible clearing and immunolabeling for the visualization of memory traces in mm-thick tissue sections from ArcCreERT2 brains. Recent developments in brain-wide engram tagging strategies, primarily through the use of transgenic mouse models such as the ArcCreERT2 line, and whole brain imaging strategies, such as CLARITY, CUBIC, and iDISCO, have created the circumstances to, for the first time, be able to visualize throughout the brain neuronal activity that is directly linked to behavior. However, as noted above, quantifying and analyzing these brain-wide memory traces presents its own challenge, and widely applicable, readily accessible solutions to this problem have thus far been limited. Although a handful of freely available programs and suites do exist, such as CellProfiler and ClearMap, these are generally tailored to specific approaches, and in particular, no currently available solution exists for quantifying multi-labeled engram cells imaged in three dimensions along the coronal plane, a relatively common scenario that is sure to become even more prominent as greater adoption of the underlying technologies progresses. Using ImageJ and R, we developed an image analysis pipeline to solve precisely this problem. Our strategy allows for the segmentation of both the encoding and retrieval populations, including identification of the reactivated cells, and registration of segmented cells to an anatomical atlas in order to analyze cell activity in a region- and layer-specific manner. Post-traumatic stress disorder (PTSD) can develop following a traumatic event and results in heightened, inappropriate fear and anxiety. Approximately 8% of the US population suffers from PTSD, the main treatment for which is repeated exposure to triggering stimuli under controlled conditions. A better understanding of the neural circuits modified during this process would help advance therapeutic treatment for PTSD. We sought to determine the brain-wide neuronal activity changes underlying fear extinction, the best laboratory model of exposure therapy, by using the ArcCreERT2 x eYFP mice and our newly developed brain-wide segmentation and registration pipeline. ArcCreERT2 x eYFP mice were administered a 4-shock contextual fear conditioning (CFC) paradigm followed by either a 10-day extinction protocol or re-exposure to the aversive context without extinction. Following the final exposure session, mice were euthanized, and active cells were quantified throughout the brain using the pipeline. We found that fear learning leads to increased functional connectivity of amygdalar and hypothalamic regions, and extinction leads to a decentralization of the fear memory network and disengages the thalamus and striatal amygdala. Additionally, coordinated reactivation of the basomedial amygdala and secondary somatosensory cortex with frontal association regions are differentially modulated following extinction, and we identified the temporal association area and medial habenula as novel brain regions involved in modulating freezing behavior. In summary, in this thesis, we have developed a novel engram analysis pipeline and shown its potential for quantifying brain-wide memory traces. This is the first study to analyze brain-wide functional connectivity following fear learning and extinction of a recent fear memory, as well as the first study to analyze fear memory trace reactivation patterns across the brain and relate all three measures to behavioral output. This work both greatly enhances our understanding of the neural underpinnings of fear extinction and provides a toolset for readily exploring the neural underpinnings of other behaviors and types of associative memory.

No description available.

This study sought to explore the existence of a relationship between age and/or military affiliation (active, veteran, or family member) and awareness of local community mental health programs available for the treatment of post-traumatic stress disorder. The study separated age from military affiliation to better distinguish between influences on awareness level. Considerations that remain critical regarding post-traumatic stress disorder were described and used to guide a comprehensive review of the literature to find directions to fulfill the goal of this study. A survey was conducted and 586 active military, veterans, and their family members responded to an instrument that contained 40 items. This study was constrained to three items from the survey; age, military affiliation, self-rated awareness of treatment for PTSD. Multiple analysis techniques found no significant (p < .05) correlation between either age and awareness or military affiliation and awareness. Further analysis found a significant (p = .003) correlation between veterans and awareness, as well as between family members of veterans (p = .017) and awareness. Veterans and their family members indicated a greater awareness of local community mental health programs available for the treatment of post-traumatic stress disorder than did active troops and/or their family members. The significance of this finding presents new opportunities to study and improve both the marketing and the delivery of mental health treatment for PTSD to the active military population. Multiple opportunities for future research are discussed.

No description available.

