Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessiv ....Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessive relative to the danger posed by a situation.Read moreRead less
Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 millio ....Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 million workdays annually. The annual costs of medical care for back pain alone have been estimated at $AUD50 billion in the US and $10 billion in Australia. Not only is chronic pain a considerable economic burden, it is also a considerable personal burden to patients. Pain is one of the strongest predictors of poor quality of life and has consistently been found to be associated with high rates of depression. Although there is a large body of research that investigates what factors are associated with chronic pain, there is surprisingly little research that investigates the mechanisms that cause chronicity. Theories of chronic pain suggest that psychological characteristics increase the propensity for people to develop chronic pain. Specifically, theories argue that those people who tend to be fearful of pain will over-attend to painful sensations and avoid pain-provoking activities and as a result are at risk of developing chronic pain. This study will test those theories. If it is found that over-attending to pain does predispose patients to develop chronic pain, this will have important implications for preventing the development of chronic pain. These findings could help to devise early interventions to prevent chronicity and thereby reduce the economic burden to health services and the emotional burden to patients in terms of reduced quality of life.Read moreRead less
The Extinction Of Conditioned Fear And Its Implications For Cue Exposure Therapy
Funder
National Health and Medical Research Council
Funding Amount
$322,430.00
Summary
This project studies extinction of Pavlovian conditioned fear reactions in rats. Extinction of these reactions is an animal model for exposure therapy used in the treatment of anxiety disorders in people. In exposure therapy, the patient, aided by the clinician, confronts trauma-related cues in the absence of any overt danger. The intention of this therapy is to reduce the ability of the trauma-related cues to provoke the fear reactions that are undermining the patient's quality of life. In Pavl ....This project studies extinction of Pavlovian conditioned fear reactions in rats. Extinction of these reactions is an animal model for exposure therapy used in the treatment of anxiety disorders in people. In exposure therapy, the patient, aided by the clinician, confronts trauma-related cues in the absence of any overt danger. The intention of this therapy is to reduce the ability of the trauma-related cues to provoke the fear reactions that are undermining the patient's quality of life. In Pavlovian conditioning, subjects (typically rats) are exposed to a signaling relation between an initially neutral stimulus (e.g., a noise) and a feared outcome (e.g., foot shock). When later repeatedly exposed to the initially neutral but now feared stimulus (the noise) in the absence of the feared outcome, the fear reactions it acquired progressively decline until eventually it fails to elicit any such reactions. The fear reactions are said to have been extinguished. There has been significant progress in understanding the psychological processes and neural mechanisms underlying the acquisition of fear reactions, but much less is known about the processes and mechanisms underlying the extinction of these reactions. The project has two general objectives. The first is to determine the conditions of extinction training that promote long-term loss of fear reactions. The second objective is to determine how the brain controls this extinction of learned fear. Achieving these aims will be significant for two reasons. First, it will contribute to understanding the mechanisms by which animals (including people) learn to adjust their behaviour to bring it into line with the current relations that exist between events in the world. Second, it will provide important information about how such adjustment is facilitated or impaired across extinction training and, thereby, contribute towards understanding both the successes and failures of cue exposure therapy for fear-related disorders.Read moreRead less
D-Cycloserine And Conditioning: Increasing The Effectiveness Of Exposure Therapy For Fear And Anxiety
Funder
National Health and Medical Research Council
Funding Amount
$400,750.00
Summary
