{"title":"Fears Worth Testing Out: A Systematic Review of the Neural Mechanisms of Treatment Outcome for Anxiety-Related Disorders.","authors":"Robin Aupperle, Hannah Berg, Jacob Armstrong","doi":"10.1007/7854_2024_549","DOIUrl":"https://doi.org/10.1007/7854_2024_549","url":null,"abstract":"<p><p>With the advent of human neuroimaging, researchers were drawn to the idea that by better understanding the human brain, more effective mental health interventions could be developed. It has been more than 20 years since the first functional magnetic resonance imaging (fMRI) studies were conducted to examine changes in brain activation with anxiety-related treatments and more than 60 studies have since been published in this vein. For the current review, we conduct a systematic review of this literature, focusing on adult studies using task-based fMRI to measure brain activation changes with pharmacologic or psychotherapy interventions for phobia, social anxiety disorder, panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Neuroscientific theories of anxiety-related disorders and their treatment have focused on prefrontal-insula-amygdala networks. Treatment-related decreases in amygdala and/or anterior insula activation were identified as the most consistent finding across disorders, with the most consistent results reported for specific phobia. Directionality of change and specific regions implicated in the prefrontal cortex were inconsistent across studies. The potential importance for probing other networks and processes as mechanisms of anxiety treatment was recognized, such as striatal regions underlying inhibitory learning or reward responsivity. Future treatment-fMRI research related to anxiety disorders would benefit from larger sample sizes, use of more nuanced computational approaches, and increased focus on replication. There is continued promise that fMRI research will enhance our understanding of how treatments work and inform the evolution of more effective or personalized mental health treatment.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alisa R Zoltowski, Caitlin A Convery, Ekomobong Eyoh, Emily Plump, Molly Sullivan, Eshani R Arumalla, Jennifer M Quinde-Zlibut, Bahar Keceli-Kaysili, Brianna Lewis, Carissa J Cascio
{"title":"Sensory Processing and Anxiety: Within and Beyond the Autism Spectrum.","authors":"Alisa R Zoltowski, Caitlin A Convery, Ekomobong Eyoh, Emily Plump, Molly Sullivan, Eshani R Arumalla, Jennifer M Quinde-Zlibut, Bahar Keceli-Kaysili, Brianna Lewis, Carissa J Cascio","doi":"10.1007/7854_2024_557","DOIUrl":"https://doi.org/10.1007/7854_2024_557","url":null,"abstract":"<p><p>In this article, we briefly overview how the expression, measurement, and treatment of anxiety in autism may be different from the general population. We review the literature on links between sensory processing differences and anxiety, which show transdiagnostic patterns but are an especially prominent feature of anxiety in autism. Specifically, we focus on how the sense of interoception, i.e., how we perceive sensory information from within our bodies, contributes to anxiety in autism. We present new findings integrating multimodal interoceptive measures and total anxiety symptoms in a sample of n = 38 non-autistic and n = 43 autistic individuals, ages 8-55 years. Using principal components analysis, we found two components relating to interoceptive confusion (i.e., self-reported ability to localize and interpret interoceptive cues): one component that closely relates to anxiety symptoms and one component that is distinct from anxiety. Interoceptive perception (i.e., performance on a lab-based task) was uniformly related to interoceptive confusion when distinguished from anxiety but showed complex relations with total anxiety symptoms. Combined, these findings suggest meaningful subtypes of interoceptive difficulties and their interrelationship with anxiety. We present conclusions and future directions for consideration of individual differences, toward creating a personalized understanding of anxiety-interoception links.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neural Markers of Treatment Response in Pediatric Anxiety and PTSD.","authors":"Dana E Díaz, Hannah C Becker, Kate D Fitzgerald","doi":"10.1007/7854_2024_547","DOIUrl":"10.1007/7854_2024_547","url":null,"abstract":"<p><p>Pediatric anxiety disorders and post-traumatic stress disorder (PTSD) are associated with elevated threat sensitivity and impaired emotion regulation, accompanied by dysfunction in the neural circuits involved in these processes. Despite established treatments like cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors, many children do not achieve remission, underscoring the importance of understanding the neurobiological underpinnings of these disorders. This review synthesizes current research on the neural predictors of treatment response and the neurofunctional changes associated with treatment in pediatric anxiety and PTSD during threat and reward processing. Several key findings emerged. First, enhanced threat/safety discrimination in the amygdala predicted better outcomes of pediatric anxiety and PTSD treatments. Second, differences in pretreatment activation within the lateral prefrontal and dorsal anterior cingulate cortices predicted treatment response, likely reflecting baseline executive control differences. Third, post-CBT decreases in activation in default mode, visuo-attentional, and sensorimotor areas may support treatment-related increases in task engagement. Finally, functional connectivity between the amygdala and other limbic, prefrontal, and default mode network nodes predicts treatment response in anxiety and PTSD, highlighting its potential as a biomarker for therapeutic efficacy. Understanding these neurofunctional markers could lead to more targeted interventions, optimizing treatment planning and potentially leading to the development of \"pretreatment\" strategies to enhance the efficacy of existing treatments. This review highlights the necessity for future research to establish more direct links between neuroimaging findings and clinical outcomes to facilitate the translation of these findings into clinical practice.