Background: Although exposure is considered an active ingredient in evidence-based treatments (EBTs) for anxiety, it is infrequently used in routine clinical care settings. Therapist-level barriers to the use of exposure include inadequate training and negative beliefs about exposure. Prior efforts to train therapists in exposure therapy have resulted in knowledge but not behavior change. This study employed a novel training strategy, experiential learning, designed to improve the translation of knowledge into clinical practice. This study’s aims were to assess the feasibility and acceptability of experiential training (ET), as well as to conduct exploratory inferential analyses examining knowledge, attitudes, and use of exposure following training. Methods: Participants included 28 therapists working in routine clinical care settings. They were randomized to one of two conditions to learn about exposure therapy: training as usual (TAU) or ET (i.e., undergoing a one-session treatment for fear of spiders). Both workshops lasted one day, and participants were expected to attend weekly consultation calls for three months after training. Qualitative interviews were conducted at the end of the consultation call period. Results: The ET was feasible and acceptable to participants. Qualitative interviews suggested that participants, including those who were fearful of spiders, had a positive response to the training and found it to be useful. Quantitative analyses found that there was a significantly greater increase in the number of exposures used following ET than TAU at 1-month follow up. Both conditions demonstrated significant increases in knowledge, attitudes toward exposures, and self-efficacy following the training. Conclusions: The findings suggest that, consistent with previous research, a one-day training resulted in significant improvements in therapist-level factors that may affect the use of exposure. In addition, there is initial evidence that ET resulted in greater use of exposure after training, which applied more broadly, could increase the number of clients receiving an EBT for anxiety. The results provide promising evidence for the utility and acceptability of ET as a strategy to increase the use of EBTs in clinical practice. / Psychology

No / Recent research addressing the use of music to support the needs of people receiving treatment for drug addiction has led to the development and implementation of music-assisted therapeutic interventions. We hypothesized that two different music modalities combined with systematic desensitization can counter-condition drug-related cues and significantly reduce the associated craving responses. We further examined the effect of the two treatments on cognitive and psychopathological components of addiction. Twenty-four individuals experiencing drug addiction were randomly assigned to one of the three study groups, namely systematic desensitization (SD) combined with listening to New Age meditation music improvised live on Tibetan bowls (IMT), systematic desensitization combined with listening to relaxing New Age music recorded in individual MP3 devices (NIMT), or a control group that received no additional therapeutic intervention (CTR). Participants in the two treatment groups received six sessions in addition to their standard treatment during a period of three weeks. Evaluation took place at baseline, post-treatment and one month after the end of treatment. Results showed that IMT and NIMT combined with SD significantly reduced craving in response to external drug-conditioned cues, while IMT appeared to be slightly more effective than NIMT in altering permissive thoughts on drug and alcohol use, depression symptoms and everyday life craving reactivity. Further investigation as to the role of music-assisted systematic desensitization as a therapeutic intervention for drug addiction treatment is warranted. / Grant from Grundtvig Education and Culture Lifelong Learning Program (agreement contract number 2013-1-FR1-GRU11-50690).

