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Lindner, P., Miloff, A., Fagernäs, S., Andersen, J., Sigeman, M., Andersson, G., . . . Carlbring, P. (2019). Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial. Journal of Anxiety Disorders, 61, 45-54
Open this publication in new window or tab >>Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial
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2019 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 61, p. 45-54Article in journal (Refereed) Published
Abstract [en]

Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n = 25 + 25 participants were randomized to either one-session therapist-led VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen’s d = 1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d = 1.35) decreases in self-reported PSA. Results were maintained or improved at six- and twelve-month follow-ups. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously impractical one-session format, and in a novel self-led, at-home format.

Keywords
Virtual reality, Exposure therapy, Internet interventions, Social anxiety disorder, Public speaking anxiety, In-vivo
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-358454 (URN)10.1016/j.janxdis.2018.07.003 (DOI)000456898000006 ()30054173 (PubMedID)
Note

Correction in: JOURNAL OF ANXIETY DISORDERS, Volume: 64, Pages: 90-90, DOI: 10.1016/j.janxdis.2019.04.002

Available from: 2018-08-29 Created: 2018-08-29 Last updated: 2019-06-19Bibliographically approved
Månsson, K., Garrett, D., Manzouri, A., Wiegert, S., Furmark, T. & Fischer, H. (2018). Affective Brain Signal Variability Separates Social Anxiety Disorder Patients From Healthy Individuals. Paper presented at 73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY. Biological Psychiatry, 83(9), S249-S250
Open this publication in new window or tab >>Affective Brain Signal Variability Separates Social Anxiety Disorder Patients From Healthy Individuals
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2018 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, no 9, p. S249-S250Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Social Anxiety Disorder, BOLD fMRI, Variability
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-359379 (URN)10.1016/j.biopsych.2018.02.644 (DOI)000433001900042 ()
Conference
73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY
Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17Bibliographically approved
Kraus, J., Frick, A., Fischer, H., Howner, K., Fredriksson, M. & Furmark, T. (2018). Amygdala reactivity and connectivity during social and non-social aversive stimulation in social anxiety disorder. Psychiatry Research: Neuroimaging, 280, 56-61
Open this publication in new window or tab >>Amygdala reactivity and connectivity during social and non-social aversive stimulation in social anxiety disorder
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2018 (English)In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 280, p. 56-61Article in journal (Refereed) Published
Abstract [en]

Social anxiety disorder (SAD) is characterized by exaggerated amygdala reactivity in response to symptom provocation, but it is unclear if such hyper-reactivity is elicited by disorder-specific challenges only or characterizes reactions to aversive stimuli in general. Here, using functional magnetic resonance imaging in 14 patients with SAD, as compared to 12 healthy controls, we found that amygdala hyper-reactivity is confined to disorder-relevant social stimulation. SAD patients displayed increased amygdala reactivity to fearful as compared to neutral facial pictures, but not in response to generally aversive but mainly non-social stimulation when compared to neutral pictorial stimuli taken from the International Affective Picture System. The increased amygdala reactivity was not mediated by an altered prefrontal inhibition among SAD patients as compared to controls, suggesting increased bottom-up processes rather than attenuated top-down control. In conclusion, the enhanced amygdala reactivity in SAD seems specific to socially relevant stimuli rather than aversive stimuli in general.

Keywords
Social phobia, Emotional faces, International Affective Picture System, IAPS, fMRI, Fear
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-364125 (URN)10.1016/j.pscychresns.2018.08.012 (DOI)000443824900008 ()30165271 (PubMedID)
Funder
Swedish Research CouncilRiksbankens JubileumsfondRiksbankens JubileumsfondThe Swedish Brain Foundation
Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Frick, A., Engman, J., Wahlstedt, K., Gingnell, M., Fredrikson, M. & Furmark, T. (2018). Anterior cingulate cortex activity as a candidate biomarker for treatment selection in social anxiety disorder. BJPsych bulletin, 4(3)
Open this publication in new window or tab >>Anterior cingulate cortex activity as a candidate biomarker for treatment selection in social anxiety disorder
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2018 (English)In: BJPsych bulletin, ISSN 2056-4694, E-ISSN 2056-4708, Vol. 4, no 3Article in journal (Refereed) Published
Abstract [en]

We aimed to identify biomarkers to guide the decision to add selective serotonin reuptake inhibitors (SSRI) to psychological treatment for social anxiety disorder (SAD). Forty-eight patients with SAD underwent functional magnetic resonance imaging and collection of clinical and demographic variables before treatment with cognitive–behavioural therapy, combined on a double-blind basis with either escitalopram or placebo for 9 weeks. Pre-treatment neural reactivity to aversive faces in the dorsal anterior cingulate cortex (ACC), but not clinical/demographic variables, moderated clinical outcomes. Cross-validated individual-level predictions accurately identified 81% of responders/non-responders. Dorsal ACC reactivity is thus a potential biomarker for SAD treatment selection.