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice.","authors":"Xiaojue Hu, Ingmar Gorman, Elizabeth Nielson","doi":"10.1007/7854_2024_529","DOIUrl":"https://doi.org/10.1007/7854_2024_529","url":null,"abstract":"<p><p>Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical clinical model for working with psychedelic experiences in therapeutic settings. Drawing from harm reduction psychotherapy, psychedelic-assisted therapy, mindfulness-based modalities, and psychodynamic therapy, PHRI offers a framework for clinicians to assist clients in preparing for and integrating psychedelic experiences without directly administering psychedelics. This approach emphasizes non-pathologizing, client-empowering strategies to address both challenging and positive psychedelic experiences. PHRI incorporates principles such as non-directive and inner-directed approaches, somatic awareness, and psychological flexibility. The model addresses common integration challenges including fear, ego dissolution, and increased emotional sensitivity. By bridging various therapeutic modalities, PHRI aims to support clients in translating psychedelic experiences into enduring positive changes while decreasing potential harms. This chapter outlines the theoretical foundations of PHRI, distinguishes it from existing approaches, and explores its application in clinical practice, with a focus on the integration phase of psychedelic experiences.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interoceptive Processing in Substance Use Disorders (SUDs): From the Neuroanatomy to Insights from Computational Models and Predictive Coding Frameworks.","authors":"Martin P Paulus","doi":"10.1007/7854_2024_519","DOIUrl":"https://doi.org/10.1007/7854_2024_519","url":null,"abstract":"<p><p>Substance use disorders (SUDs) represent complex public health challenges characterized by a blend of genetic, cognitive, environmental, and psychosocial factors. This chapter explores the critical role of interoceptive processing - the internal sensing of physiological states - in the neurobiology and treatment of SUDs. Interoceptive dysfunctions are highlighted as central to the craving, emotional regulation, and decision-making processes that underpin addictive behaviors. The importance of the insula in sustaining drug use, particularly nicotine, underscores a broader involvement of interoceptive pathways in SUDs. Altered interoceptive processing is evident across various SUDs, where individuals demonstrate both a heightened sensitivity to drug-related cues and a diminished ability to process aversive stimuli, suggesting substantial neurobiological underpinnings that complicate treatment outcomes. Moreover, we delve into the theoretical and computational approach to understanding interoceptive processing in SUDs. This perspective utilizes a predictive coding framework, positing that the brain continuously generates and updates predictions about internal states based on sensory inputs. In SUDs, disruptions in this predictive mechanism can lead to inaccuracies in interoceptive perception, contributing significantly to the compulsive nature of drug-seeking behaviors and the challenges associated with treatment. We explore how computational models, such as Bayesian inference, provide insights into the interplay between expected and received interoceptive signals, highlighting the role of hyper-precise prior beliefs in the persistence of craving and impulsivity. This theoretical approach not only deepens our understanding of the neural and cognitive bases of addiction but also suggests novel intervention strategies. By recalibrating interoceptive predictions through targeted therapies, such as neuromodulation and mindfulness training, we can potentially restore the interoceptive accuracy, thereby offering new avenues for effective treatment of SUDs.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sex Differences in Neural Circuits Underlying Fear Processing.","authors":"Leire Rodríguez Romero, Neha Acharya, Jaime Fabregat Nabás, Ignacio Marín, Raül Andero","doi":"10.1007/7854_2024_543","DOIUrl":"https://doi.org/10.1007/7854_2024_543","url":null,"abstract":"<p><p>Neural circuitry involved in anxiety and fear-related disorders exhibits strong sexual modulation. A limited number of studies integrating female and male data have revealed differences in neural networks, and distinct interconnectivity between these brain areas. Despite the efforts to incorporate female or mixed-sex data, there is compelling evidence that sex, as a biological variable, significantly influences fear processing. This chapter presents primary findings on sex differences in fear circuitry. It is imperative to consider this factor to ensure scientific research's integrity and understand how fear is processed in the central nervous system.