Aktuelle Forschungsprojekte
ELAN: Decision making and learning in the treatment of anxiety disorders
Exposure therapy – a specific form of cognitive behavioral therapy (CBT) – is a first-line treatment for anxiety disorders. The effectiveness of exposure therapy has been proven in many studies and this therapy has already helped many patients. Still, we do not know enough about the mechanisms of action, e.g. which treatment content is particularly important for which patient. The aim of the ELAN study, funded by the German Research Foundation (DFG, PI1269/2-1), is to better understand the mechanisms of action of exposure therapy and thereby improve the effectiveness of psychotherapy for anxiety disorders. We are particularly interested in how and when anxiety-inducing situations are avoided or approached.
All participants received highly effective exposure therapy conducted by specially trained therapists. Our short-term therapy is accompanied by diagnostic questionnaires, additional laboratory tasks, and an everyday assessments using smartphones. This allows us to pinpoint factors that are associated with particularly good treatment success and. Initial study results also provided important insights into the mechanisms of pathological avoidance in anxiety disorders.
Press releases:
Our study, together with several cooperation partners featured in a recent documentary by Arte: Wenn Angst krank macht – Anatomie eines Gefühls (German Documentary)
PROTECT-AD: Providing Tools for Effective Care & Treatment of Anxiety Disorders
Cooperation: BMBF-Forschungsverbund PROTECT-AD
More information: BMBF-Network Mental disorders
Overview of latest findings: PROTECT-AD
ENHANCE
Anxiety sensitivity (AS), or the fear of anxiety and related sensations, represents an individual difference variable implicated in the risk and maintenance of anxiety and related disorders. Symptom induction exercises (e.g., spinning, voluntary hyperventilation, straw breathing, using a tongue depressor) are useful for providing exposure to benign bodily sensations (e.g., dizziness, racing heart, breathlessness, choking), allowing individuals with elevated AS to learn that, while perhaps uncomfortable, these sensations are not harmful, but safe.
The current study involves the development and testing of a large-group one-session exposure therapy protocol designed to target AS. The investigators will compare two variants of the protocol and include a general stress reduction protocol as a control condition (CONTROL). The first variant (STANDARD) is a standard protocol, modeled after those developed by Margraf and colleagues, that includes a combination of psychoeducation (about the nature and [exposure] therapy of anxiety sensitivity) and interoceptive exposure therapy modeling and practice. The second variant (ENHANCED) is identical to the first but also includes post-exposure practice processing aimed at facilitating threat reappraisal (i.e., safety learning). All interventions will be delivered in large-group format (N ≥ 25 participants) by a team of clinicians (N = 3) trained in the delivery of exposure therapy. In an effort to improve the quality of research on exposure therapy, another central aim of this study is to examine the feasibility of an exposure therapy consortium. The investigators have established a network of research sites (N=11) with expertise in exposure therapy.
Cooperation: Global Exposure Therapy Consortium (ETC)
More information: Global Exposure Therapy Consortium (ETC)
Facilitating fear-opposite approach
Persistent dysfunctional avoidance is a key characteristic of clinical fear and anxiety. A reduction of avoidance is a core target of behavioural treatments, but persistent avoidance may result in treatment refusal, drop-out, or limited treatment success. Better understanding of dysfunctional avoidance and its reduction may thus optimize individual treatment outcome. Importantly, dysfunctional avoidance is linked to severe impairments and costs, which were oftentimes neglected in human fear and avoidance research. The first funding period thus examined avoidance as a behavioural response to prevent a feared outcome, but at the same time resulting in costs (i.e., costly avoidance). Main findings showed that (1) costs do not directly reduce conditioned fear in healthy individuals, but strongly reduced avoidance. (2) This reduction of avoidance despite high levels of fear (i.e., fear-opposite approach) can subsequently initiate fear extinction, thus indirectly reduce conditioned fear. (3) Patients with anxiety disorders showed distinct deficits in fear-opposite approach. (4) Directly targeting avoidance compared to passive fear extinction better reduced long-term avoidance and fear. Based on the findings of deficits in fear-opposite approach in patients and benefits of targeting avoidance, projects of the second funding period aim to examine how fear-opposite approach can be facilitated by behavioural interventions. In contrast to testing between-subject trait differences, focusing on the induction of within-subject state changes provides evidence how traditional exposure may be supplemented by add-on interventions. Ultimately, the anticipated findings thus aim to provide first insights how distinct behavioural interventions can optimise exposure treatments for individual patients.
More information: PI1269/2-2
Fear-generalization and its predictive value for anxiety-related psychopathology
More information: PI1269/5-1