Place, publisher, year, edition, pages
Cambridges Institutes Press, 2018
Keywords
Functional magnetic resonance imaging, anxiety, prediction, selective serotonin reuptake inhibitors, cognitive–behavioural therapy, social phobia
National Category
Psychology Psychiatry
Identifiers
urn:nbn:se:uu:diva-353596 (URN)10.1192/bjo.2018.15 (DOI)000436933400012 ()29922481 (PubMedID)
Funder
Swedish Research CouncilRiksbankens JubileumsfondThe Swedish Brain FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish Society for Medical Research (SSMF)
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2018-09-26Bibliographically approved
Motilla Hoppe, J., Frick, A., Åhs, F., Linnman, C., Appel, L., Jonasson, M., . . . Furmark, T. (2018). Association between amygdala neurokinin-1 receptor availability and anxiety-related personality traits. Translational Psychiatry, 8(1), 168
Open this publication in new window or tab >>Association between amygdala neurokinin-1 receptor availability and anxiety-related personality traits
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2018 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 8, no 1, p. 168-Article in journal (Refereed) Published
Abstract [en]

Animal studies indicate that substance P (SP) and its preferred neurokinin-1 (NK1) receptor modulate stress and anxiety-related behavior. Alterations in the SP-NK1 system have also been observed in human anxiety disorders, yet little is known about the relation between this system and individual differences in personality traits associated with anxiety propensity and approach-avoidance behavior, including trait anxiety, neuroticism, and extraversion. Exploring this relation could provide important insights into the neurobiological underpinnings of human anxiety and the etiology of anxiety disorders, as anxious traits are associated with increased susceptibility to develop psychopathological conditions. Here we examined the relationship between central NK1 receptor availability and self-rated measures of trait anxiety, neuroticism, and extraversion. The amygdala was chosen as the primary region of interest since this structure has been suggested to mediate the effect of the SP-NK1 system on anxiety. Anxious traits and NK1 receptor availability, determined with positron emission tomography and the radiotracer [11C]GR205171, were measured in 17 healthy individuals. Voxel-wise analyses showed a significant positive correlation between bilateral amygdala NK1 receptor availability and trait anxiety, and a trend in similar direction was observed for neuroticism. Conversely, extraversion was found to be negatively associated with amygdala NK1 receptor availability. Extraversion also correlated negatively with the NK1 measure in the cuneus/precuneus and fusiform gyrus according to exploratory whole-brain analyses. In conclusion, our findings indicate that amygdala NK1 receptor availability is associated with anxiety-related personality traits in healthy subjects, consistent with a modulatory role for the SP-NK1 system in human anxiety.

National Category
Pedagogy
Identifiers
urn:nbn:se:uu:diva-358759 (URN)10.1038/s41398-018-0163-1 (DOI)000443079700001 ()
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-12-10Bibliographically approved
Mansson, K., Wager, T. D., Isacsson, N., Kolbeinsson, O., Andersson, G., Fischer, H. & Furmark, T. (2018). Brain Before Behavior: Temporal Dynamics in the Treatment of Social Anxiety - Neural Changes Occur Early and Precede Clinical Improvement. Paper presented at 73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), 2018, New York, NY. Biological Psychiatry, 83(9), S130-S131
Open this publication in new window or tab >>Brain Before Behavior: Temporal Dynamics in the Treatment of Social Anxiety - Neural Changes Occur Early and Precede Clinical Improvement
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2018 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, no 9, p. S130-S131Article in journal, Meeting abstract (Other academic) Published
Keywords
Social Anxiety Disorder, BOLD fMRI, Cognitive Behavior Therapy, Temporal Dynamics, Amygdala
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-361430 (URN)000432466300319 ()
Conference
73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), 2018, New York, NY
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10Bibliographically approved
Månsson, K., Lindqvist, D., Yang, L., Wolkowitz, O., Nilsonne, G., Isung, J., . . . Furmark, T. (2018). Can Psychological Treatment Slow Down Cellular Aging in Social Anxiety Disorder?: An Intervention Study Evaluating Changes in Telomere Length and Telomerase Activity. Paper presented at 73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY. Biological Psychiatry, 83(9), S351-S352
Open this publication in new window or tab >>Can Psychological Treatment Slow Down Cellular Aging in Social Anxiety Disorder?: An Intervention Study Evaluating Changes in Telomere Length and Telomerase Activity
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2018 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, no 9, p. S351-S352Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Telomerase, Telomere, Social Anxiety Disorder, Cognitive Behavior Therapy, Cellular Aging
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-359378 (URN)10.1016/j.biopsych.2018.02.904 (DOI)000433001900299 ()
Conference
73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY
Note

Meeting Abstract: S13

Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17Bibliographically approved
Olofsdotter, S., Åslund, C., Furmark, T., Comasco, E. & Nilson, K. W. (2018). Differential susceptibility effects of oxytocin gene (OXT) polymorphisms and perceived parenting on social anxiety among adolescents. Development and psychopathology (Print), 30(2), 449-459
Open this publication in new window or tab >>Differential susceptibility effects of oxytocin gene (OXT) polymorphisms and perceived parenting on social anxiety among adolescents
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2018 (English)In: Development and psychopathology (Print), ISSN 0954-5794, E-ISSN 1469-2198, Vol. 30, no 2, p. 449-459Article in journal (Refereed) Published
Abstract [en]