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS. / AFRIKAANSE OPSOMMING: Navorsing doelstelling Om 'n nuwe konsep dat die blootstelling van pasiënte met fibromialgie sindroom (FMS) aan beeldmateriaal van oefening, ontlok neurofisiologiese veranderinge in funksionele brein-areas wat verband hou met pyn katastrofering te toets; sodoende voorlopige steun vir die verdere ontwikkeling/toetsing van 'n virtuele realiteit blootstelling terapie (VRET) oefenprogram wat gemik is op die vermindering van pyn katastrofering na oefenterapie in pasiënte met die FMS te bied. Metodes Die hoofstudie van hierdie navorsing bestaan uit 'n drie-fase verkennende fMRI studie. Fase 1 het die ontwikkeling/validering van die fMRI visuele taak behels. Fase 2 het die ondersoek van die verskille in die neurale korrelate geassosieer met pyn katastrofering tussen deelnemers met FMS en gesonde kontroles wanneer hulle blootgestel word aan verskeie beeldmateriaal van oefening en passiewe/ontspannende aktiwiteite behels. Fase 3 het die toets van die voorlopige effektiwiteit van 'n nuwe VRET oefenprogram op pyn katastrofering in deelnemers met FMS behels. Die fMRI taak het bestaan uit twee stimuli: aktiewe (oefening aktiwiteit beeldmateriaal)/passiewe (ontspannende aktiwiteit beeldmateriaal). Strukturele beelde sowel as bloed-suurstof-vlak-afhanklike (BSVA) kontraste is vir die toestande verkry en vergelyk binne-deelnemers/groepe en tussen-groepe. Die toestand van belang was die aktiewe>passiewe toestand (waar brein aktivering vir die passiewe toestand afgetrek is van die aktiewe toestand). Die brein volumes wat ingesamel tydens die 'aan' toestande is vergelyk met die brein volumes wat ingesamel is gedurende die 'af' toestande met die gebruik van Studente se t-toets. Drempel statistiek beelde is gegroepeer deur Z> 2,3 en 'n (gekorrigeerde) groepeerde betekenisvolle drempel van p = 0.05. Resultate Die regter (R) middel- en inferior-frontale gyrus en R posterior serebellum is betekenisvol geaktiveer vir die deelnemers met FMS, maar nie vir die gesonde kontrole groep nie, gedurende die aktiewe>passiewe toestand (fase 2). By basislyn, tydens die aktiewe>passiewe toestand (fase 3), die intervensie / VRET groep het betekenisvolle aktivering (p <0.05) in die R insulaire korteks, R anterior en posterior serebellum, R para- hippokampus gyrus, R middel-frontale gyrus, R korpus kallosum, R talamus, R supramarginale gyrus en R middel- en superior-temporale gyrus; die kontrole groep het betekenisvolle aktivering in die R anterior en posterior serebellum, R middel- en superior-temporale gyrus, R middel-frontale gyrus, R insulaire korteks, R supramarginale gyrus en R presentrale gyrus. Post-intervensie, tydens die aktiewe>passiewe toestand, was R posterior serebellum aktivering betekenisvol (p <0.05) vir die intervensie groep; R anterior serebellum, links (L) middel- en inferior-frontale gyrus en R superior pariëtale lob aktivering was betekenisvol (p <0.000) vir die kontrole groep, alhoewel geen betekenisvolle basislyn aktivering in hierdie areas by die kontrole groep plaasgevind het nie. Gevolgtrekking Ons kan nie bewyse vir die effektiwiteit van 'n nuwe VRET program vir pyn katastrofering in pasiënte met FMS bevestig nie. Nietemin, dui die bevindinge van hierdie studie wel daarop dat pyn katastrofering in pasiënte met FMS bevestig kon word met fMRI. Verdere navorsing is dus geregverdig om 'n behoorlike VRET oefenprogram te ontwikkel en die uitwerking van hierdie program op pyn katastrofering in pasiënte met FMS te toets.

The present research sought to understand patient experiences during Hyperbaric Oxygen Therapy (HBOT) by using 24 HBOT patients (17 men, 7 women) to examine the relationship between individual variables and anxiety, and providing One Session Exposure Therapy (OSET; Öst, 1989) if necessary. Pre-HBOT participants completed the following measures: State-Trait Anxiety Inventory (STAI; Spielberger, 1983), Claustrophobia Questionnaire (CLQ; Radomsky, Rachman, Thordarson, McIsaac, & Teachman, 2001), Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and Treatment Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000). State Anxiety was assessed pre-HBOT and at the tenth and last sessions. Findings suggest Dispositional Anxiety (STAI-Trait + ASI), Expectancy of symptom improvement (CEQ), and gender were significantly predictive of State Anxiety before and during HBOT. Limitations and directions for future research are discussed.

This study used an interdisciplinary approach to examine an intervention for reducing public speaking state anxiety. A quasi-experiment was conducted to determine if a multiple-exposure treatment technique (TRIPLESPEAK) would help to attenuate public speaking anxiety. The treatment group reported experiencing significantly less state anxiety during their post-test presentation than did the control group. This lead to the conclusion that exposure therapy can be used to help students enrolled in basic communication classes begin to overcome their fear of speaking in front of an audience. Follow-up analysis of the treatment group's reported anxiety levels during all five presentations (pre-test, Treatment Presentation 1, Treatment Presentation 2, Treatment Presentation 3, and post-test) revealed an increase in anxiety from the last treatment presentation to the post-test presentation. In order to explore this issue, Shannon's entropy was utilized to calculate the amount of information in each speaking environment. Anderson's functional ontology construction approach served as a model to explain the role of the environment in shaping speakers' current and future behaviors and reports of anxiety. The exploratory analysis revealed a functional relationship between information and anxiety. In addition, a qualitative study was conducted to determine which environmental stimuli speakers perceived contributed to their anxiety levels. Students reported experiencing anxiety based on four categories, which included speaker concerns, audience characteristics, contextual factors and assignment criteria. Students' reports of anxiety were dependent upon their previous speaking experiences, and students suggested differences existed between the traditional presentations and the treatment presentations. Pedagogical and theoretical implications are discussed.