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Organization of Anxiety Symptoms Along the Threat Imminence Continuum.","authors":"Ya'ira Somerville, Rany Abend","doi":"10.1007/7854_2024_548","DOIUrl":"https://doi.org/10.1007/7854_2024_548","url":null,"abstract":"<p><p>Pathological anxiety is highly prevalent, impairing, and often chronic. Yet, despite considerable research, mechanistic understanding of anxiety and its translation to clinical practice remain limited. Here, we first highlight two foundational complications that contribute to this gap: a reliance on a phenomenology-driven definition of pathological anxiety in neurobiological mechanistic research, and a limited understanding of the chronicity of anxiety symptom expression. We then posit that anxiety symptoms may reflect aberrant expression of otherwise normative defensive responses. Accordingly, we propose that threat imminence, an organizing dimension for normative defensive responses observed across species, may be applied to organize and understand anxiety symptoms along a temporal dimension of expression. Empirical evidence linking distinct anxiety symptoms and the aberrant expression of imminence-dependent defensive responses is reviewed, alongside the neural mechanisms which may underpin these cognitive, physiological, and behavioral responses. Drawing from extensive translational and clinical research, we suggest that understanding anxiety symptoms through this neurobiologically-informed framework may begin to overcome the conceptual complications hindering advancement in mechanistic research and clinical interventions for pathological anxiety.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deepening Psychedelic Integration: Exploring Complex Settings, Understanding User's Struggles, and Implementing Safe Interventions.","authors":"Marc Aixalà","doi":"10.1007/7854_2024_532","DOIUrl":"10.1007/7854_2024_532","url":null,"abstract":"<p><p>This chapter adopts a transdisciplinary approach to explore the concept of psychedelic integration, considering its various contexts ranging from clinical trials to Neo-shamanic, traditional, and recreational settings. It aims to provide a comprehensive understanding and description of integration, distinguishing between the needs of maximising potential benefits and addressing adverse reactions. Psychedelic Integration is a widely used term that refers to a variety of practices commonly employed after psychedelic experiences to help ground the benefits or address the challenges that arise from them. Although the term is broadly accepted, it lacks a precise definition, and a wide range of practices and techniques, often quite different from one another, are included under this category. Drawing on the experiences at the ICEERS (International Center for Ethnobotanical Education Research and Services) Integration and Support Service since 2012, the chapter highlights the practical aspects of clinical intervention.The chapter delves into the profiles of individuals seeking integration support, focusing on the primary challenges they encounter. These profiles include lack of preparation, unresolved experiences, difficulties with facilitators, traumatic psychedelic episodes, the exacerbation of pre-existing mental disorders, the emergence of previously unknown traumatic events, repeated psychedelic use without proper integration, and perceptions of being attacked or possessed by entities.Moreover, an overview of a method of clinical intervention that underscores the fundamental values inherent in psychedelic work is presented. This approach aims to integrate these values into the intervention process, employing a brief and focused methodology. By tailoring the intervention to the individual's specific needs, this method facilitates effective integration and support.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio Florido, Vincent R Curtis, Nicolas C Pégard, Jose Rodriguez-Romaguera
{"title":"Disentangling the Neural Circuits of Arousal and Anxiety-Like Behavior.","authors":"Antonio Florido, Vincent R Curtis, Nicolas C Pégard, Jose Rodriguez-Romaguera","doi":"10.1007/7854_2024_539","DOIUrl":"https://doi.org/10.1007/7854_2024_539","url":null,"abstract":"<p><p>Anxiety disorders are prevalent and debilitating conditions characterized by excessive concern and fear, affecting thoughts, behaviors, and sensations. A critical component of anxiety is arousal, a complex process involving alertness regulation and stimulus salience modulation. While arousal is adaptive in normal circumstances, dysregulation can lead to hypoarousal or hyperarousal, affecting response selection and threat perception. This chapter reviews challenges in studying arousal in preclinical anxiety models, emphasizing the need for multicomponent measurement and analysis. Novel methodologies integrating physiological measurement with activity tracking of neurons with single-cell resolution in awake animals are discussed, with emphasis in current challenges. Understanding these mechanisms is crucial for developing effective treatments for anxiety disorders.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Developmental Shifts in Amygdala Function.","authors":"J Amiel Rosenkranz","doi":"10.1007/7854_2024_538","DOIUrl":"https://doi.org/10.1007/7854_2024_538","url":null,"abstract":"<p><p>Mammals have evolved with strategies to optimize survival and thrive in their native environment. This includes both physical and behavioral adaptations, and extends to their social environment. However, within a social context, the roles of an animal change across development, and their behavior and biology must update to match these changes. The amygdala has a key role in social and emotional processing and expression, and displays developmental changes in early juvenile, adolescent, and adult transitions. Furthermore, the amygdala is highly sensitive to the social environment. This chapter will describe the primary amygdala developmental changes, how this maps onto major changes in social and emotional domains, and propose a framework where developmental stage of intra-amygdala circuits and its regulation by cortical inputs biases the animal toward developmentally appropriate social and emotional behavior. This developmental plasticity also presents an opportunity for retuning the developmental trajectory in the presence of ongoing challenges during maturation, such as constant threat or resource scarcity, so there can be realignment of behavior to match environmental demands.</p>","PeriodicalId":11257,"journal":{"name":"Current topics in behavioral neurosciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}