Social anxiety is one of the most commonly reported mental health problems among adolescents, and it has been suggested that parenting style influences an adolescent's level of anxiety. A context-dependent effect of oxytocin on human social behavior has been proposed; however, research on the oxytocin gene (OXT) has mostly been reported without considering contextual factors. This study investigated the interactions between parenting style and polymorphic variations in the OXT gene in association with social anxiety symptoms in a community sample of adolescents (n = 1,359). Two single nucleotide polymorphisms linked to OXT, rs4813625 and rs2770378, were genotyped. Social anxiety and perceived parenting style were assessed by behavioral questionnaires. In interaction models adjusted for sex, significant interaction effects with parenting style were observed for both variants in relation to social anxiety. The nature of the interactions was in line with the differential susceptibility framework for rs4813625, whereas for rs2770378 the results indicated a diathesis–stress type of interaction. The findings may be interpreted from the perspective of the social salience hypothesis of oxytocin, with rs4813625 affecting social anxiety levels along a perceived unsafe–safe social context dimension.

National Category
Neurosciences Psychology
Identifiers
urn:nbn:se:uu:diva-323574 (URN)10.1017/S0954579417000967 (DOI)000430924500006 ()28606214 (PubMedID)
Funder
Fredrik och Ingrid Thurings StiftelseThe Swedish Brain Foundation, F02015-0315Forte, Swedish Research Council for Health, Working Life and Welfare, FORTE 2015-00897Åke Wiberg Foundation, MI5-0239Swedish Research Council, VR 2015-00495EU, FP7, Seventh Framework Programme, INCA 600398Stiftelsen Söderström - Königska sjukhemmet, SLS-559921
Available from: 2017-06-08 Created: 2017-06-08 Last updated: 2019-04-04Bibliographically approved
Groenewold, N., Bas-Hoogendam, J. M., Amod, A. R., van Velzen, L., Aghajani, M., Filippi, C., . . . van der Wee, N. J. J. (2018). Subcortical Volumes in Social Anxiety Disorder: Preliminary Results From Enigma-Anxiety. Paper presented at 73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY. Biological Psychiatry, 83(9), S247-S248
Open this publication in new window or tab >>Subcortical Volumes in Social Anxiety Disorder: Preliminary Results From Enigma-Anxiety
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2018 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, no 9, p. S247-S248Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Structural MRI, Social Phobia, Thalamus, Meta-analysis, Harmonized Protocols
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-359376 (URN)10.1016/j.biopsych.2018.02.640 (DOI)000433001900038 ()
Conference
73rd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 10-12, 2017, New York, NY
Funder
NIH (National Institute of Health), BD2K U54 EB020403
Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17Bibliographically approved
Olofsdotter, S., Furmark, T., Åslund, C. & Nilsson, K. W. (2018). The mediating role of parenting behaviors in the relationship between early and late adolescent levels of anxiety: Specificity and informant effects. Journal of Adolescence, 69, 118-129
Open this publication in new window or tab >>The mediating role of parenting behaviors in the relationship between early and late adolescent levels of anxiety: Specificity and informant effects
2018 (English)In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 69, p. 118-129Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The role of parenting behavior is often highlighted in the development of anxiety in youth. However, previous reports are limited in terms of the specificity of relationships between different types of anxiety and parenting behaviors, informant effects on these relationships, and direction of effects.

METHODS: This study investigates these questions using longitudinal data from 1350 Swedish adolescents and their parents. Adolescents' self-reports of six dimensions of anxiety and adolescents' and parents' reports of six dimensions of parenting behaviors were used in the analyses. Parallel multiple mediation models were employed to analyze specificity and informant effects within a reciprocal effects model.

RESULTS: Overall, and irrespective of informant, this study found little support for a mediating role of parenting behaviors in the relationship between early and late adolescent levels of anxiety. Evidence for specificity within the parenting-anxiety relationship was scarce with specific mediating effects observed only for panic/agoraphobia and total anxiety through the parenting dimension of rejection.

CONCLUSIONS: The findings of this study concern the un-conditional mediating role of parenting. Parenting behaviors may be more influential among some adolescents, depending on individual differences in other factors related to the development and course of adolescent anxiety. Thus, further research on moderating factors of the influence of parenting on adolescent anxiety is warranted.

Keywords
Adolescence, Anxiety, Mediator, Parenting
National Category
Neurosciences
Research subject
Child and Youth Psychiatry; Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-374321 (URN)10.1016/j.adolescence.2018.09.011 (DOI)000458345900014 ()30292944 (PubMedID)
Funder
The Swedish Brain Foundation, F02015-0315Fredrik och Ingrid Thurings StiftelseForte, Swedish Research Council for Health, Working Life and Welfare, 2015-00897Åke Wiberg Foundation, MI5-0239
Available from: 2019-01-20 Created: 2019-01-20 Last updated: 2019-03-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6821-9058

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