SYMPOSIA

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