The psychological, social, and financial costs of anxiety problems are among the highest burden-of-disease costs to the community. The most effective long-term psychological treatment for anxiety disorders is cognitive behaviour therapy (CBT), in particular exposure therapy. However only a small minority of individuals receive comprehensive treatment, and a portion of these individuals re-experience symptoms in the long-term. These difficulties are partially due to the cost of treatment and diff ....The psychological, social, and financial costs of anxiety problems are among the highest burden-of-disease costs to the community. The most effective long-term psychological treatment for anxiety disorders is cognitive behaviour therapy (CBT), in particular exposure therapy. However only a small minority of individuals receive comprehensive treatment, and a portion of these individuals re-experience symptoms in the long-term. These difficulties are partially due to the cost of treatment and difficulties with relapse. Recent research has shown that D-Cycloserine (DCS) facilitates extinction in animals and possibly in humans. DCS has the potential to offer a simple, brief, and cost-effective intervention that enhances treatment effects. In the United States the new NIMH director has set research into DCS and exposure to fear as a high priority that is likely to have a significant public health impact. This proposal provides an opportunity for Australian researchers to become involved in a rapidly expanding research field. The research team at UNSW have already established an international reputation in DCS applications, fear conditioning in humans, and clinical trials in humans. They are in a unique position internationally to investigate the means by which DCS exerts its effects and to conduct randomised clinical trials of DCS in recovery from fear in humans.The goal is to test DCS in facilitating exposure and extinction of fear. The research will directly lead to recommendations for clinical application and demonstrate whether the drug has the capability of significantly increasing the success of exposure therapy by reducing the time required for treatment, the rate of relapse, the financial cost of treatment, and the overall burden of anxiety to the community. The fear-conditioning studies will also inform our theoretical understanding of emotion processing and fear conditioning in humans, which in turn will allow clinical applications to be optimised.Read moreRead less
Increased Vulnerability To Stress During Opiate Dependence: Molecular, Anatomical, And Behavioural Correlates
Funder
National Health and Medical Research Council
Funding Amount
$272,640.00
Summary
Heroin addiction is a major health and societal problem in Australia. It is consistently associated with an adverse impact upon individual users, their families, and communities. It is a chronically relapsing condition for which few, if any effective prevention and treatment strategies exist. Moreover, why an individual initiates and maintains heroin taking remains unclear. Stress and negative emotions have a strong impact on heroin use. Stress may drive some individuals to start using heroin, s ....Heroin addiction is a major health and societal problem in Australia. It is consistently associated with an adverse impact upon individual users, their families, and communities. It is a chronically relapsing condition for which few, if any effective prevention and treatment strategies exist. Moreover, why an individual initiates and maintains heroin taking remains unclear. Stress and negative emotions have a strong impact on heroin use. Stress may drive some individuals to start using heroin, stress increases the pleasurable effects of heroin and stress increases the aversive effects of heroin withdrawal. These effects will encourage addiction and discourage addicts from seeking treatment. Stress can also cause an otherwise drug-free individual to relapse to heroin addiction despite having been drug-free for some time. In this project we will study why stress has such a large impact on heroin addicts and heroin addiction. We will test the hypothesis that heroin use actually produces profound alterations in the neural network in the brain which controls responses to stress. This project uses a simple animal model of heroin addiction whereby rats are injected with morphine to study the regulation of several genes which are important in responding to stress. We will also study how this exposure and changes in gene expression alter neurobiological, cardiovascular, and behavioural responses to stress. This project will identify parts of the brain that are altered during heroin addiction, and will also identify why heroin addicts are more vulnerable to stress than the general population. Therefore, this project will help us to identify targets for therapeutic intervention (both psychological and pharmacological) and possibly disrupt the addictive cycle.Read moreRead less
Falls Prevention For Stroke Patients Following Discharge Home: Contributory Factors And A Randomised Trial Intervention.
