Joseph K. Carpenter

Although negative autobiographical memories play a defined etiological role for trauma-related disorders, it is less clear what role they play in other anxiety-related disorders. Understanding the prevalence of negative autobiographical memories that are conceptually related to a patient’s symptoms (i.e., symptom-relevant negative autobiographical memories; SNAMs)¹ in anxiety-related disorders may help inform the development of novel memory-based interventions. The current scoping review examined the prevalence of SNAMs in anxiety disorders and obsessive-compulsive disorder, including SNAMs that were reported to have occurred around symptom onset (i.e., Symptom Onset SNAMs) and SNAMs that were reported to have occurred at any time (i.e., Lifetime SNAMs). Lifetime SNAMs also included a subcategory of SNAMs associated with intrusive imagery. The relationship of the presence of SNAMs to symptom onset, disorder status, and symptom severity was also examined. A systematic search identified 39 relevant articles. The prevalence of Symptom Onset SNAMs assessed by the Phobic Origins Questionnaire, interviews, and the Origins Questionnaire ranged from 30–89% (IQR = 50–68.5%; samples = 23), 23–61% (IQR = 30–49%; samples = 11), and 17–37% (samples = 6), respectively. The prevalence of Lifetime SNAMs ranged from 89–100% (samples = 6) and Intrusive Imagery-Related Lifetime SNAMs ranged from 38–100% (IQR = 60.5–79%; samples = 12). Five of 14 studies observed a significantly higher rate of SNAMs in patient relative to control samples. Findings are discussed with regard to limitations of the current evidence and future research that can inform the value of targeting SNAMs in treatment.

Although negative autobiographical memories play a defined etiological role for trauma-related disorders, it is less clear what role they play in other anxiety-related disorders. Understanding the prevalence of negative autobiographical memories that are conceptually related to a patient’s symptoms (i.e., symptom-relevant negative autobiographical memories; SNAMs) in anxiety-related disorders may help inform the development of novel memory-based interventions. The current scoping review examined the prevalence of SNAMs in anxiety disorders and obsessive-compulsive disorder, including SNAMs that were reported to have occurred around symptom onset (i.e., Symptom Onset SNAMs) and SNAMs that were reported to have occurred at any time (i.e., Lifetime SNAMs). Lifetime SNAMs also included a subcategory of SNAMs associated with intrusive imagery. The relationship of the presence of SNAMs to symptom onset, disorder status, and symptom severity was also examined. A systematic search identified 39 relevant articles. The prevalence of Symptom Onset SNAMs assessed by the Phobic Origins Questionnaire, interviews, and the Origins Questionnaire ranged from 30-89% (IQR = 50-68.5%; samples = 23), 23-61% (IQR = 30-49%; samples = 11), and 17-37% (samples = 6), respectively. The prevalence of Lifetime SNAMs ranged from 89-100% (samples = 6) and Intrusive Imagery-Related Lifetime SNAMs ranged from 38-100% (IQR = 60.5-79%; samples = 12). Five of 14 studies observed a significantly higher rate of SNAMs in patient relative to control samples. Findings are discussed with regard to limitations of the current evidence and future research that can inform the value of targeting SNAMs in treatment.

Background: Prior research has shown PTSD treatment leads to reductions in cardiovascular reactivity during trauma recall, but the extent to which such reductions are associated with changes in PTSD symptoms is less clear. Moreover, such relationships have not been investigated in a cognitively focused PTSD treatment.Objective: To examine changes in cardiovascular reactivity to the trauma memory in patients receiving cognitive processing therapy (CPT), CPT with a written trauma account, and a written account only condition. We also examined the association of such changes with symptom improvement.Method: 118 women with PTSD secondary to interpersonal violence completed pre- and post-treatment assessments of PTSD symptoms and cardiovascular reactivity during a script-driven imagery task.Results: Results indicated a significant but modest reduction in cardiovascular reactivity in CPT conditions. Changes in cardiovascular reactivity and reexperiencing symptoms were significantly associated among the whole sample. Among individuals with the greatest reactivity to the trauma memory at pretreatment, associations were also seen with changes in total PTSD, numbing, and trauma-related guilt.Conclusions: Results indicate that previous findings on the effect of PTSD treatment on cardiovascular reactivity during trauma recall extend to cognitively oriented treatment. Baseline cardiovascular reactivity may influence the extent to which reductions in PTSD symptoms and reactivity during trauma recall are related.

