Exposure therapy

Summary

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias. Medical uses Generalized anxiety disorder There is empirical evidence that exposure therapy can be an effective treatment for people with generalized anxiety disorder, citing specifically in vivo exposure therapy, (exposure through a real life situation), which has greater effectiveness than imaginal exposure in regards to generalized a

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https://en.wikipedia.org/wiki/Exposure_therapy

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Fear and other anxiety disorders are extraordinarily robust and difficult to treat. Among the most effective treatments for anxiety disorders are exposure-based therapies, during which a patient is repeatedly confronted with the originally fear-eliciting stimulus in a safe environment so that the once fearful stimulus can be newly interpreted as neutral or safe. A fundamental element for successful exposure-based therapies is the reactivation/recall of the traumatic memory, which initiates a time-limited process called memory reconsolidation, during which a memory becomes susceptible to disruption. Presently, the neuronal subpopulations and molecular mechanisms underlying successful fear memory attenuation remain completely unknown, which represents a big gap in memory research. Therefore, the aim of this work is to first identify the neuronal subpopulations that are causally implicated in effective attenuation of remote fear memories. This will help to determine whether the original traumatic memory trace has been permanently modified or a new memory trace of safety has been superimposed over the original one. The second aim is to develop a tool that allows for the isolation of the neuronal subpopulations causally implicated in remote memory attenuation, in order to be able to delineate the epigenetic and transcriptional mechanisms at play within these subpopulations. This will help to identify a molecular signature of effective remote fear memory attenuation. The results of my research suggest for the first time that there is a small population of neurons in the dentate gyrus - that was active during the recall of fear â that needs to be reactivated during extinction to attain successful remote fear attenuation. While the inactivation of such population during extinction impairs fear attenuation, its activation ameliorates behavioral extinction. Furthermore, I have successfully established a method to isolate this neuronal subpopulation from the brain, namely by fluorescence-activated cell sorting. This tool will allow follow up studies to pursue the quest for the molecular signature of successful remote memory attenuation. Overall, these findings could help us to better understand the intricate principles of effective remote fear memory attenuation, and thus to develop new strategies that improve the treatment of anxiety disorder.

EPFL2017

Simulating interactions with virtual characters for the treatment of social phobia

Helena Stephanie Grillon Le Gallennec

Virtual Reality (VR) has nowadays become a very useful tool for therapists in the treatment of phobias. Indeed, it allows the simulation of scenarios which are difficult to reproduce in real life. It also allows for a situation to be repeated as much as one wants. Moreover, it allows for a complete control over the situation. The simulation can be stopped if the patient cannot handle it. It can also be tweaked for gradual exposure. Virtual Reality Exposure Therapy (VRET) has proven to be efficient in the context of phobias such as acrophobia or the fear of flying. Social phobia, however, are much harder to deal with. Indeed, as humans, we are experts in human representations and behaviors; it makes it much harder to obtain credible and immersive environments. In this thesis, we describe a set of tools and applications which we have developed to be used in VRET of social phobia and agoraphobia with crowds. We first describe how we create different scenarios for VRET of social phobia. We then expose the application we have developed which allows for elaborate interactions between a user and virtual characters. In particular, we have designed and implemented a software which allows for virtual characters to change behavior depending on the user's eye contact behavior. It allows them to seem interested when being looked at and distracted when not. We then describe the model we have implemented to simulate gaze attention behaviors for crowds of virtual characters. This consists of a method that automatically detects where and when each virtual character in a crowd should look. Secondly, it consists of a dedicated gaze Inverse Kinematics (IK) solver in order for the virtual characters to satisfy the constraints defined by the automatically detected points to be looked at. This allows for the characters to perform the looking motion in a natural and human like way. We then describe the architecture we have developed to combine the work we have done in the domain of social phobia and this model of attention behaviors for crowd characters. We thus use our model of looking behaviors to allow for crowd characters to look at each other. We also use eye-tracking and optical motion capture to determine where a user is looking in a CAVE environment. The virtual characters then respond by either looking at the user, looking at what the user is looking at, or looking at other characters in the crowd. We thus obtain an immersive and interactive environment for VRET in the domain of agoraphobia with crowds. The third part of this thesis describes various experiments we have conducted in order to validate our applications. Our first study consists of using VR in a head-mounted display (HMD) for the treatment of social phobia. In this study, we also use eye-tracking in order to analyze eye contact avoidance behaviors before and after therapy. We then discuss the use of eye-tracking as a tool to help assess and diagnose social phobia. Since eye contact avoidance behaviors are frequent in people suffering from such phobias, eye-tracking can certainly be a helpful tool. We describe an experiment in which we tested eye-tracking as a diagnosis and assessment tool on a phobic population and on a control group. We also describe an experiment to evaluate the potential of our proposed interaction loop in the context of social phobia. Finally, we describe the experiment we have conducted to evaluate our application in the context of agoraphobia with crowds.

EPFL2009

Dynamics of HIV Latency and Reactivation in a Primary CD4+T Cell Model

Istvan Bartha, Julia di Iulio, Jacques Fellay, Amalio Telenti, Christian Axel Wandall Thorball

HIV latency is a major obstacle to curing infection. Current strategies to eradicate HIV aim at increasing transcription of the latent provirus. In the present study we observed that latently infected CD4+ T cells from HIV-infected individuals failed to produce viral particles upon ex vivo exposure to SAHA (vorinostat), despite effective inhibition of histone deacetylases. To identify steps that were not susceptible to the action of SAHA or other latency reverting agents, we used a primary CD4+ T cell model, joint host and viral RNA sequencing, and a viral-encoded reporter. This model served to investigate the characteristics of latently infected cells, the dynamics of HIV latency, and the process of reactivation induced by various stimuli. During latency, we observed persistence of viral transcripts but only limited viral translation. Similarly, the reactivating agents SAHA and disulfiram successfully increased viral transcription, but failed to effectively enhance viral translation, mirroring the ex vivo data. This study highlights the importance of post-transcriptional blocks as one mechanism leading to HIV latency that needs to be relieved in order to purge the viral reservoir.

Public Library Science2014

Simulating interactions with virtual characters for the treatment of social phobia

Helena Stephanie Grillon Le Gallennec

EPFL2009

EPFL2017