Funder
National Health and Medical Research Council
Funding Amount
$549,440.00
Summary
Falls are common after stroke, with over 50% of people being discharged home from hospital after stroke experiencing one or more falls in the subsequent six months. Despite a large focus on falls prevention in the community generally, and increasing research that a range of activities (such as exercise, medication review, home hazard modification) are effective in reducing falls among older people generally, there have been no randomised trials evaluating the effectiveness of falls prevention ac ....Falls are common after stroke, with over 50% of people being discharged home from hospital after stroke experiencing one or more falls in the subsequent six months. Despite a large focus on falls prevention in the community generally, and increasing research that a range of activities (such as exercise, medication review, home hazard modification) are effective in reducing falls among older people generally, there have been no randomised trials evaluating the effectiveness of falls prevention activities for people with stroke. This research will evaluate whether a detailed assessment and program of falls prevention activities (exercise, falls prevention information, bone strength recommendations, and other activities based on the assessment findings) will reduce falls in stroke patients with increased risk of falling. Two additional issues associated with falls among people with stroke will also be investigated. Detailed analysis of walking and stepping over obstacles will be evaluated to determine long term problems which might increase the risk of falling, and the effect of the falls prevention program will also be evaluated on the walking and stepping over the obstacle tasks. A third study will investigate the development of fear of falling firstly as a result of the stroke and resultant walking difficulties, and then how this changes when a fall occurs. The interaction between falls, fear of falling, and reduced activity and walking will be explored. The outcomes of this project will improve the understanding by health professionals of key factors contributing to increased risk of falling following stroke, and provide clear direction and resources for general application of the program in other stroke rehabilitation programs nationally. The main anticipated outcome is 33% reduction in falls, and improved balance, walking, and confidence for people returning home after stroke.Read moreRead less
Selective Attention And Fear Avoidance In The Maintenance And Management Of Pain Associated With Rheumatoid Arthritis
Funder
National Health and Medical Research Council
Funding Amount
$195,660.00
Summary
Despite advances in the treatment of RA, the condition continues to have a chronic course for the majority of patients. Research has established that the way in which people think about pain and illness influences their responses to symptoms. In turn, these factors can impinge on quality of life and disability. For people with chronic pain problems, those who are fearful of pain and concentrate on symptoms have a poorer outcome in the long-term. In RA, striking a balance between rest and exercis ....Despite advances in the treatment of RA, the condition continues to have a chronic course for the majority of patients. Research has established that the way in which people think about pain and illness influences their responses to symptoms. In turn, these factors can impinge on quality of life and disability. For people with chronic pain problems, those who are fearful of pain and concentrate on symptoms have a poorer outcome in the long-term. In RA, striking a balance between rest and exercise is thought to be crucial. As such, ignoring the pain can lead to overactivity and subsequent joint damage and may be as unhelpful as underactivity. This project aims to investigate the relationship between people's fear of pain and the degree to which they attend to pain. It is suggested that those with very high or very low levels of fear towards the pain will either over-attend or under-attend to pain in comparison to healthy controls and patients with a moderate level of fear. Optimum levels of fear avoidance are expected to be associated with less disability and improved joint function. These findings have implications for the management of RA. Psychological treatments for patients with RA have been found to be effective in reducing pain, disability and improving mood. Treatments usually focus on a combination of changing people's attitudes and behaviours. However, whether strategies that aim to change attitudes or those targeting behaviour are more successful or have specific treatment effects is unknown. The present project will compare a treatment targeting behaviours associated with RA and encouraging a balanace between rest and exercise, with a treatment targeting patient's beliefs about the illness. It is expected that the treatments will have specific effects, which may better allow tailoring of psychological management to patient's individual needs.Read moreRead less
Understanding Fear Of Falling And Risk Taking In Older People
Funder
National Health and Medical Research Council
Funding Amount
$355,877.00
Summary
Fear of falling is a very significant issue for many older people. Estimates of the prevalence of fear of falling in older community-dwelling people range from 29 to 92% in those who have suffered previous falls, and 12 to 65% in those have not. Fear of falling can lead to restriction and curtailment of activity, reduced quality of life, anxiety, depression and social isolation. To date, all studies addressing fear of falling have simply considered no fear to be good and presence of fear to be b ....Fear of falling is a very significant issue for many older people. Estimates of the prevalence of fear of falling in older community-dwelling people range from 29 to 92% in those who have suffered previous falls, and 12 to 65% in those have not. Fear of falling can lead to restriction and curtailment of activity, reduced quality of life, anxiety, depression and social isolation. To date, all studies addressing fear of falling have simply considered no fear to be good and presence of fear to be bad, and have not attempted to assess whether this fear is rational or irrational in relation to actual balance abilities or physical functioning. In this study, we aim to find out which psychological, physical, health and lifestyle factors distinguish between older people with and without an irrational fear of falling based on their actual physical falling risk. We also wish to understand the role that fear of falling and other psychological factors (anxiety, depression and avoidance) play in causing older people to fall; and to measure how falls can lead to increased fear of falling, anxiety and depression and reduced physical functioning. The complex nature of psychological risk factors of falling and the limited background information on this subject, hampers its integration in falls prevention programs. Although there is growing awareness of this problem among health care providers, additional research is needed about why older people develop a fear of falling in order to fully understand fear of falling and to tailor specific intervention and prevention strategies.Read moreRead less