Purpose of Review: Effective treatment of anxiety-related disorders is crucial, considering the prevalence of such disorders and their association with poor psychosocial functioning. To evaluate the most recent evidence on the efficacy of cognitive behavioral therapy (CBT) for anxiety-related disorders in adults, we conducted a meta-analysis of randomized placebo-controlled trials published since 2017. Recent Findings: Ten studies with a total of 1250 participants met the inclusion criteria. Seven of these studies examined PTSD. The findings demonstrated small placebo-controlled effects of CBT on target disorder symptoms (Hedges’ g = 0.24, p < 0.05) and depression (Hedges’ g = 0.15, p = n.s). When examining only PTSD studies, effects were reduced (Hedges’ g = 0.14, p < 0.05). Heterogeneity in most analyses was very low, and no publication bias was found. Summary: Effect sizes from placebo-controlled trials from the past 5 years appear to be smaller than those in prior meta-analyses. The findings are largely driven by research on PTSD, with few placebo-controlled trials of other anxiety-related disorders published since 2017.

PTSD is often associated with heightened physiological reactivity during fear conditioning procedures, but results vary across studies. This study examined whether anxiety sensitivity (AS), or the fear of arousal-related sensations, strengthens the relationship between PTSD symptoms and skin conductance responses (SCR) during fear conditioning and extinction. Because gonadal hormones implicated in fear learning fluctuate across the menstrual cycle, the stability of these relationships in women was examined in two distinct menstrual cycle phases. Thirty-two trauma-exposed women, half of whom had PTSD, completed the Clinician-Administered PTSD Scale, Anxiety Sensitivity Inventory, and a fear conditioning and extinction paradigm during the mid-luteal (mLP) and early-follicular (eFP) menstrual cycle phases. In the mLP, stronger SCR to stimuli paired with shock (CS+) during fear acquisition significantly predicted greater PTSD symptoms only when AS was high and after removing an outlier. This appeared driven by effects on Numbing and Hyperarousal symptom clusters. Other hypothesized interactions between AS and CS responses were not significant. However, in the eFP, differential SCR between the CS+ and CS− during extinction predicted significantly greater PTSD symptoms, and there was a trend for this effect being stronger as AS increased. Results offer preliminary evidence that high AS contributes to a stronger relationship between SCR during fear acquisition and PTSD symptoms, at least among women in the mLP. Further research investigating the impact of individual differences in traits such as AS on the relationship between conditioned fear responses and PTSD symptoms is warranted.

Although many individuals who engage in mindfulness endorse less anxiety, others experience heightened anxiety when focusing on particular sensations. This study aimed to determine whether specific mindfulness items related to observing internally or externally differ in individuals with panic disorder (PD) or elevated anxiety sensitivity (AS). We examined a clinical sample of 1521 Japanese individuals who completed online self-report questionnaires. Several multiple indicator multiple cause (MIMIC) models investigated differential item functioning among the items in the Observe facet of the Five Facet Mindfulness Questionnaire (FFMQ), based on PD and/or AS. This process was repeated to examine the relationship between the Anxiety Sensitivity Index-3 (ASI-3) subscales and particular items of the Observe facet. Increased AS correlated with increased observing generally, and increased AS was associated with greater scores on observing internal items and lower scores on external items. When PD and AS were analyzed simultaneously, only AS remained significant. The cognitive subscale showed the same pattern of results as the total ASI-3 subscale. We conclude that AS modulates the mindfulness experience.

Fear of enclosed spaces prevents many people from receiving magnetic resonance imagining (MRI) scans. Although exposure therapy can effectively treat such fears, reductions in fear during exposure often do not generalize beyond the context in which they took place. This study tested a strategy designed to increase generalization, which involved revisiting the memory of a prior exposure to enhance retrieval of extinction learning. Forty-five participants with claustrophobia that included fear of MRI scans underwent a series of exposures lying inside a narrow cabinet. One week later, participants were randomly assigned to enhanced mental reinstatement (EMR) or control procedures. Prior to entering a mock MRI scanner, EMR participants recalled the memory of exposure training and listened to an audio recording of themselves describing what they learned, whereas control participants recalled a neutral memory. Compared to the control condition, EMR led to significantly reduced heart rate reactivity in the mock MRI scanner, but not self-reported fear or avoidance. There were no differences between conditions in claustrophobia symptoms or MRI fear at one-month follow-up. Results suggest some benefits of mental reinstatement for improving generalization of gains following exposure training for claustrophobia, with measures of subjective fear and physiological arousal showing discordant outcomes.