SYMPOSIA
SYMPOSIA
SYMPOSIA
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Abstracts of the Invited Speakers<br />
References:<br />
1. Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwinn GM: Antidepressant for bipolar depression: A systematic review of randomized, controlled trials. Am J<br />
Psychiatry 2004;161:1537-1547.<br />
2. Möller HJ, Grunze H: Have some guidelines fort he treatment of acute bipolar depression gone too far in the restriction of antidepressants? Eur Arch Psychiatry<br />
Clin Neurosci 2000;250:57-68.<br />
3. Sachs SG, Nierenberg AA, Calabrese JR, Ketter TA, Marangeli LB, Milowitz DJ, Miyahara MS, Bauer MS: Effectiveness of adjunctive antidepressant treatment for<br />
bipolar depression. N Eng J Med 2007;356:1711-1722.<br />
4. Ghaemi SN, Rosenquist KJ, Ko YJ, Baldassano CF, Kontos NJ, Baldessarini RJ: Antidepressant treatment in bipolar versus unipolar depression. Am J<br />
Psychiatry2004;161:163-165.<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S39-40<br />
JOINT <strong>SYMPOSIA</strong><br />
[JS-01]<br />
International Association for Cognitive Psychotherapy (IACP)<br />
Symposium title: Advances and problems in cognitive behavior therapy (CBT)<br />
Recent advances in the treatment of anxiety disorders<br />
Stefan Hofmann<br />
Department of Psychology, Boston University, Boston, USA<br />
E-mail: shofmann@bu.edu<br />
Cognitive behavioral therapy (CBT) is the first-line psychological treatment for anxiety disorders. Although effective, partial or nonresponse<br />
to treatment remains an all-too-common occurrence, with over half of patients failing to respond fully to first-line cognitive<br />
behavioral therapy. The same is true for pharmacological interventions for anxiety disorders. Combining CBT with conventional anxiolytic<br />
medication is typically not more effective than unimodal therapy for treating anxiety disorders. This presentation will examine strategies<br />
to augment and modify CBT to enhance its efficacy. Recently, the search for new strategies to augment CBT has turned to a unique model<br />
of combination therapy. Rather than using pharmacotherapy as an anxiolytic in its own right, it is used to augment the core learning<br />
processes of cognitive-behavior therapy and exposure procedures. Moreover, recent work in emotion research points to new intervention<br />
strategies for anxiety disorders, such as mindfulness-based therapies and meditation practices.<br />
The first half of this presentation will review the current literature on conventional and novel combination strategies. A particularly<br />
successful prototype of a novel augmentation strategy of CBT is the use of d-cycloserine (DCS), a partial agonist at the glycine recognition<br />
site of the glutametergic N-methyl-D-aspartate receptor, to facilitate extinction learning. The second half the presentation will review<br />
novel and adaptive emotion regulation strategies, including mindfulness and loving-kindness mediation.<br />
The efficacy of CBT for anxiety disorders can be enhanced by (1) augmenting the treatment with the cognitive enhancers such as DCS,<br />
and (2) modifying the intervention using novel emotion regulation strategies. The augmentation strategies are based on the fact that<br />
exposure-based treatments in humans partly rely on extinction to reduce the fear response in anxiety disorders. In fact, animal studies<br />
have consistently shown that DCS facilitates extinction learning. Similarly, recent human trials have shown that DCS enhances fear<br />
reduction during exposure therapy of some anxiety disorders. Positive findings so far have been reported in placebo-controlled trials for<br />
specific phobia, social anxiety disorder, panic disorder, and obsessive compulsive disorder. The strongest effects were observed in studies<br />
in which patients receive a small dose of DCS (50 mg) acutely 1 hour before the exposure trials with no more than 5 administrations<br />
weekly. The modification strategies of CBT have primarily focused on enhancing adaptive emotion regulation strategies, beyond<br />
traditional reappraisal strategies. Whereas cognitive reappraisal strategies are antecedent focused, these novel strategies are primarily<br />
emotion response focused. Although these strategies have only recently been studied as treatments for anxiety disorders, they are rooted<br />
in ancient Eastern and Buddhist practices. CBT is an evolving science that integrates traditional and modern approaches and is in line with<br />
modern emotion and neuroscience theories.<br />
Key words: Cognitive behavior therapy, anxiety disorders, combination drug therapy, NMDA, glutamate, mindfulness, meditation, emotion<br />
regulation<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S40<br />
S40 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org